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THE COMMON SENSE OF THE 
MILK QUESTION 



THE MACMILLAN COMPANY 

NBWVOXK • BOSTON • CHICAGO 
ATLANTA • SAN PRAHCISCO 

MACMILLAN & CO., Limitbd 

LONDON • BOMBAY • CALCUTTA 
MBLBOURNB 

THE MACMILLAN CO. OF CANADA, Lnx 

TORONTO 



i! 

i i 
s I 
II 



-J 



THE COMMON SENSE OF THE 

MILK QUESTION 



BT 



JOHN SPARGO 

AUTHOR OF **THB BITTBR CRT OF THB 
CHILDREN," BTC. 



THE MACMILLAN COMPANY 

1908 

AU riffhta re§er9 0A 



SF 




OomioBT, IMS, 
Bt THB MACMILLAN 0OMPA9T. 



Set up and electrotyped. Published April, 1908. 



NotfBoob 9n9* 

J. 8. CuBhtng Co. — Berwick & Smith Oo. 

Norwood, Mm8., U.S.A. 



h 



THIS VOLUME IS DEDICATKO 
TO 

MR. NATHAN STRAUS 

▲ PIOKEEB IN THE GREAT WORK OF SAVING INFANTS 

FROM NEEDLESS SLAUGHTER 

WITH THE author's PROFOUND ADMIRATION 

AND GRATITUDE 



-^ "• • • .--. - •• -r^J 



PREFACE 

The present volume owes its existence to a demand 
for the publication of various lectures upon the sub- 
ject delivered by the author in many cities during the 
past seven years, and to a growing personal convic- 
tion of the need of a popular, easily understandable 
exposition of a subject which the lay reader finds 
fraught with many difficulties. 

No apology is ofifered for the book — except for its 
many shortcomings, which none will deplore more 
than the author — nor for the fact that it is written 
by a layman for lay readers. There is a voluminous 
and bewildering literature wholly devoted to the 
subject, as may be inferred from the fact that one 
single bibUography with which I am acquainted con- 
tains no less than 8375 titles, and is still so incomplete 
as to cause the student a good deal of exasperation I 
Much of this literature — perhaps I should not be far 
wrong if I were to say almost the whole of it — is 
either not accessible to the ordinary reader, or, what 
is equally important, unintelligible to him. 

Now, it is perfectly obvious that if ever we are to 
deal with the politico-social aspects of the milk 
problem, this must be remedied to the extent of pro- 

▼ii 



Vm PREFACE 

viding the average intelligent citizen with some 
statement of the question which can be readily undeiv 
stood and appreciated. To provide such a state- 
ment is the very modest aim of this volume. 

By way of assurance to that public which I thus 
venture to address, I desire to repeat here a statement 
which I have made in almost every one of my lectures 
upon the milk question ; namely, that there are no 
mysteries in the great problem of the relation of the 
public milk supply to the public health which need 
frighten away any intelligent lajrman. There are 
mysteries, unquestionably, many wonderful phe- 
nomena, which the ph}rsiologist, the pathologist, and 
the bacteriologist are as unable to explain as the 
humblest layman; there are also many means of 
investigation which require scientific and special 
training. The results of such investigation, however, 
can be so stated, I believe, that any reader of average 
intelligence can understand them. The social and 
economic aspects of the problem belong to general 
civic knowledge, not wholly nor mainly to the medical 
profession. 

In connection with the much-disputed subject of 
pasteurization, I have found it necessary to modify 
certain statements made in an earlier work. The 
Bitter Cry of the Children, In that work I ex- 
pressed the conviction that the pasteurization of milk 
is ''a grave mistake." I am still of that opinion in 



PREFACE IX 

80 far as I believe it to be a very serious mistake to 
trust wholly to the destruction of germs in milk, rather 
than to aim at a germless, clean supply, needing 
no such treatment. I am, above all else, an adhe- 
rent of what is caUed "The Clean MUk School." Still, 
under existing conditions, I am (as indeed I have al- 
ways been) an advocate of pasteurization as a pre- 
cautionary measure. Pasteurization is a makeshift, 
not a solution of the problem, but I do not despise 
the makeshift on that account. In my earlier work 
I desired to lay special emphasis upon the desirability 
and the possibility of securing a safe and wholesome 
milk supply for all our cities, and I am grateful for 
the many assurances that have come to me of the fact 
that the volume in question contributed in some de- 
gree to the direction of public attention to that very 
important matter. I desire to state, however, that 
in my own family pasteurization has been practised, 
simply because I could not consent to the exposing 
of my children to the perils of raw milk as they are 
described in the following pages. 

As far as possible, I have acknowledged my indebted- 
ness to other writers, either in the text itself or at the 
end of the book. I wish it were possible for me to like- 
wise acknowledge my indebtedness to all who have so 
kindly assisted me, but that is out of the question. 
Nearly a thousand correspondents, mostly physicians 
and veterinarians, have given me the benefit of their 



X PREFACE 

experience and advice; more than three hundred 
farmers and dairjmien have kindly permitted me to 
visit their premises and helped me in many other 
wa3rs; and, not less important, numerous mothers have 
given me their confidence and most loyal cooperation. 
To all of these I have tendered my thanks personally, 
and it remains only for me to make this public ac- 
knowledgment of valuable assistance freely and gen- 
erously given. 

To some of my friends I am so deeply indebted for 
special assistance that a word of acknowledgment, 
other than that given above, seems necessary. I 
desire, therefore, to take this opportunity of specially 
thanking the following gentlemen : Dr. Henry Dwight 
Chapin, Professor of Diseases of Children at the New 
York Post-Graduate Hospital; Professor R. A. 
Pearson, of Cornell University ; Dr. George W, Goler, 
Health Officer, Rochester, N.Y.; Dr. Thomas Dar- 
lington, Health Commissioner, New York City; 
Dr. W. H. Park and William E. Burton, of the Health 
Department, New York City; Dr. E. F. Brush, of 
Mount Vernon, N. Y. ; Dr. John B. Huber, of New York 
City ; Dr. Arthur Greene, of the Straus Laboratories, 
New York City; Professor Gustav Bang, of Copen- 
hagen; Mr. Lewis W. Hine, of Yonkers, N.Y., and 
Mr. William Wirt Mills, of the New York Evening 
MaUy who generously placed at my disposal a valuable 
collection of papers and reports. 

YONKBBS, N.Y. J- S. 



CONTENTS 

Prbfacb yii 

CHAm» 

I. The Risk ik thb Value of Babzsb. . . 1 

IL When the Mothers Fail 14 

m. Why Cow's Milk? 46 

lY. Filth as Infants* Food 82 

y. Milk-borne Diseases 120 

YI. A Brief Summary of the Problem . . 151 

VII. Remedial Theories and Experiments . . 174 

Vin. Pure verscs Purified Milk .... 241 

IX. Outlines of a Policy of Reform . . . 267 

Appendices 307 

Index 341 



LIST OF ILLUSTRATIONS 

FULTB 

L Cow Yard with Stagnant Fool . Frontispiece 

rACEZIG PAOB 

n. An Unsanitary Cow Bam 34 

III. Cow Bam where Cleanliness is Impossible . . 42 

IV. "Cheap" Milk— for the Babies of the Tene- 

ments 52 

V. Manure heaped inside of Cow Barn where Milk- 
ing is Done 62 

VI. An Ideal Cow Stable 72 

Vn. Cows that Need Washing 85 

Vni. Filthy Barn-yard with Fools of Liquid Matter . 95 

IX. A Typical Retail Milk Store .... 105 

X. Dirty Cow Bam 112 

XI. Diseased Cow, Milk from which was sold in New 

York 124 

Xn. Effect of Raw Tuberculous Milk upon a Guinea 

Fig 130 

Xin. Cow in Last Stage of Tuberculosis • . . 142 

XIV. A Study in Headlines 154 

XV. Bacteria in the Atmosphere .... 160 

XVI. Same Interior as Shown in Plate V . . .166 

XVn. Milk sold on the Open Sidewalk .... 172 

XVm. A Straus Depot for Adults 186 

XIX. "Clean Milk" Farm, Rochester, N.Y. . . 206 

XX. Infants' Milk Depot, Rochester, N.Y. ... 212 

xiii 



XIV LIST OF ILLUSTRATIONS 

PLATE PAOIVO TAOn 

XX r. Bottle-washing Tent, Rochester Depot . . 218 

XXIL Rochester Depot—Packing the Milk in loe . 228 

XXIII. Straus Depots — Pasteurization Plant. . . 242 

XXIV. Straus Pasteurization Plant— Filling Bottles . 250 
XXV! One of the Straus Infants* Milk Depots . . 264 

XXVI. (a) Modest and Inexpensive Cow Stable . . 200 

(b) A Railroad Milk Station— New York City. 290 



\ 



'i 



THE COMMON SENSE OF THE 
MILK QUESTION 



THE COMMON SENSE OF THE MILK 

QUESTION 

CHAPTER I 

THE RISE IN THE VALUE OF BABIES 



Never in the history of the world probably — 
certainly not in modem times — was so much intelli- 
gent and earnest effort devoted to the welfare of chil- 
dren as to-day. In all civilized countries the physical, 
mental, and moral well-being of the children occupies 
a large and increasing share of the attention of thinkers 
and statesmen. There are still many little ones who 
needlessly suffer because of the ignorance and greed 
of parents and guardians, or because of distressing 
social negligence and ignorance; the bitter cry of 
wronged and despoiled childhood still rises in painful 
volimie to rebuke us and lacerate our hearts. I would 
not minimize that cry of rebuking anguish, nor seek 
to hide from the vision of men one single trace of the 
agony of suffering childhood which torments us and 
goads us to do justice to the helpless victims. Heaven 
knows that amid the din and strife of our busy world 

B 1 



2 THE COMMON SENSE OF THE BflLK QUESTION 

the cry of the children is none too loud, that it is even 
now sometimes unheard so that we pass unheeding 

** The black sides of the pit, the quenchless fire." 

Still, with my eyes upon the pit, I am conscious of 
the bright, kindly sun above, and know that the world 
is a better place for children than ever before in its 
history. Never before were the arms of society 
spread for their protection around the children as 
now. 

The fact is that modem nations place a higher 
value upon child life to-day than they formerly did, 
or than any of the nations of the past. Instead of 
regarding the child as a burden, we regard it as an 
asset, and the death of a child we have come to look 
upon as a loss to the community. We think with 
horror of the widespread practice of infanticide, by 
Central Australians, Melanesians, Eskimos, Fijiansi 
the Chicimecs of Mexico, and many other savage 
peoples,^ and utterly fail to comprehend the barbarous 
custom, or the economic conditions which inspired it. 
Obviously, to such people the coming of a child must 
have meant an additional burden, not an addition 
to the wealth of the group, family, or community. 

Fortunately, among modem civilized nations it is 
otherwise. Universally, a steady increase of popula- 
tion by the natural propagation of the species is 
regarded with favor, and a stationary or declining 
birth-rate looked upon as calamitous. It is in no 



THE RISE IN THE VALUE OF BABIES 3 

cynical spirit that I suggest here that our changed 
attitude toward the child is largely attributable to 
our fear of just such calamitous racial decline. For 
among the most impressive social phenomena of our 
time the diminishing birth-rate in most civilized 
countries holds a prominent place. 

I would not take issue with those who glory in the 
increase of solicitude for the welfare of children as 
an evidence of the growth of pure altruism. At 
the same time, I cannot escape the conviction that 
there is much significance in the fact that France, 
the nation which feels most keenly the perils of a 
diminishing birth-rate, leads the world in those vast 
social experiments which aim, in the words of Sir John 
Gorst, ''to make the most of such children as are 
brought into the world." ' It is because of the very 
narrow margin of births over deaths that France 
values her babies more highly than any other country.' 
In the great Australian commonwealths, the decline 
in the birth-rate during recent years has caused great 
anxiety and compelled statesmen and men of science 
to seek ways and means of preventing needless in- 
fantile mortality.* When England was confronted 
by a dearth of soldiers the dwindling of the birth-rate 
became a matter of vital concern. Statesmen and 
scientists were forced to give it their attention, and, 
as in the other countries named, the question of 
properly caring for the children bom was invested 



4 THE COBIMON SENSE OF THE MILK QUESTION 

with a new and vital importance and urgency.' In 
this country, likewise, our alarm at "race suicide" 
has ^ven a very noticeable impetus to chDd study, 
and especially to the effort to save as many as pos- 
sible of the tens of thousands of babies now needlessly, 
ignorantly sacrificed every year. 

n 

From the Malthusian cry of "overpopulation" to 
the Rooseveltian cry of "race suicide'' is an astound- 
ing transition. Throughout a large part of the 
nineteenth century the influence of the Malthusian 
dread of an increase of population beyond the limits 
of the means of sustenance dominated the political 
economy of the English-speaking world, and, with the 
exception of France, most of the rest of the world 
included in the category of civilization. The idea 
was not restricted to the economists, but obsessed the 
popular mind in a most remarkable manner. When- 
ever it was proposed to do anjdihing for the improve- 
ment of the conditions surroimding the lives of the 
masses, the cry was raised that nothing could be done 
until means were found to check "the devastating 
torrent of babies." • 

Now the pendulum has swimg to the other extreme. 
There is universal concern and fear because of a stead- 
ily declining birth-rate^ and the cry of race suicide 



THE RISE IN THE VALUE OF BABIES 5 

terrifies the nations. Of the facts there can be no 
question ; the decline in fertility of the human species 
in highly civilized countries ranks among the most 
challenging social phenomena which sociologists are 
trying to explain. That the birth-rate should be 
decreasing so rapidly in the newer countries is 
an astonishing condition of the problem. Canada, 
sparsely populated, with an immense empire of terri- 
tory and practically boundless resources, presents an 
interesting study. There the decline in fertility 
seems to be greatest among people of Anglo-Saxon 
inheritance. In the Province of Quebec, which is 
mainly populated by French Canadians, the birth-rate 
per thousand in 1901 was 35, while in Ontario, a prov- 
ince populated mainly by people of British origin, the 
birth-rate in the same year was only 21.1 per thou- 
sand.^ In Montreal, in 1902, the birth-rate of each 
of the three classes into which the vital statistics 
of the city are distributed was as follows : — 

Fzench Canadians . . . « • . 48.6 

Other Catholics 22.4 

Fh>te8tants 23.7 

The great majority of the second and third classes 
were undoubtedly of British origin, so that the figures, 
taken in conjimction with those already cited, suggest 
a racial decline — the comparative infertility of the 
British descendants and the superiority of the 
FrendL* 



6 THE COBfMON 8EN8S OF THE MILK QUESTION 

How, then, shall we account for the comparative' 
success of the French descendants in view of the no- 
table failure of their blood relations in France ? May 
it not be that the racial distinction suggested by the 
Canadian figures is an accident, of little or no influence, 
and that the real reason for the great difference in the 
birth-rate lies in the differences of social conditions 
and intellectual development ? There is more poverty 
and much more illiteracy among the French Canadians 
than among the people of British origin, and these 
are conditions which favor a high birth-rate. If this 
be the real reason for the difference in fertility, Can- 
ada's experience conforms to a universal fact of tre- 
mendous importance, namely, that sterility almost 
invariably accompanies intellectual and material 
advance on the part of nations. 

In England the decline in the birth-rate is prin- 
cipally due to the growing infertility of the richer, 
and not the poorer, classes ; * in this country, likewise, 
the decline is chiefly among the better-favored classes, 
people of native American stock." There is no failure 
among the poor and often ignorant immigrants who 
crowd our cities, nor among the negroes. In South 
Africa, again, it is the intelligent, progressive, educated 
British who are infertile," just as it is the people of 
British origin, alert, educated, prosperous, and pro- 
gressive, who fail to maintain a healthy rate of increase 
in the Australian states, despite all the advantages 



THE RISE IN THE VALUE OF BABIES 7 

which a young and vigorous people must have in 
such immense and fruitful countries^ where they are 
imburdened by oppressive militarism. In the whole 
range of modem vital statistics^ I know of nothing 
more interesting to the sociologist than the striking 
decline m the Australasian birth-rates, shown in the 
accompanying table. 

Table I 



AusTRAUAx Statu 


\: BiRTR-RATB PER 


1000 POPULATIOH* 


PknoD 


Nsw 
South 
Waus 


VlCTO- 
BIA 


Qutms- 

LAMD 


South 

AUSTKA- 
UA 


Wser 

Austra- 
lia 


Tabma- 

IflA 


Nhw 
Zha- 

LA2r]> 


1871-1875 . . 
1881-1885 . . 
1891-1895 . . 
1895-1900 . . 


89.05 
87.65 
82.98 

27.98 


85.69 
80.76 
80.93 
26.22 


40.81 
86.87 
85.15 
80.40 


37.24 
88.52 
81.54 
26.59 


81.80 
84.57 
80.77 
28.78 


29.72 
35.02 
82.84 
28.28 


40.02 
86.50 
27.66 
26.74 



That there is an increasing tendency to sterility in 
modem life, particularly among the more progressive 
nations, is shown in a most striking manner by the 
accompanying statistical table. It will be observed 
that while the percentage of decrease is greatest in 
the Australian states, their condition is no more alarm- 
ing than that of France with its very small percentage 
of decrease. But France has long been confronted 

*A6M!jpti6d from the Report of the Royal Commiesion on the De- 
elhie of the Birth-rate and on the Mortality of Infanta in New 
South Walea, 1904. 



8 THE COMMON SENSE OF THE MILK QUESTION 



by the spectre of a dwindling birth-rate, while for the 
Australian countries the condition is a new one. Race 
suicide is no longer a French phenomenon; it is 
universal 

Table n 

Showing the Decrease of Birth-bates per 1000 Popu- 
lation IK Various Countries in Ten Years 



Cou2mT 



South Australia • 

Victoria . . . . 
New South Wales 

Queensland . . 

West Australia . 

New Zealand . • 

Tasmania . . . 

Italy 

England . • • . 

Hungary. . • • 

Portugal . • . . 

Scotland . . • . 

Sweden . . » » 

German Empire • 

Belgium . • • . 

France . . • . 

Austria . • • . 

Ireland . . . . 



1891 


1000 


83.0 


25.8 


83.6 


26.8 


84.6 


27.4 


86.4 


80.2 


85.6 


80.7 


29.0 


25.6 


81.9 


28.2 


87.2 


88.0 


81.4 


28.7 


42.6 


89.6 


81.7 


80.0 


81.2 


29.6 


28.8 


27.1 


87.0 


85.6 


80.0 


28.9 


22.6 


21.9 


88.1 


87.4 


23.1 


22.7 



Whether we should regard the fact of a dwindling 
birth-rate pessimistically, as Mr. Roosevelt does, or 
optimistically, as Mr. H. G. Wells " does, is too big 
a question for discussion here. It may be that, as 
Major Charles E. Woodruff and other scientists con- 



THE BIBE IN THE VALUE OF BABIES 9 

tend, the declining birth-rate is but the beneficent 
working of a great natural law, universally operative 
in all species, tending to keep population within the 
limits of subsistence. The birth-rate diminishes; but 
80 does the death-rate. An increased or even sta- 
tionary birth-rate with a decreasing death-rate would 
inevitably lead to overpopulation, according to this 
optimistic view. Formerly the birth-rate was very 
high because the death-rate was also high — condi- 
tions which still obtain in backward countries. To 
the holders of this view, the decline in the birth-rate 
is only a sign of Nature's mysterious and automatic 
adjustment to conditions. 

This is a cheerful view to take of a grave condition, 
and one that is, moreover, seductively plausible. 
The chief objection to it is the tremendous assumption 
involved, that the death-rate can be continually re- 
duced as fast as the birth-rate declines. While it is 
true, perhaps, that during the last fifty years the death- 
rate has steadily decUned, so that in spite of the de- 
clining birth-rate the excess of births over deaths 
remains practically unaltered, few physicians, I 
imagine, believe that the same rate of decrease in the 
death-rate can be maintained for any considerable 
period. In this connection it is interesting to note 
that the death-rate in 1900 among the whites of native 
parentage in Connecticut, Maine, New Hampshire, 
Rhode Island, and Vermont exceeded the birth-rate 



10 THE COMMON SENSE OF THE MILK QUESTION 

by 1.5 per thousand, while among the whites of for- 
eign parentage the excess of births over deaths was 
44.5 per thousand.^' It is perfectly obvious that if 
this condition were common to all the states, the 
native stock would soon be entirely extinct. 

m 

It is a well-known fact that the fecundity of the 
poorer classes is always greater than that of the well- 
to-do classes. More than twenty years before the ap- 
pearance of the famous and epochal work of Malthus, 
Adam Smith had pointed out in The WedUh of 
Nations that poverty seemed favorable to procrea- 
tion.^* All authorities upon the subject agree that 
in all countries the wealthiest classes are the most 
infertile. Polybius attributed the decay of Greece 
to depopulation by this means. Like Mr. Roosevelt, 
he regarded the evil as a moral one : — 

''In our times all Greece has been afflicted with a 
failure of ofifspring, in a word with a scarcity of men ; 
so that the cities have been left desolate and the land 
waste ; though we have not been visited either with a 
series of wars or with epidemic diseases. Would it 
not be absurd to send to inquire of the oracles by what 
means our numbers may be increased, and our cities 
become flourishing, when the cause is manifest, and 
the remedy rests with ourselves ? For when men gave 



THE BISE IN THE VALUE OF BABIES 11 

themselves up to ease, and comfort, and indolence, 
and would neither marry, nor rear children bom out 
of marriage, or at most only one or two, in order to 
leave these rich, and to bring them up in luxury, the 
evil soon spread, imperceptibly, but with rapid growth ; 
for when there was only a child or two in a family for 
war or disease to carry off, the inevitable consequence 
was that houses were left desolate, and cities by de- 
grees became like deserted hives, and there is no need 
to consult the gods about the mode of deliverance for 
this evil : any man would tell us, that the first thing 
we have to do is to change our habits, or at all events 
to enact laws compelling parents to rear their chil- 
dren." « 

The decay of Rome has been attributed to the same 
cause by more than one historian. Seeley impressively 
describes the great Empire as suffering from a disease, 
a slow disease which tamed her hitherto invincible 
power. The disease was sterility. "Men were want- 
ing; the Empire perished for want of men." " Momm- 
sen describes the same evil in a famous passage: 
"Celibacy and childlessness became more and more 
common, especially among the upper classes. . . . We 
encounter even in Cato's sentiments the maxim to 
which Polybius a century before traced the decay of 
Hellas, that it is the duty of a citizen to keep great 
wealth together, and therefore not to beget too many 
children. Where were the times when the designa- 



12 THE COMMON SENSE OF THE MILK QUESTION 

tion 'children producer' (proletarvus) had been an 
honor for the Roman?"" 

In our modern Rooseveltian campaign against 
race suicide there is evidently an expression of fear 
lest the experience of these great civilizations of 
antiquity be ours. Like Polybius, the statesmen and 
scholars of to-day, in overwhelming majority, regard 
the evil as being essentially a moral one. They attrib- 
ute the decline in the birth-rate among the classes en- 
dowed with economic comfort, education, and leisure 
to an unwillingness to bear the responsibilities of 
parenthood. Personally, however, I cannot accept 
this explanation of the phenomenon. Presumptuous 
though it may be, I cannot escape the conviction that, 
while there are undoubtedly — as in all ages — many 
persons of whom the charge is true, the decline in the 
birth-rate is not due in any measurable degree to 
choice. The number of women unwilling to bear 
children is probably not greater than the number of 
women unable to bear children — the yeammg Han* 
nahs of ''sorrowful spirit." There are tens of thou- 
sands of women who feel that to live and die childless 
is humiUating failure, who mourn bitterly that they 
cannot know 

** A mother's pleasure in her infant race ; 
But friendless and forlorn, alive descend 
Into the dreary mansions of the dead.''* 

* Sophocles, Anbigime, 



THE RISE IN THE VALUE OF BABIES 13 

It is probable that the decline of the birth-rate is 
due, as Adam Smith noted long ago, to socio-biologic 
rather than moral causes. There would seem to be 
some subtle physiological reaction, tending practically 
to the atrophy of the maternal function — not merely 
of child-bearing, but of child-nursing also — as a 
result of intellectual and nervous development, and 
the general complexity of life, which belong to a high 
state of civilization. It has been urged that intel- 
lectual development suggests artificial checks on gen^ 
eration," but he would be a rash man who would con- 
tend that such checks are more common among the 
richest than among the very poorest, or that foeticide 
is more common in the mansions than in the tenements. 
I, for one, do not believe it." It is much more likely 
that the difference is due to an automatic check upon 
the purely animal, or physical, functions of the human 
organism which operates with the extension of other 
functions, such as the nervous and intellectual. 

Whatever reason may exist for the decline, there 
can be no doubt as to the fact, nor any as to the fear 
with which the spectre of race suicide oppresses 
almost every one of the progressive modem nations. 
It is that fear which, more than anything else, is 
responsible for the tremendous amount of social effort 
which is now being directed towards the promotion 
of the phjrsical welfare of children, for that dominant 
tendency in the social legislation of our time which 
marks this as being preeminently the children's age. 



I 



CHAPTER n 



WHEN THE MOTHERS FAIL 



A GREAT many factors enter into the stream of 
causes which makes the vast ocean of needlessly 
sacrificed baby lives. Poverty and ignorance are 
among the most important of these factors. The 
ignorance of many mothers is simply appalling. To 
hear a group of settlement workers, visiting nurses, 
and physicians relating their experiences and enumer- 
ating the many deleterious things given to young 
babies, is a tragic and heartrending experience. 
Babies a few weeks old given tea, beer, vegetables, 
bread, fish, candy, ice-cream — the awful list might 
extend almost indefinitely.^ Undoubtedly, ignorant 
and improper feeding is a prime factor in the problem 
of infantile mortality. 

I say 'ignorant and improper feeding," because I 
desire to draw a sharp distinction between feeding 
such as that described above, which is due to gross 
ignorance on the part of the mothers, and feeding 
which, while it proves to be imsuitable and produc* 

U 



WHEN THE MOTHERS FAIL 15 

tive of ill resxiltS; and is therefore improper, is never- 
theless not so much the result of special ignorance on 
the part of the mothers as of general human ignorance 
concerning some important aspects of a relatively 
new problem, the substitution of artificial foods for 
mother's milk. Every physician of large general 
practice knows of cases in which babies have died, 
literally of starvation, simply because science could 
not provide them with a proper substitute for the 
milk their mothers' flattened breasts refused to yield. 
I know of several cases in which medical men of large 
experience and unusual qualifications have seen their 
own children wither and die aft^r the most heroic 
devotion to the task of saving them. This is a con- 
dition of ignorance, of course, but it needs to be 
sharply distinguished from the ignorance of the 
mother who blindly gives her child food which science 
and common sense alike have long associated with 
disease and death. 

Among savage tribes in many parts of the world 
the custom has prevailed of killing suckling babes 
whose mothers died, or of burying the infant alive 
in the same grave as the mother.^ They knew no 
means whereby they could keep the child alive, ex- 
cept in those rare instances where foster mothers 
were available, as when a mother lately bereaved of 
her own child claimed the motherless little one to fill 
its place. Inability to nurse their own offspring is 



16 THE COBiMON SENSE OF THE BHLK QUESTION 

a rare occurrence among the women of savage tribes, 
practically unknown; and if such a thing happened 
the child would doubtless be allowed to perish. 
From certain passages in the New Testament — 
notably Hebrews v. 2, 1 C!orinthians iii. 2, and 
1 Peter ii. 2 — some writers have inferred that among 
the Jews artificial infant feeding was by no means 
rare, the infants being fed upon the milk of animals/ 
generally of goats, Proverbs xxvii. 27, or sheep, 
Deuteronomy xxxii. 14; but, so far as I am aware, 
there is no evidence that such artificial feeding was 
extensively practised, nor do the passages cited lend 
much support to the contention that the milk of goats 
and sheep was used as a food for yoimg infants in 
place of human breast milk. 

It is significant that Hebrew women have an ex- 
ceptionally good record in this respect, failures to 
nurse their offspring being much rarer among thqm 
than among Gentile women of the same class,^ and 
also that the elaborate Rabbinical provisions concern- 
ing the dietetic use of milk and its hygiene make no 
special mention of milk intended for infants.* While 
it is probably true that the artificial feeding of infants 
was sometimes resorted to in ancient times, it was 
never practised to anything like the extent with 
which we are familiar to-day. For with us the in- 
ability of a mother to nurse a child is not an occa- 
sional event ; on the contrary, among the middle and 



/ 



WHEN THE MOTHERS FAIL 17 

upper classes in the progressive countries, it is so 
common as to almost become the rule, only the ex- 
ceptional mother being able to nurse her offspring. 
It is for this reason that I have called the substitution 
of artificial foods for mother's milk a relatively new 
problem. The modem mother is growing more and 
more unable to nurse her child at her breast. For 
some subtle reason, this fimction of maternity is 
being atrophied in civilized women; and the higher 
their civilization, the less able are they to suckle 
their infants. 

II 

I am convinced that it is not, as is very generally 
supposed^ that modern mothers are unwilling to nurse 
their offspring, setting social pleasures above maternal 
duties. I know that there are many eminent physi- 
cians and other competent observers who attribute 
the decline of breast-feeding wholly to social and 
economic causes : to a desire on the part of the lei- 
sured class to evade a responsibility which seriously 
interferes with social pleasures;* and to the necessity 
of earning a living which forces many women of the 
poorer classes to become wage-earners in factories, 
or other people's kitchens, to the neglect of their 
infants.^ I am of the opinion, however, that neither 
unwillingness due to indolence or personal or class 
vanity, nor the exigencies of wage-earning occupa- 
o 



18 THE COMMON SENSE OF THE MILK QUESTION 

tions, and their incompatibility with the function of 
breast-nursing, nor both groups of causes combined, 
can account for more than a moderate percentage of 
these serious maternal failures. 

As in the case of the birth-rate, the decline of breast- 
nursing is most strongly marked among the leisured 
and well-to-do classes, and this fact probably accounts 
for the widespread opinion that love of social frivoli- 
ties is responsible for the decline. But, while there 
is unquestionably a good deal of degeneracy among 
a section of our leisured class, whose unnatural orgies 
and sensational voluptuousness warrant the belief 
that they are abnormal in their mental development 
and capable of almost any perversity, it is simply 
absurd to charge that this is true of the leisured class 
generally. To bring such an indictment against the 
women of a whole class is out of the question. For it 
is a serious indictment: to charge a mother with 
deliberately sacrificing her baby for the sake of social 
frivolities is, after all, to accuse her of being inhuman 
and something of a monster. Such women do exist 
aiid have existed in all ages, but it is impossible to 
believe their number to be anything like so great as 
the number of mothers who do not nurse their own 
ofifspring. 

Similarly, while the industrial occupations in which 
women are engaged away from their homes will 
account for a good many mothers not nursing their 



WHEN THE MOTHERS FAIL 19 

babies who would otherwise be able to do so, the 
number b by no means commensurate with the 
number of mothers who fail to nurse their infants. 
No one who is at all familiar with the facts will claim 
that all| or even mosti women of the working class 
who do not nurse their infants at the breast are en- 
gaged in wage-earning pursuits. Such a claim would 
be preposterous upon its face.* The trouble with all 
such explanations is that, while containing a con- 
siderable body of truth, they are not adequate as 
explanations. Each of the causes we have considered 
operates in some degree, but even when taken to- 
gether they do not suffice to explain the phenomenon. 
With the vast majority of women who find them- 
selves unable to discharge this important maternal 
duty the trouble is not social or economic, but physuh 
logical. This cannot be too strongly emphasized. 
We have to deal with nothing less fundamental than 
the absolute decay of the function itself. There is 
not, so far as I am aware, any considerable body of 

* I have only discuBeed here the phase of the question which 
has been 00 much to the fore in England recently, — the 
interference of industrial pursuits with maternal duty. There 
18 a very much bigger question of the effects of industrialism 
upon the maternal functions, which I cannot undertake to 
discuss here, and which is not properly in place here : to wit, 
the physiological results of empl03rment during girlhood in 
factories, stores, sweat-shops, and so on. It would be interest- 
ing to know whether such employment, especially when it is 
bcigun at a tender age and continued during several years, has 
not a prejudicial effect upon all maternal functions. 



20 THE COBfMON SENSE OF THE MILK QUESTION 

statistical testimony in existence which can be cited 
as conclusive evidence upon this point. As was 
pointed out by the British Interdepartmental Com- 
mittee on Physical Deterioration, notwithstanding 
that such knowledge may be regarded as essential 
to any comprehensive investigation of the problems 
of maternity and infantile health, the lacteal inability 
of mothers has received but scant attention from 
physiological investigators.* 

The fact is admitted, however, by many of the 
leading medical authorities, though, as already 
pointed out, some eminent physicians hold to the 
view that the failure is due to social and economic 
causes, and not to any physiological failure. Hun- 
dreds of physicians of extensive practice among 
various social classes have assured me that in their 
experience the unvnUing mother is rarely met, while 
the mother who is physically unable is common. 
Many pathetic stories of the mortification of such 
mothers have been told me, sometimes by the mothers 
themselves, and I am unable to resist the conclusion 
that physical disability accounts for more cases of 
failure to feed infants at the breast than all other 
causes combined. What the causes of this physio- 
logical development are, can only be conjectured in 
the absence of adequate scientific research and 
investigation. 

Professor, von Bunge, a famous German authority, 



WHEN THE MOTHERS FAIL 21 

with the assistance of over one hundred German, 
Swiss, and Austrian physicians, all of whom had 
been his pupils and were selected because of their 
reliability as observers, gathered particulars con- 
cerning two thousand cases in the countries named. 
His researches have convinced him that relatively 
few mothers refuse to nurse their offspring, and that 
by far the largest number of mothers who do not 
nurse their infants at the breast are physically unable 
to do so. He believes that more than half of the 
mothers in central Europe are physically unable to 
suckle their infants.* In other words, he admits 
that the lacteal fimctions are being atrophied. 

That there are some women who are physically 
incapable of lactation has never been seriously dis- 
puted. Engel has made careful study of the breasts 
of a number of women who died during lactation, 
most of them either during or soon after labor. He 
found a class in which the mammary gland was in- 
completely developed, the fibrous elements far out- 
weighing the granular portion. No cause for the 
condition could be discovered.** The significant 
thing about Engel's researches is that they tend to 
confirm the theory of the atrophy of the lacteal 
functions. 

In this country, Dr. L. Emmet Holt, a well-known 
authority upon all that relates to pediatrics, finds 
this incapacity to nurse infants at the breast to be 



22 THE COMMON SENSE OF THE MILK QUESTION 

increasing among all classes, but mainly among the 

well-to-do and leisured classes. Of the well-to-do 

and cultured, he tells us, not more than twenty-five per 

cent of those who have earnestly and intelligently at- 

tempted to nurse have succeeded in doing so for as long 

as three months. "An intellectual city mother who 

is able to nurse her child successfully for the entire 

first year is almost a phenomenon," he says. Dr. 

Holt finds a marked decline in nursling ability among 

the poorer classes in our cities, although not yet to 

the same degree as among those higher in the social 

scale." 

m 

When, regarding the decline of nursing ability as a 
physiological phenomenon, we dismiss the alleged 
social and economic causes as being entirely inade- 
quate, granting them only a subordinate influence 
as contributory factors, we must seek the primary 
cause or causes elsewhere. One of the first reasons 
to suggest itself to our minds is that it is due to im- 
proper dress, such as tightly laced corsets, unsuit- 
able food, and unwholesome ways of living in general,^' 
especially dissipation. How far any or all of these 
enter into the problem has never yet been scientifically 
ascertained, and must, therefore, be the subject of a 
good deal of conjecture. It does not seem to me, 
however, that much can be attributed to the influence 
of dress. For this feeling there are several reasons: 



WHEN THE MOTHERS FAIL 23 

in the first place, the increase of athleticism among 
young girls and women, the extension of their edu- 
cation to the universities, and the opening to them 
of many new industrial and commercial occupations 
have done much towards rationalizing women's dress, 
so that they are probably better dressed, from the 
view-point of physiology and hygiene, than for many 
centuries past. Occasionally some monstrous and 
injurious feminine fashion appears, but it is usually 
short-lived because of its being ill adapted to the 
freedom of movement which characterizes modem 
women, especially in athletics. Secondly, the dis- 
ability is, apparently, not the result of a gradual 
change in the anatomy of the female, such as might 
be produced by tight-lacing, for example, in the 
course of several generations. The hmnan body is not 
structurally modified to any very great degree in a 
single generation. 

But in considering the phenomenon of lacteal fail- 
ure in women we have to bear in mind that it appears 
often in a single generation, fully developed, and as 
an apparently permanent condition of the sex. My 
friend. Dr. J. M. Morgan, who is a negro physician of 
large practice, assures me that among his people it 
is a very common thing to find young mothers en- 
tirely unable to nurse their babies at all, or, in other 
cases, for more than a few weeks, whereas their 

• 

mothers never experienced any such difficulty. The 



24 THE COMMON SENSE OF THE MILK QUESTION 

same thing is true of our immigrant population. 
Any one who is familiar with the tenement popula- 
tion of our large cities will know that it is a common 
sight to see the immigrant mothers on the streets 
nursing their children. No matter how poorly 
nourished they may appear to be, as a rule they can 
nurse their offspring. But their daughters, when 
they marry, frequently cannot do this ; and I submit 
that, even if their dress differed radically from that 
of the mothers, which is usually not the case, the 
time would not be sufBcient to effect such a change 
in their physiology. A few years ago I gathered 
particulars concerning seventy-five women of foreign 
parentage, being mostly Slavs and Italians, whose 
babies were being fed artificially. Of the seventy- 
five there were twenty who had never had any milk 
of their own to give their babies; fourteen who had 
been able to nurse their babies less than a month; 
twenty-seven who had nursed their babies for periods 
ranging from one to three months, all the rest having 
been compelled to give up in less than six months. 
And there was only one woman among the number 
who had herself been "bottle-fed." 

With regard to the influence of food there is likewise 
very little evidence. Upon the whole, dietetic stand- 
ards are probably higher to-day than ever before. 
Certain it is that the majority of the immigrants who 
come to this country adopt a much better standard 



WHEN THE MOTHEBS FAIL 25 

of Uving^^' The change is not so much one of form 
as of quantity and quality. Yet the immigrant 
woman does not generally cease to be able to nurse 
her offspring. If she could nurse her babies before 
coming to this country^ she is usually equally well 
able to nurse those born after coming here. Where 
the struggle for a living is keen, or the child born in 
this country is one of a large family, her milk may be 
so poor that the children become rachitic/^ but in 
general she is as well able to nurse her offspring as 
before. The fact that she gets better, or at least 
different, food does not produce the disability to 
nurse her children which we find in her daughter, 
who gets substantially the same diet. Again, while 
there is a great difference between the standards of 
diet of the well-to-do class and the poor, both classes 
suffer from the disability to discharge the maternal 
fimction of nursing. 

Surprisingly little is known concerning the relation 
of food to lactation. We do not know by what 
physiological processes the constituents of food are 
transformed into milk constituents, either among 
human beings or the lower animals. Experiments 
conducted by Professor Jordan, at the New York 
State Experiment Station, showed the surprising 
result that the quality of a cow's milk was not in- 
fluenced by the quality of the cow's food. When 
cows were fed upon poor food, deficient in fat con- 



26 THE COMMON SENSE OF THE MILK QUESTION 

stituents, it did not serve to reduce the amount of 
fat in the milk, nor, in the case of cows giving poor 
milk, could the amount of fat in the milk be increased 
by adding to the amount of fat constituents in their 
food.*' The question arises, How, then, are we to 
account for the fact that a cow's milk may be and 
often is rich in the very qualities in which its food is 
poor? It might be suggested that the cows draw 
upon their body fat in such cases, but Professor 
Jordan's experiments seem to disprove this, for 
among the animals observed by him there was no 
decrease in weight to indicate a withdrawal of the 
reserve fats of the body into the milk. 
* The evidence seems to be overwhelmingly against 
the popular notion that the feed given cows influences 
the quality of their milk more than anything else. 
It is much more easy to influence the qvantity of milk 
by the adjustment of the feed than the quality. If 
the cow is naturally a "good milker," in the qualitar- 
tive rather than the quantitative sense, her milk will 
remain of good quality under the most adverse con- 
ditions as regards feeding and hygiene, only disease 
or old age serving to make the quality poor." Similar 
facts have been so frequently observed in connection 
with nursing women, that it was for a long time 
believed that the analogy between the human and 
the bovine mother was so complete that it was use- 
less to make any effort to improve the quality of 



WHEN THE MOTHERS FAIL 27 

breast milk. Physicians generally have prescribed 
a dietary for the sake of securing a sufficient iSow of 
milk, but very few of them have studied the relation 
of diet to the quality of the milk, most of them be- 
lieving that practically nothing could be done. The 
work of Dr. Thomas Morgan R6tch, however, estab- 
lishes the fact that, while the science of lacteal regu- 
lation is in its infancy and a great deal of experiment 
needs to be carried on and carefully studied, it is pos- 
sible to materially influence the quality of the human 
mother's milk by means of a careful regulation of the 
diet." Possibly the experiments of Jordan do not 
represent the final judgment concerning the relation 
of diet to milk in cows ; further researches along the 
same lines may establish the fact of the influence of 
nutrition upon the quality of the bovine lacteal fluid 
as conclusively as Rotch has in the case of the human 
mother. 

There are, of course, many familiar phenomena | 

which point to a very direct connection between 
nutrition and lactation. It is well known that if 
cows eat turnips, garlic, or onions, the milk is speedily 
and directly influenced, so that the pungent flavor 
can be tasted in the milk and butter. In like man- 
ner, nursing mothers not infrequently find that I 
unripe fruits, or vegetables such as asparagus,^* 
eaten, even in the most moderate quantities, or 
laxative drugs taken for medicinal purposes, affect 



28 THE COMMON SENSE OF THE MILE QUESTION 

the milk and produce intestinal troubles^ sometimes 
quite serious, in their infants. Diseases in the diges- 
tive tract of breast nurslings are sometimes traced to 
the mother's milk. The child does not thrive; its 
digestive system seems to be upset ; there is diarrhoea 
and frequent vomiting; or, in other cases, constipa- 
tion, perhaps accompanied by fever or convulsions. 
Analysis of the mother's milk may reveal that it is 
excessively rich in fat, and therefore indigestible; or, it 
maybe, the milk is deficient in fat, causing constipation. 
In an interesting study of the variations of fat 
in mothers' milk. Dr. Louise Tayler-Jones, of Phila- 
delphia, cites the case of an infant, being nursed by 
its mother, who was gradually wasting away, losing 
weight daily.** Analysis of the mother's milk showed 
that it contained far too much fat and too little 
protein. The mother had been industriously exer- 
cising and cramming herself with meat and drink 
in order that she might be able to nurse her offspring, 
an interesting case of commendable but misdirected 
zeal. The exercise was stopped to secure an in- 
crease of proteidS; and the meat and drink reduced 
in order that the amount of fat might be decreased. 
The effect of ten days of this treatment is clearly 
shown by the following figures: — 

Result of First Akaltsis 

PsbCsmt 

Fat 6.04 

Sugar 7.00 

Proteid 1.05 



WHEN THE MOTHERS FAIL 29 

RxsuLT OF Second Akaltsu in Tsn Dats 

PnOnnr 
Fat 8.40 

Sugar 7.00 

Fh>teid 1.35 

Many cases similar to the foregoing might be 
cited to show the influence of nutrition upon lacta- 
tion, were further demonstration necessary. There 
is, doubtless, a very definite relation between the 
nutrient qualities of the diet and the nutrient value 
of the milk produced. This is true of the human 
species, and probably of the lower animals also. 
Nevertheless, it is certain that many mothers whose 
diet is alarmingly deficient in all the constituents 
deemed necessary to the proper nutriment of the 
body will produce milk which is apparently not 
deficient in those qualities ; and other mothers whose 
diet appears to be in every way satisfactory will 
produce milk that is deficient in the very nutrients 
which in their food marks its superiority. Why 
this should be so we do not know, any more than we 
know why the milk of exceptionally robust women 
is in general of poorer quality than that of lean 
women.** Science has not yet explored the vast 
domain of ph3rsiological chemistry very far. 

Enough has been said in this connection to show 
that, while there is no present evidence of suflBcient 
volume to justify the belief that defective nutrition 
is the sole cause, or even a very important contrib- 



30 THE COBiMON SENSE OF THE MILK QUESTION 

utory cause, of lacteal failure in the human species, 
it would be rash to conclude that they are not in 
any manner related. 

Another explanation, and one which seems to 
the writer quite fantastic, is that offered by Professor 
von Bunge, to whose valuable and monumental 
researches reference has already been made. He 
suggests that the decline of nursing ability is a sign 
of hereditary degeneracy, passing from mothers to 
daughters and caused mainly by alcoholism, usually 
that of the fathers.'^ It is an interesting theory, 
doubtless containing important elements of truth, 
but, with all the deference due to such a profound 
scholar and patient investigator, it is impossible to 
resist the belief that the much overworked theory of 
heredity has once more been conveniently resorted 
to for explanation of a phenomenon which can only 
be properly explained upon other grounds. From 
the time of Hippocrates to the present the heredi- 
tary transmission of alcoholic taint has been held 
to be responsible for all kinds of degeneracy." The 
deformity of Vulcan as a result of Jupiter's intem- 
perance marks the antiquity of the belief. In any 
case, it is by no means certain that the decay of the 
lacteal function in the human species is a sign of 
degeneracy, any more than that the decay of the 
vermiform appendix is a sign of degeneracy. 

\^th this brief survey of some of the most impor- 



WHEN THE MOTHERS FAIL 31 

tant speculations concerning the causes of this inter- 
esting and important phenomenon; it is here suggested 
that, in all probability, it is analogous to the decline 
of fertility among certain classes, and due to pre- 
cisely similar causes. Like procreation, nursing is 
a purely animal function;^ and, like the power to 
procreate, the ability to nurse offspring declines in 
the most marked degree among the leisured, cultured, 
and well-to-do classes. Among savages, as already 
noted, the condition is practically unknown, and 
among primitive people everjrwhere it is exceedingly 
rare. But as we ascend the scale of civilization it 
is met with in ever increasing degree. In the state- 
ment quoted from Dr. Holt, which has been cor- 
roborated for me by scores of physicians, emphasis 
is laid upon the fact that it is the well-to-do woman 
and the intellectual woman who most frequently 
fail to nurse their babies. As in the case of the birth- 
rate, there would seem to be some subtle physiologi- 
cal reaction tending to dwarf the purely animal 
functions as a result of the development of other 
than animal functions in the human organism. 

It might be urged against this view that the Jew- 
ish race has for a long time been singularly progres- 
sive in its mental development, and that, notwith- 
standing this fact, Jewish mothers are much more 
commonly able to nurse their offspring than Gen- 
tile mothers. But in this connection it must not 



32 THE COMMON SENSE OF THE MILK QUESTION 

be forgotten that, except in the more progressive 
nations during the past few years, the average Jew- 
ish woman has been secluded and uneducated; that 
for many centuries it has been customary to regard 
the mental development of the girls in Hebrew fami- 
lies as a matter of no consequence whatever. It 
would be interesting to know for certain whether 
among the mmority of highly educated Jewish women 
the disability to nurse their children prevails. Sev- 
eral Jewish physicians have assured me that such is 
their belief ; but the relatively small number of such 
women included in their practice, and the fact that 
none of the physicians had given the matter special 
attention, or kept records of the cases, forbid my 
attaching very much importance to their opinions, 
except in so far as they may be supported by scien- 
tifically reliable data. 

It is important to remember in this discussion 
that the decay of the lacteal functions is not ascribed 
to education^ but to the development of civilization. 
It is not merely that as we ascend the scale of civi- 
lization women are in general more highly educated, 
using the term in the strict pedagogic sense, but 
that they are subject to profound and far-reaching 
intellectual and nervous developments, in which 
education is only a factor. The factory workers of 
Lancashire or Massachusetts may not be educated 
much, if any, above the standard prevailing among 



WHEN THE M0THEB6 FAIL 33 

the peasant women of Norway or Sweden, where 
breast-feeding is practically universal, and where 
the infantile death-rate is almost the lowest in the 
world as a consequence of that fact, ranging from 
10 to 13 per cent.** But there is an mtellectual 
and nervous development in the case of the fac- 
tory worker in which formal education plays a rel- 
atively small part. There is the excitement of 
the city life, the haste and strain, with its enor- 
mous psychological and physiological demands. The 
woman in the great industrial centres has the osten- 
tation of wealth constantly thrust before her, stir- 
ring feelings of envy and of curiosity concerning the 
life of people who are not of her world, though be- 
longing to her race. The great drama of life is ever 
before her with its excitation. In her own way, 
she becomes, quite unconsciously, a student of the 
greatest of human problems. Cheap newspapers, 
garishly decked shops, flamboyant posters, and sen- 
sational plays, all these and a thousand other things 
tend to make her life highly complex as compared 
with that of the placid peasant women of Europe. 
Surely, it is not too much to expect that this tre- 
mendous environmental difference, demanding as 
H does so much more from the one than from the 
other, should produce profound change in women's 
lives, both physiological and psychological. As 
the purely animal nature becomes less dominant 



34 THE COMMON SENSE OF THE MILK QUESTION 

in life and we develop a nature that is more complex 
is it wonderful or strange that some of the animal 
functions should undergo change? 

Of course, the obvious thought suggested by such 
speculation as this is that there would seem to be 
no reason why the change should affect one sex only. 
Men have been subjected to very similar changes 
in condition; they, too, have passed from the simple 
stolid life of the ox, their placidity stirred only by 
the occasional outbreak of deep passion, to a life 
that is highly complex and full of continuous excita- 
tion. Why, then, it is natural to ask, should they 
be free from the mental and physical changes which 
these things have wrought in their sisters and wives ? 
To which the answer is another question: Are they 
free from the changes? Do we know that the de- 
cline in fertility is a female phenomenon exclusively, 
rather than a human phenomenon, affecting both 
sexes ? That women should undergo greater changes 
than men is only natural, for they have been far more 
violently uprooted from old and planted amid new 
conditions. It must not be forgotten that educa- 
tion and economic conditions have, in a very special 
degree, suddenly thrust new measures of responsi- 
bility upon women, making them self-reliant where 
they were subservient and dependent; equals where 
they had been inferiors. It may well be, it seems 
to me, that in such phenomena as the decline of 



I 

3 



n 



WHEN THE MOTHERS FAIL 35 

fertility and lactation the human race is only p&yixLg 
the natural price for its freedom to 

*' Move upward, working out the beast. 
And let the ape and tiger die." 

Where there are so many complex and conflicting 
factors, few of which have been adequately explored, 
it is well to guard against hasty judgments based 
upon partial knowledge. It is with the utmost 
reservation, therefore, that I suggest the identity, 
or close relation, of the decline of lacteal ability 
with the decline of fertility. It is to be fervently 
hoped that, as advised by the British Interdepart- 
mental CJommittee on Physical Deterioration,'* much 
closer attention will be paid to this question in the 
future than has heretofore been given to it; for it 
unquestionably is of fundamental importance in the 
study of many of our most urgent and vital prob- 
lems. 

IV 

Whatever reasons for the decline of breast*feeding 
may be disclosed by subsequent investigation, and 
whether it proves to be a sign of degeneracy or of 
progress, of its importance there can be but one 
opinion. It necessitates the development of a sys- 
tem of artificial feeding for infants, really of artifi- 
cial motherhood. Something of a sensation would 
be caused if it were annoimced by some reputable 






36 THE COMMON SENSE OF THE MILK QUESTION 

scientist that from henceforth, owing to some revo- 
lution in the phjrsiology of the female sex, it would 
be necessary to take the human foetus from the 
womb at an early stage of its development and 
develop it by artificial means, in order to pre- 
serve the continuity of the race. Yet, one of 
the greatest living authorities. Dr. Henry Dwight 
Chapin, insists that ''During the suckling period the 
infant should be looked upon as being a foetus and 
not as a perfectly formed human being." ^ In sup- 
port of this view. Dr. Chapin cites the fact that 
among the lower forms of animal life there is often 
no placental connection between the mother and 
her young, but a mammary attachment, the foetus 
growing fast to the teat and being nourished until 
it has acquired the power to suck independently, 
when it ceases to be adherent to the teat and sucks 
at will." Naturally, the baby is physiologically 
dependent upon its mother long after birth, for 
nourishment, as completely as during the foetal 
stage of its development. In other words, to quote 
Dr. Chapin again, ''From a physiological standpoint 
the artificially fed baby is a premature child, and 
an3rthing but maternal milk is foreign to its digestive 
tract;"" for it must be borne in mind that the 
human mother, like all mammals, furnishes her 
infant with milk suited to it at the various stages of 
its growth. The character of her milk undergoes 



WHEN THE MOTHERS FAIL 37 

subtle and important changes as the digestive tract 
of the infant changes in the course of its develop- 
ment. 

It is for this reason that, in its natiu'al state, the 
milk of one species is, in a sense, poison to any other 
species. Anything but maternal milk is a foreign 
substance in the digestive tract of an infant, liable 
to cause serious irritation and disorder; but when 
maternal milk cannot be had, if we are to prevent 
starvation and death, something else must be used, 
and an endeavor made to have that substitute as 
little poisonous as possible. Thus it is that the 
physiological chemist must set himself to the task of 
finding a food as closely resembling human mother's 
milk as possible at every stage of the child's growth 
so as to carry on artificially the work which Nature 
does in making blood, tissue, bone, and nervous energy. 
The digestive tract of a baby is a wonderful factory, 
where these processes are carried on by Nature by 
means of automatic machinery; and when Nature 
fails, man must assume the delicate task of carrying 
on the work by other and clumsier methods. 

It is not impossible, nor even very unlikely, that 
in the course of a few generations artificial feeding 
of infants will be the rule in civilized countries and 
breast-feeding practically unknown.^* The evolu- 
tion of the species proves that Nature is wonderfully 
adaptable, and there is no reason to fear that the 



38 THE COKMON SENSE OF THE MILK QUESTION 

change will prove disastrous to the human race. It 
is in the transition period that there is trouble; the 
consequences are frightfully severe in their morbidity 
during the period of experimentation, while science 
is patiently and slowly learning the secrets of Nature's 
wondrous processes. Doubtless a tremendous mor- 
tality attended the change from a diet of roots to a 
more varied diet, including grains and cooked meat, 
by our early ancestors in the far-away infancy of 
the race, but the species survived nevertheless. So * 
it is not wonderful that the mortality among arti- 
ficially fed infants at the present time is shockingly 
great; we have little more than begun the study of ^ 
the problems of infant feeding. 

Still, it is impossible to read the statistics relating 
to the mortality of artificially fed babies without 
a sense of sickening depression. To know that, 
according to Dr. H. M. Koplik, in our large cities 
more than half of the deaths of infants under one 
year are due to summer diarrhoea, almost exclusively 
caused by defective feeding,*® or that Chaterinkofif 
found that of 20,000 infants dying of intestinal dis- 
orders in France four-fifths were bottle-fed," is to 
realize something, but only a little, of the extent 
of the evil. We have seen that in Norway and 
Sweden the death-rate among babies is low in con- 
sequence of the almost universal practice of breast- 
feeding; now let us take some figures relating to 



1 

/ 



WHEN THE MOTHERS FAIL 39 

bottle^ed babies: Drs! Hope, Meinert, and Ballard 
collected data relating to 1,943 cases in which death 
occurred during the first year, with the astounding 
result that only 61, or 3 per cent, were found 
to have been breast-fed.'' Almost as startling 
are some figures published in 1905 by the Medical 
Officer of Health in Birmingham, England, giving 
particidars relating to 178 infants who died under 
six months old. Of the total number 16 were fed at 
the breast, 28 partially fed at the breast, and no less 
than 135 were artificially fed. The medical officer gives 
it as his opinion, based upon long and close observa- 
tion, that the mortality of infants who are artificially 
fed is at least thirty times as great as among those 
who are nursed at the breast." Add to these terrible 
figures the fact that official statistics in Germany 
show the mortality in the first year among artifi- 
cially fed infants to be 51 per cent as against 
only 8 per cent of those who are nursed exclu- 
rively at the breast,*^ and no further evidence of 
the serious part which artificial feeding plays in 
infantile mortality rates will be necessary. The old 
temperance cry, "There is death in the bottle!" 
has a new and terrible signification in the case of 
the bottle-fed baby. 

Facts like these have led philanthropists in many 
instances, and public authorities in a few instances, 
to try various schemes for the promotion of breast- 



40 THE COMMON SENSE OF THE MILK QUESTION 

feeding. Among the most interesting of recent pri- 
vate experiments is that conducted by Messrs. Bhir 
and Bhir, owners of a large manufacturing estab- 
lishment at Elbeuf, France. Large numbers of mar- 
ried women are employed, and those with young 
babies are encouraged to nurse them at the breast. 
They are urged tp keep the infant in the municipal 
crbc?ie, near the works, during the daytime, and are 
allowed to take the time necessary at regular inter- 
vals during the day to nimse them. For every child 
who is exclusively breast-fed in this manner right 
up to the age for weaning, one hundred francs is 
deposited in a bank by the firm. According to 
Professor Budin, the results of this sj^em have 
been quite encouraging. Except for the financial 
part of the scheme, and the fact that the crkches are 
frequently right on the premises, the same system 
is followed in most of the government factories and 
workshops connected with the match and tobacco 
monopolies, the postal telegraph and telephone ser- 
vices, and the like." 

In Cologne, Germany, such women are persuaded 
to stay at home, and as long as they continue to 
suckle their babies and to care for them properly 
in other ways, they are paid by the city out of the 
municipal funds.* It is frankly recognized that 
efficient motherhood is a valuable service to the 
state. Much the same course is followed in several 



WHEN THE MOTHERS FAIL 41 

French municipalities.*^ It is not believed that by 
such methods the number of those who fail to nurse 
their children because of physical disability will be 
materially lessened^ but rather that all who are 
physically able to do so, but who would be otherwise 
prevented, owing to the necessities of earning a 
living, will be enabled to do their full maternal duty. 
But the value of babies in sterile France is very high ! 



A bewildering array of proprietary artificial foods, 
most of them cunningly advertised, with all sorts 
of impressive names, tempts the mother who is unable 
to nurse her baby as Nature intended. Of the great 
majority of these "foods" it is safe to say that they 
are positively dangerous, little better than poisons, 
m fact. Of the very small minority of them which 
do not deserve this sweeping denunciation, there is 
probably not a single one which can be given with 
perfect safety to every child, or with reasonable 
expectancy of good results. Those containing a 
large proportion of baked wheat or barley flour may 
often be used with advantage as diluents, that is, 
they may advantageously be used in conjunction 
with a liberal quantity of milk ; ■' but their use is 
uneconomical, as will be seen from the fact that it 
is only the flour in them which it is either necessary 
or desirable to use, and that can be bought much 



42 THE COMMON SENSE OF THE MILK QUESTION 

more economically of the grocer than at a druggist's, 
put up in a fancy box at an enormous price. 

Among our best medical authorities there is a 
consensus of opinion upon this point. Dr. Chapin 
is exceedingly moderate in his language when he 
says that '' From a ntUritioruil standpoint these foods 
by themselves are almost without exception inferior 
to the best grades of condensed mUk."^ Careful 
analysis of some of the very best and most expen- 
sive of these proprietary foods shows them to con- 
tain very little more fat than condensed skim-^rnilk^^ 
Practically every one of the patent infant foods upon 
the market to-day is deficient in fat ; most of them 
cause scorbutus; most of them contain too large 
a percentage of sugar. Added to this list of com- 
plaints against them is the fact that a majority of 
them — some of the best among the number — 
contain such foreign elements as starch, maltose, and 
so on." 

These facts are not so well understood by the gen- 
eral public as they ought to be, but the medical 
fraternity knows them very well. To their lasting 
honor, the leaders of that great profession, especially 
those who devote themselves to the problems of 
pediatrics, have spoken out boldly upon the subject. 
But it is equally to the dishonor of thousands of 
medical men that they go on supporting what they 
know, or should know, to be a pernicious evil. The 



■:::• 



!i 



I 

i 



— 9 
« • • • 



••• 



WHEN THE MOTHERS FAIL 43 

columns of the medical papers are full of advertise- 
ments of these concoctions, which are at best swindles 
and often deadly, as the facts cited show. As one 
prominent physician wrote me, commenting upon a 
magazine article which I had published upon the 
subject, when you ^' look over the medical journals, , 
many of them of the highest repute, and see the 
glaring statements of infant foods set forth, you 
wonder that there is an American mother left willing 
to nurse her child." 

Then, also, there is the dishonest connection be- 
tween the manufacturers and the health bureaus 
of the coimtry. No sooner is a baby bom than the 
advertisements of patent foods begin to pour in 
upon the mother. Sometimes, in big cities, not 
more than twenty-four hours pass before the torrent 
of literature begins to flood the house. The diffi- 
culties of breast-feeding are glaringly presented; 
wonderful stories of successful feeding upon this, 
that, or the other food are enumerated, backed up 
by illustrations of over-fattened babies in a manner 
that reminds one of the live-stock pictures which 
one sometimes sees adorning farmers' kitchens. The 
mother wonders how the manufacturers and vendors 
could have secured her name, how it was possible 
for them to know of the baby's birth. How, except 
from the local health bureau or the phsnsician 7 There 
is an alliance between the manufacturers and some 



44 THE COMMON SENSE OF THE MILK QUESTION 

of the health bureaus of the country — a form of 
graft that is more than ordinarily detestable. 

Among the rich it has always been customary to 
secure the services of a wet-nurse in cases where the 
mother was either unable or unwilling to nurse her 
child, and the practice is very commonly recom- 
mended in such cases by medical men. For the 
poor, of course, such substitution is out of the ques- 
tion. While the practice has many advantages, 
it has also many disadvantages, and it is open to 
very serious question whether careful artificial feed- 
ing is not, upon the whole, safer and better.** In 
the first place, as we have seen, the mother's milk 
is continually undergoing changes which correspond 
to the needs of the infant. It is practically impos- 
sible to secure a wet-nurse, in this country at any 
rate, whose baby is not either considerably older, 
or yoimger than the one she undertakes to nurse, 
and there is often trouble in consequence, her milk 
being unsuited to the child. Sometimes several 
nurses have to be tried before one is secured whose 
milk agrees with the baby, and the constant disturb- 
ance, often extending over several weeks, is always 
a disadvantage and not infrequently a peril. Then, 
too, there is the fact that there is always danger 
of S3rphilitic infection, for even the most careful 
examination will sometimes fail to reveal syphilis 
in a woman. Even in the present state of semi- 



WHEN THE M0THEB8 FAIL 45 

enlightenment upon the subject of artificial infant 
feeding, it is probably quite as safe as substitute 
breast-nursing. The humble and docile cow is the 
foster-mother, or wet-nurse, of the modem infant. 
In the striking phrase of Dr. McCleary, "The human 
infant tends more and more to become a parasite 
of the milch cow." *• 



CHAPTER m 

WHY cow's MILK? 



The use of the milk of animals as food by the 
human race is of great antiquity. It probably 
began with the domestication of animals, which 
Morgan has described as one of the four preeminent 
accomplishments of barbarism,^ even if it did not 
precede that great achievement and serve as one of 
the causes which led to it. In any case, the dietetic 
use of milk is one of the oldest of human customs, 
being incalculably aged. The earliest Hebrew Scrip- 
tures and Homer's Iliad contain abundant evidence 
of its widespread prevalence in very early times.' 

Biologically considered, milk is a whitish, opaque, 
Uving liquid which is secreted by the mammary 
glands of the females among all the animals called 
''mammals" for the nourishment of their young. 
Man is a mammal and belongs, biologically, in a class 
with apes and monkeys, dogs and cats, sheep and 
goats, camels and elephants, horses and cows, and 
even whales, porpoises, and dolphins. It is the 
fact that all these animals, as well as many others, 
sudkle their young which causes them to be thus 

4A 



WHY cow's MILK? 47 

classified. But while all the TnamniAlfl are milk- 
producing animals, rearing their young to a state 
of comparative independence upon the lacteal fluid 
secreted by them in their mammary glands, the 
milk which they produce varies greatly according 
to the variations in the animals themselves. The 
differences in the appearance of the milk of differ- 
ent species are not very great. Some kinds look a 
little yellower than other kinds, or perhaps a little 
thicker, but in general the milk of all animals bears 
a very noticeable resemblance. This is all the 
more remarkable when we think of the great differ- 
ences in the appearance of the animals themselves. 
There is little hkeness between a woman and a camel 
or an elephant, and the contrast between the human 
being and the porpoise is quite as marked. That 
a cat's milk should closely resemble the milk of a 
cow or reindeer in appearance is remarkable in view 
of the absence of any likeness between the animals, 
and, more especially, the great differences in food 
and habits which characterize them. 

If, however, we make an analysis of the milks of 
some of these animals to ascertain their chemical 
constituents, and then compare them, we shall find 
that there are much greater differences in the com- 
position of the various kinds of milk than would be 
supposed by one who judged them only by their 
looks. This is what we should naturally expect^ 



48 THE COBfMON SENSE Ot THE MILK QUESTION 

for of course the milk must contain proper nourish- 
ment for the yoimg of the animal producing it, and 
we could not expect that the same kind of nourish- 
ment would do for a kitten and a young elephant; 
that the food intended by Nature for a young porpoise 
would suit the stomach and nutritional needs of a 
human infant. 

But before we proceed to examine the constituents 
of the milk of various animals we must consider 
carefully a most significant fact. In the preceding 
chapter it was pointed out that there are many im- 
portant variations in the composition of the milk 
of women. Not only are there differences in the 
milk of a woman at various stages of her baby's 
growth, but one woman's milk at a given period of 
lactation will frequently differ in marked degree 
from the milk of another woman at the same period 
of lactation. We also observed that cow's milk is 
subject to much the same variation. Not only do 
the various breeds differ in this respect, but the milk 
of one cow is frequently much richer than the milk 
of another cow of the same breed in the same herd.* 
It will be readily understood, therefore, that a good 
deal of latitude has to be allowed if we are to talk 
of the "average" composition of any kind of milk. 
The table which follows is probably as satisfactory 
as any that could be compiled, but it is only one chosen 
from among a large number in which there are more 



WHY cow's MILK? 



49 



or less important differences. In a general way, 
however, the figures given are satisfactory and will 
serve our purpose admirably if we only bear in mind 
that the milk of individual animals differs at various 
stages of the lacteal period: that there is consider- 
able variation in the character of the milk produced 
by individual animals of the same species, and even 
of the same parentage; that among the domestic 
animals there are marked differences in the quantity 
and quality of the milk produced ; that many factors 
besides those named, such as age, health, food, 
and probably climate, influence the quality of the 
milk. It is therefore a somewhat ''rough and ready" 
measure with which we have to deal. 

Table III 
Composition of the Milk of Different Animals 



AXZMAI. 


Watbb 


SOLIDB 


Fat 


Casxik 


Albu- 
min 


Milk 

BUOAB 


Ash 


Woman 


87.4 


12.6 


3.8 


w 


1.3^ 


6.2 


0.3 


Cow . , 






87.2 


12.8 


3.7 


3.0 


.5 


4.9 


.7 


Goat . . 






85.7 


14.3 


4.8 


3.2 


1.1 


4.4 


.8 


Buffalo 






81.4 


18.6 


7.5 


5.8 


.3 


4.1 


.9 


Ewe . , 






80.8 


19.2 


6.9 


5.0 


1.5 


4.9 


.9 


Llama . . 






86.5 


13.5 


3.2 


3.0 


.9 


5.6 


.8 


J&aro 






91.5 


8.5 


1.2 


1.2 


.1 


5.7 


.3 


ASB . . . 






89.6 


10.4 


1.6 


.7 


1.6 


6.0 


.5 


Camel . . 






86.6 


18.4 


3.1 


4.6 


4.0 


5.6 


.7 


Sow. . . 






84.0 


16.0 


4.0 


7.2 


7.2 


3.1 


1.1 


Elephant . 






67.9 


32.1 


19.6 


8.1 


3.1 


8.8 


.6 


Porpoise < 






41.1 


58.9 


45.8 


11.2 


11.2 


1.3 


.6 


Bog . . 






75.4 


24.6 


9.6 


6.1 


5.1 


3.1 


.7 


Cat . . . 






82.1 


17.9 


3.3 


3.1 


6.0 


4.9 


.6 



V 



50 THE COMMON SENSE OF THE MILK QUESTION 



Perhaps it may be well to add to the foregoing 
table a few words of explanation. While the analysis 
simply divides the constituents of milk into water 
and solidS; fat is really a semisolid. The solid con- 
stituents proper are sugar, casein, albumin, and 
mineral matter, called ash, or salts. Casein is a 
protein compound of very great importance, forming 
with albumin the chief nitrogenous value in milk. 
Curd is formed of casein through the action of acid. 
It forms one x>f the principal ingredients of cheese — 
about 25 per cent of its bulk — when coagulated 
by the action of rennet. The ash or salts in milk 
consists principally of phosphates and chlorides of 
soda, potash, and lime/ 



W«ltr 






J D D S 


■ 




tnm 









DZAOBAM 8BOWINO COUPOKBIITB OV Ck>W'B MiLK 

With this explanation it will be easy to appreciate 
the nutritive values of the various milks described. 
It will be quite obvious, for instance, that the enor- 
mous percentage of fat in the milk of the porpoise 
— more than eighteen times that of woman's milk 



WHY cow's MILK? 61 

— entirely removes it from the digestive capacity 
of the human species. So, too, in the case of the 
elephant, whose milk contains more than five times 
the fat contained in human milk. On the other 
hand, the milk of the mare and the ass are deficient 
in fat, though the milk of both animals has been 
more or less extendvely used as a food in some parts 
of the world,' and the milk of the ass is even used 
occasionally in this country as a food for very feeble 
infants.* Now, the principal animals whose milk 
has been used by mankind for food are the cow, 
the goat, the sheep (ewe), the ass, the camel, and the 
reindeer. Most of these would have been selected 
from the foregoing table of analysis by any lajrman 
called upon to select those which in their composition 
most nearly resembled human milk. 

Let us, then, take the milks of these species and 
compare them a little more closely with reference 
to their food values. As we have seen in an earlier 
chapter, the important task before the man of science 
is to find some substitute for breast milk which 
closely resembles it ; something that will make blood, 
tissue, muscle, bone, and nervous energy in as nearly 
as possible the same manner as mother's milk. In 
analyzing the food values of the principal domestic 
unimftla and comparing them with human milk, we 
are taking the first important step toward the solu- 
tion of our problem. 



52 THE COMMON SENSE OF THE MILK QUESTION 

We may divide food into four great classes, as 
follows : (1) protein, sometimes called proteid, or al- 
buminoids; (2) fat; (3) carbohydrates; (4) mineral 
matter, usually called ash or salts. ^ In addition to 
these, water is a very important ingredient of food, 
entering as it does into the composition of every 
part of the body, the bones even containing more 
than 10 per cent of water.' It follows, therefore, 
that the large percentage of water contained in all 
kinds of milk is not wholly waste and without nutrient 
value. Protein is the muscle-building element and 
is of prime importance, as the word itself indicates.* 
It contains carbon, hydrogen, oxygen, and nitrogen 
and, generally, but not always, sulphur. Sometimes 
there is found in addition to these phosphorus and 
iron. Fat, as most people know, is composed of 
carbon, hydrogen, and oxygen only. Carbohydrates 
is the name given to a compoimd of hydrated carbon. 
The carbon is compounded with hydrogen and oxygen 
in the proportion of two to one, the proportion in 
which these two elements combine to form water. 
All the glucoses and sugars are carbohydrates, there- 
fore the sugar in milk, which differs from cane sugar 
very materially, belongs to that class. The mineral 
matter in milk, the salts or ash, is principally useful 
in building and hardening bone. This is by no means 
a very complete or exact analysis of food elements, 

* Protein = I take the firat place. 



WHY cow's MILK? 



53 



but it is sufficient for our purpose in trying to grasp 
the essentials of the milk problem. In the following 
table the relative percentages of protein, fat, carbo- 
hydrateSy and mineral matter in the principal milks 
which are used as human food are shown: — 

Table IV 
Food Constituents of Different Milks 



Ahimax. 


pBonuf 


Fat 


Miix SnoAK 


MimsAL MAiras 


Woman 


1.6 


8.4 


6.1 


0.2 


Goat. . . 


8.7 


4.8 


8.6 


0.8 


Cow • • • 


8.6 


8.7 


4.9 


0.7 


Eire . . . 


4.9 


9.8 


5.0 


0.8 


Mare . . 


2.0 


1.2 


6.7 


0.4 


Ass . . . 


2.2 


1.6 


6.0 


0.5 


Camel . . 


4.0 


8.1 


5.6 


0.8 


Reindeer . 


10.4 


17.1 


2.8 


1.5 



It will be seen that all the animals included in the 
above table, which comprises the principal species 
that have been kept wholly or partly for their milk, 
yield milk that is much richer than woman's milk 
in the muscle-forming element, protein. If we were 
choosing a milk for this one quality, chemical analysis 
would indicate the wisdom of selecting the milk of 
either the mare or the ass, which are nearest to wom- 
an's in that one particular. But when we consider 
these with regard to the percentage of fat contained 
in them, they are seen to be very notably deficient. 
Strangely enough, the milk of the camel and the cow 



54 THE COMMON SENSE OF THE MILK QUESTION 

are about equally near mother's milk, the slight 
deficiency of fat in the first being about the same as 
the slight excess in the second. Next in order comes 
goat's milk, so that we may value them in the fol- 
lowing order: (1) cow's milk; (2) camel's milk; 
(3) goat's milk. In carbohydrates all three are 
notably deficient, but the camel is nearest, with the 
cow second and the goat third. 

The tremendous excess of protein and fat in the 
milk of the reindeer as compared with human milk 
and that of all other animals included in the table 
would seem to render its use as human food im- 
possible. But it is extensively used by the Lap- 
landers,* various Eskimo tribes along the coasts of 
Siberia,*® and, to a limited extent, by the Eskimo 
tribes in Alaska since our own government intro- 
duced the reindeer there nearly twenty years ago 
to provide the people with some protection against 
possible famine." Whether the milk is ever given 
to infants, and, if so, to what extent and in what 
manner it is modified, I have been unable to as- 
certain. Nor have I been able to obtain any analysis 
of the milk of Eskimo or Laplander women to com- 
pare with that of reindeer milk. It is not improbable, 
I think, that the difference between the two is very 
much less than our figures suggest. The reindeer 
is a native of the coldest climates and needs the 
seemingly excessive fat for heat. We know that 



WHY cow's MILK? 55 

the human inhabitants of these arctic lands consume 
enormous quantities of blubber and other animal 
fats for the same reason, and it may be found that 
the milk of the women contains an amoimt of fat 
that is far in excess of that which is common in more 
temperate climates." 

n 

Now, it is evident that even if the nomads of 
Africa, Asia, and India possessed the information 
concerning the chemical composition of the various 
kinds of milk which is now before us, it would not 
take them long to decide in favor of the camel. 
Economically speaking, they would have no choice, 
since the camel is the only one of the animals in- 
cluded in the comparison which is adapted to the 
peculiar conditions of the desert. The reason why 
practically all the numerous Biblical references to 
milk are to the milk of either the goat or the sheep, 
indicating that the cow was not the common milch 
animal of Palestine, is simply that the country was, 
as a whole, not suited to the pasturing of large cattle, 
though wonderfully well adapted to the needs of 
sheep and goats/' In this country efforts made to 
domesticate the camel failed, the animal being un- 
economical.^^ For this reason, of the three animals 
whose milk most nearly resembles that of the hmnan 
mother in its chemical composition, one is unavail- 



56 THE COMMON SENSE OF THE MILK QUESTION 

able so far as the inhabitants of Europe and America 
are concerned. 

There are two species, then, whose lacteal secre- 
tion more nearly resembles woman's milk than that 
of any other species available for general milch pur- 
poses, namely, the cow and the goat. The milk 
of the latter is very extensively used in some parts 
of the world, and a great deal can be said in its favor 
as a substitute for human breast milk. It is not, 
however, very much used in this country. As be- 
tween the two animals we have chosen the cow. 
The reasons for this choice are probably in large 
part sentimental and to some extent economic. 
It is commonly believed that the goat is not a clean 
animal, especially in its dietetic habits. While 
most Authorities upon the goat declare this to be 
a gross Ubel upon a very clean animal,^' there can 
be no doubt that it enters into the popular preju- 
dice against the goat and partly accoimts for the 
discrimination against the animal. True, the male 
goat has almost always an offensive odor, but this 
objection does not apply to the female. Horace, 
the Roman poet, long ago set the world an excellent 
example by truthfully imputing the offence to the 
male goat alone, calling the females 

"The ladies of the unfragrant lord." 

Again, many persons who have never tried goat*s 
milk, either as a beverage or as a food for them- 



WHT cow's MILK? 67 

seltes or their infants^ have an idea that the milk 
has a peculiar and unpalatable taste. This likewise 
is unjust to the gentle animal which has been most 
aptly called "the poor man's cow." There is a very 
serious objection to the goat in the fact of its un- 
deniable record as a destroyer of young trees and 
shrubs, but this can be overcome by tethering, and 
presents no very great difficulty. 

On the economic side, the objection that there is 
no demand for goat's milk to justify goat-keeping 
upon a large scale, in a commercial way, is trite. 
That is an economic consequence of the prejudice 
against the animal. Doubtless there are many 
persons in all our villages and small towns, where 
goat-keeping is practicable, who are reasonably 
free from prejudice and open to conviction upon the 
subject of the animal's worth, especially as the 
provider of an excellent milk for infant feeding, who 
are simply ignorant of its economic merits. The 
yield of milk is not large enough compared with that 
of the cow to be attractive, though in proportion 
to its size and weight the goat jrields not less than 
the average cow. A fairly good goat will yield two 
quarts of milk or more daily, two or three milkings 
a day being necessary." It is not an expensive 
animal to buy and is probably the cheapest animal 
of its size in the world to maintain. The average 
American laughs at the idea of valuing the goat for 



58 THE COMMON SENSE OF THE MILK QUESTION 

its economic qualities, but it is doubtful whether, 
all things considered, there is a more economical 
domestic animal anywhere. 

There are several reasons why goat's milk is superior 
to cow's milk as a substitute for breast milk in infant 
feeding. In the first place, while the cow is particu- 
larly subject to a specially virulent form of tuber- 
culosis, which dread disease it is, as we shall see later, 
capable of acquiring from man and of transmitting 
to man in its milk, through the infection of the di- 
gestive tract, the goat is practically * immune from 
the disease. Professor Nocard has observed that 
of 130,000 goats and kids brought to the slaughter- 
houses of Paris the meat inspectors failed to find 
a single one suffering from tuberculosis and requir- 
ing condemnation." The testimony upon this point 
is overwhelming, and if there were no other ad- 
vantage in goat's milk, this immunity from the 
disease which scourges mankind ought to make it 
popular, providing that its milk proved equally 
as nutritious and digestible as cow's milk. If we 
were choosing a foster-mother or wet-nurse for an 

* I say " practically immune " in view of the fact that goats 
have been successfully inoculated with bovine tubercle bacilli 
by Arloing, and with both bovine and human tubercle bacilli by 
De Jong. Nevertheless, instances of successful inoculation 
with either variety are so rare as to call attention to the strik- 
ing degree of immunity enjoyed by the goat. See ''Some 
Observations on the Tuberculosis of Animals," by D. E. Salmon^ 
D.V.M., Maryland Medical Journal, February, 1904. 



WHY cow's MILK? 59 

infanti and there were two candidates apparently 
equally desirable in all other respects save this one, 
both being plentifully supplied with good milk, but 
one of them the victim of an active and malignant 
disease, is there any intelligent being who doubts 
what the choice would be? Yet, in the case of 
choosing an animal to be virtually the wet-nurse 
of the nation, we have chosen the one infected with 
disease and constantly passing on the infection to the 
little ones. 

Goat's milk is superior in richness and flavor to 
that of the cow, but what of its digestibility 7 In 
the milk of both animals the percentage of casein 
is very much greater than in human milk, the averages 
being: — 

HvMAir Cow QOAT 

1.0 per cent 8.0 per cent 8.2 per cent 

This indicates a tougher and harder curd, casein 
being the curd-forming element in milk. Now, 
note the reason for this difference in the toughness 
and hardness of the curd in the three milks: both 
the caw and the goat have four stomachs, while man 
has only one I The digestive apparatus of the human 
infant is adapted to the assimilation of a soft-curded 
milk, while the young of the cow and the goat have 
digestive systems equally well adapted to the assimi- 
lation of milks containing hard, tough, fibrous curds. 



60 THE COMMON SENSE OF THE MILK QUESTION 

We shall have reason to return to this important 
subject of the relation of milk to the digestive system, 
but for the present it is enough to note the fact that 
goat's milk is rather harder in curd than cow's milk, 
and that both are very different to woman's milk 
in that respect, taxing the digestive organs accord- 
ingly. 

To offset the slight inferiority to cow's milk due to 
the harder and tougher curd, Dr. J. Finley Bell has 
shown that goat's milk has other advantages.^' Not 
only is the milk much less subject to bacterial con- 
tamination, but the fat in it, while the percentage is 
higher than in cow's milk, seems to be much more 
nearly akin to the fat in human milk than is that 
contained in cow's milk. As a result of the success 
which attended the use of goat's milk in cases of 
infantile diseases of the digestive tract, after cow's 
milk had failed. Dr. Bell imdertook an investigation 
into the subject of the relative digestibility of the 
milk of cows and goats. He found that the milk 
fat of the two species differed from each other and 
from that of the human species in that they melted 
at quite different temperatures. The temperature 
at which the fat of goat's milk melted was much 
nearer to the melting-point of human milk fat than 
the melting-point of the bovine milk fat. The 
temperature (centigrade) at which each melted was : 
human, 36.5°; goat, 34.5° to 36.0°; cow, 38.0° to 



WHY cow's MILK? 61 

40.5^.** By a very simple and rational method of 
experiment Dr. Bell thus showed why, in spite of its 
slightly tougher curd and larger percentage of fat, 
goat's milk proved superior to cow's milk from the 
standpoint of digestibility. 

In many parts of Switzerland and France it is 
customary for babies to take their nourishment 
directly from the goat's udder, just as they would 
from their mothers' breasts.'® The udder and teats 
of the goat are carefully cleaned by washing, and 
then the child sucks the teats as other children do 
their mothers' nipples. According to the British 
Medical Journal, the results are in every way satis- 
factory.'^ Among the Italians who come to this 
country in such large numbers goat's milk is very 
highly esteemed as an infants' food, especially in 
times of sickness.'' Down amid the crowded tene- 
ments of New York City, when a little Italian baby 
is sick, weakened by diarrhcea and much vomiting, 
the distracted mother will very often take the frail 
sufferer in her arms across the ferry into New Jersey, 
in quest of goat's milk, which she generally finds in 
one of the many straggling Italian settlements on 
the outskirts of near-by towns. In this connection it 
is interesting to remember that among the ancient 
Hebrews many curative properties were attributed to 
the goat. Just as the blood of the male goat was 
believed to be more like human blood than that of 



62 THE COMMON SENSE OF THE MILK QUESTION 

any other animal," so the milk of a goat, freshly 
drawn from the udder, was regarded as a cure for 
pains of the heart," while the milk of a white goat 
was regarded as having special properties as a cure 
for many ills.^ 

All things considered, then, the neglect of the goat 
as a milch animal, especially as a provider of milk for 
infants, is very much to be deplored. The animal 
seems to be altogether well fitted to be the wet-nurse 
of the human infant, much more so than the cow, 
and it is a great pity that ignorance concerning its 
habits and qualities should stand in the way of its 
more general employment. That an extensive use of 
its milk in place of that of the cow would lead to a 
considerable reduction in the enormous mortality 
from the various forms of tuberculosis which afflict 
infants is highly probable, indeed, practically certain. 
It is to be hoped that the Department of Agriculture 
at Washington, and the several state bureaus, will 
see fit to make known the truth concerning the much 
maligned goat, and to encourage its breeding and use 
for milch purposes. 

m 

Cow's milk, then, is the staple diet of a very large 
part of the infant population of this and other coun- 
tries. Moreover, the number of children fed upon it 
is continually increasing. No matter how earnestly 



* •• • 



• • • • I 



« • « • 

• • . 

• •••• 



WHY cow's MILK? 63 

we may desire to see the milk of some other animal 
tried in its stead, for a long time to come cow's 
milk will be the staple diet of a majority of bottle-fed 
babies. It is computed that of the 18,000,000 cows 
in this comitry, the milk of more than 5,000,000 is 
used as mUk^ most of it in a raw state. What the 
constituents of cow's milk are, and how it compares 
in its chemical composition with the milk of other 
species, we have already seen. There remain, how- 
ever, some other important aspects of its use by man 
as a food to be considered. 

Milk, by which is here meant cow's milk, is often 
spoken of as though it were a perfect food. That the 
milk of any animal is normally a perfect food for its 
own young b true, so there is no doubt that cow's 
milk is a perfect food — for calves. But as a food for 
human beings it is far from perfect. Milk contains 
the four classes of nutrients necessary for man, 
protein, fat, carbohydrates, and mineral matter, in 
more nearly the correct proportions than any other 
single food material. A quart of milk contains about 
the same amount of nutritional value as twelve 
ounces of beef or six ounces of bread. But the nutri- 
ment is better balanced than in either bread or beef. 
For while in the meat there is protein and fat, and in 
bread protein and carbohydrates, milk has all three 
in about equal proportions.*^ 

The protein is present in larger quantities than the 



64 THE COMMON SENSE OF THE MILK QUESTION 

human body demands^ however. A moderately ac- 
tive man of average build requires about 0.28 of a 
pound of protein daily, but the milk required to give 
just that amount of protein would yield too little of 
the necessary fat and carbohydrates to provide the 
body with proper energy. On an average, 3400 
calories of energy are required, but the milk which 
would provide that would also provide too much 
protein, 0.34 of a pound. To get just 0.28 of a poimd 
of protein it would be necessary to take an amount of 
milk deficient in energy-making elements to the extent 
of 700 calories, or nearly twenty per cent of the total.*" 
Other reasons why milk cannot be regarded as a 
perfect food for adults are, first, that the quantity 
of water contained in it is so great that it would be 
necessary for a man to drink at least four or five 
quarts daily to obtain sufficient nourishment from it ; 
second, that it has not enough solid bulk. It seems 
to be a law of nature that man in common with most 
animals needs a certain bulk to his food. The dis- 
tention of the stomach appears to be necessary and 
the bulk of the solids in man's food to play an impor- 
tant part in promoting the peristaltic action of the 
intestines.*' 

As an element in the diet of the human adult, milk 
and its products may be said to be invaluable, but 
milk is not of itself a suitable food for the normal 
man or woman. For invalids and very young chil- 



r 



WHY cow's MILK ? 65 

dren, however, it is practically a perfect food — as 
nearly perfect as anjrthing of which we know. Its 
advantages are well known: it is as a rule easily 
digested, it does not irritate the alimentary canal, 
and by using a milk diet the physician is better able 
to regulate both the quantity and the quality of the 
nourishment given to an invalid or an infant than in 
any other way. Of all animal foods milk is the most 
easily digestible. It has been found that, on an 
average, an adult digests about 97 per cent of the pro- 
tein, 95 per cent of the fat, and 98 per cent of the 
carbohydrates in milk. According to the experi- 
ments made by our American authorities, a child one 
year old digests less — 90 per cent of the protein, 
96 per cent of the fat, and 86 per cent of the car- 
bohydrates.'* These figures, it may be added, repre- 
sent the digestion of a healthy child with whom cow's 
milk agrees. 

But the enormous death-rate among bottle-fed 
babies shows that it is exceptional rather than usual 
for cow's milk thus to agree with young infants, 
especially during the first few weeks of life and during 
hot weather, when there is a certain depression of the 
digestive system and when it is difficult to keep milk 
pure and sweet owing to the rapidity with which it 
decomposes. One cause of difficulty is the hardness 
of the curd as compared with that in breast milk, 
the infant's natural food. Dr. Chapin's investiga- 



66 THE COMMON SENSE OF THE MILK QUESTION 

tions of the relation of infant dietetics to the com- 
parative anatomy of the digestive tract have revolu- 
tionized the whole science of infant feeding. He has 
conclusively demonstrated that the milk of each spe- 
cies is suited to the structural character of the diges- 
tive apparatus. He points out that in each of the 
species the '' milk of the mother behaves in the young 
animal's stomach very much as the food of the mother 
behaves in her stomach."" By this method, he 
believes, the young animal is being taught to digest 
its food in just the same way as it must when it is 
grown up. 

The cow, the goat, and the sheep have each four 
stomachs. Taken together, these four stomachs 
form about 70 per cent of the digestive tract. But 
while the horse and the ass eat much the same kind 
of food as the cow and the sheep, they have only 
one stomach, which forms about 8 or 9 per cent of the 
digestive tract. This stomach holds less than one- 
half of a meal. Like the horse and the ass, man has 
but a single stomach, and this forms about 20 per cent 
of the digestive tract as compared with 70 per cent in 
the case of the cow and only 8 or 9 per cent in the case 
of the horse.'' Do these great variations in the kind 
and size of the digestive organs of the different species 
mean anything? do they signify variations in the 
manner of digesting food which will help us to ex- 
plain why it is that so many infants die every 



WHY cow's MILK ? 67 

year of illnesses caused by diseases of the digestive 
tract? 

Let us examine a little more closely the digestive 
tract in a cow, a horse, and a man, and note briefly 
some of the most important features in the digestive 
process in each case. In the cow we have four stom- 
achs, each connected with the others, and occupying 
altogether 70 per cent of the digestive tract. The 
fourth stomach has its outlet into the intestine, and 
careful examination will show that the outlet is so 
small that only liquid, or semi-liquid, food can pass 
through it. If we could watch the working of this 
complicated apparatus in the case of a yoimg calf, 
we should find that the process of digestion goes on 
about as follows : when the milk of the mother goes 
into the first stomach it clots with a firm, hard curd. 
As this clotted mass passes from stomach to stomach, 
the curd is gradually reduced, until, from the fourth 
stomach, it passes into the intestine in a digested, 
liquid form. 

Taking next in order the horse, we find at the outset 
a very different apparatus. Here is a single stomach, 
very small, and occupying only about nine per cent 
of the digestive tract. The outlet from the stomach 
to the intestine, instead of being so small that only 
liquid or semi-Uquid food can pass through it, is very 
large. If we could watch the stomach at work during 
the time the horse was taking a meal, we should find 



68 THE COMMON SENSE OF THE MILK QUESTION 

that; while the animal was eating, the stomach emp- 
tied its contents, altogether undigested, into the in- 
testine. At the other end of the intestine is a very 
large caecum, or gut, which occupies about 60 per cent 
of the digestive tract. The digestion of the food in 
this case is not performed by the stomach, but by the 
intestine. Now, if we could only observe the working 
of this digestive system in a very young foal, we 
should find the mare's milk forming, not a hard clot 
like the cow's, but a clot very soft and like jelly. This 
jellylike clot passes at once into the intestine from 
the stomach and is there digested. Now, then, sup- 
pose that instead of letting the mare nurse her off- 
spring, we take it away and feed it upon cow's milk, 
or the milk of some other animal which resembles it 
in having a hard, tough curd. As the hard clots of 
curd pass into the intestine, which is suited only to 
the digestion of a soft, jellylike curd, what happens ? 
Why, obviously, intestinal irritation and inflam- 
mation. The hard curd is a foreign substance in 
the intestine; it cannot be digested. Thus in the 
stomach of the foal the milk intended for a calf by 
Nature becomes an irritant and a poison. 

Now, let us take the human infant. Here, again, 
we have a young animal with a single stomach, which 
occupies about 20 per cent of the entire digestive 
tract, or less than one-third the proportion occupied 
by the four stomachs of the calf in its digestive tract. 



WHY cow's MILK? 69 

We notice at once that, as in the case of the calf, 
the outlet from the stomach to the intestine is very 
small. As we watch the milk from the mother's 
breast pass into the infant's stomach, we observe 
that it does not clot in a hard, tough curd like cow's 
milk, nor in a jelly as in the case of mare's milk, 
but in a soft mass, broken into numberless small 
particles. It is neither hard and solid, nor soft and 
gelatinous, but flocculent. In this state it passes 
into the intestine, where the process of digestion is 
completed. If, instead of mother's milk, speedily 
precipitated into this flocculent form, cow's milk with 
its enormously harder curd enters the tender stomach, 
what happens? Why, the stomach is overtaxed 
trying to break the curd into particles small enough 
to enter the intestine, and there is disorder until the 
foreign substance can be got rid of, with resulting 
nausea or diarrhoeal illness. Such portions of the curd 
as have been broken and passed into the intestine 
are very liable to cause just the same kind of dis- 
turbance there, with serious, if not fatal, result. 



IV 



From the foregoing discussion it will be perfectly 
apparent, even to one who has never given the matter 
the slightest thought before, that in looking for a 
substitute for breast milk upon which to feed our 



70 THE COMMON SENSE OF THE MILK QUESTION 

babieS; it is necessary to pay attention to other factors 
beside the percentages of protein, fat, and carbo- 
hydrates which the substitute contains. Even if we 
could secure a milk the chemical composition of which 
was exactly the same as that of human milk, it would 
still be far from a perfect substitute, unless it behaved 
similarly in the digestive process. It is evident, then, 
that while a chemical analjrsis is necessary and 
helpful, it is not, by itself, competent to warrant the 
fitness of the milk of any animal as a food for any other 
than its own young. Comparative anatomy of the 
digestive organs, and a close study of their function- 
ing, must go hand in hand with chemical analysis.** 

Furthermore, the chemical analysis of milk must be 
carried much farther than is necessary to determine 
the proportion of the various food constituents con- 
tained in it. That is but the beginning of phjrsio- 
logical chemistry as it bears upon the problem of the 
artificial feeding of infants. There are many other 
matters of profound importance which need to be just 
as carefully studied. For example, there is in all 
milk fats a substance of a phosphorescent nature, 
called lecithin — from the Greek root, lehUhos, 
yolk of an egg. This substance is contained in hu- 
man milk to a much greater degree than in the milk 
fat of other animals, such as the cow and the goat. 
That there is a very good reason for this may be pre^ , 
sumed, for Nature's economy is exceedingly scientific 



WHY cow's MILK ? 71 

and wise; the relative abundance of lecithin in the 
milk of the human mother is not a whim or an ac- 
cident, but an important fact which we cannot 
properly ignore. 

We ask ourselves, then, what is the purpose of 
lecithin? what does it do? Science reveals the fact 
that it is this substance which forms a very large 
part of the brain and nerves. So another question 
arises, why should there be less of it in the milk of 
cows, goats, sheep, and horses than in woman's milk ? 
For answer to this question, let us compare the newly 
bom offspring of these various species: ''Within 
half an hour after birth a calf, lamb, kid, or colt can 
stand, and in a day or two runs around and sees, hears, 
and smells about as well as its mother. In other 
words, it is bom with a fully developed nervous system. 
But a baby is very different in this respect, and it 
needs material for building up its nervous system, 
and this is found abundantly in woman's milk, but 
not so much in other milks." Thus Dr. Chapin 
answers our question.^ 

There are other wonderful elements in milk which 
are not disclosed by ordinary analysis. In fact, the 
story of a drop of milk, could it be fully told, would 
prove one of the great romances of science. We can- 
not even enumerate these wondrous elements in the 
present discussion, but there is one without some notice 
of which we shall not be able to understand subse- 



72 THE COMMON SENSE ON THE MILK QUESTION 

quent chapters. It is well known that breast nurslings 
are remarkably immune from infectious diseases, 
even though their mothers may be infected during the 
lactation period." Mothers suffering from typhoid 
fever, diphtheria, measles, scarlet fever, and many 
other diseases which are highly infectious, frequently 
continue nursing their infants without infecting them 
in the slightest degree. In many isolation hospitals 
it is the rule not to separate the nursing infant from 
its mother, even though the mother is suffering from 
such a disease as diphtheria and the infant is perfectly 
healthy. Professor Roger, an eminent French author- 
ity, has published a list of forty-nine cases of nursing 
mothers admitted with their infants to his isolation 
hospital. Fifteen had measles, nineteen scarlet fever, 
eight tonsQitis, one diphtheria, five erysipelas, and one 
mumps. With the exception of one very debUitated 
child, who contracted erysipelas, no child contracted 
disease, notwithstanding that all were suckled by their 
mothers.** It is believed that this unmunity of breast- 
fed babies from infectious disease is due to the fact 
that the mother's milk carries into the infant's body 
certain protective anti-toxins which are called, in the 
technology of the laboratory, "anti-bodies." 

When an animal is attacked by poisonous bacteria, 
certain neutralizing qualities are formed in the blood, 
which, to a certain degree, produce an active resistant 
against the poison. In a healthy anunal the blood 



• • < 



• • • • 

• • • 

• •• 



'• • • 



/ 



WHY cow's MILK? 73 

thus develops considerable bactericidal powers, en- 
abling the animal to resist the attack. Now, if it 
be true that these anti-bodies are secreted in the lacteal 
fluid of the mother and carried into the digestive 
tract of the infant, to be distributed throughout the 
body, we have, another very important reason for 
the superior advantages enjoyed by breast-fed over 
bottle-fed babies in the struggle for existence. For 
while the milk of the cow may likewise contain these 
useful anti-bodies, they are effective only in protecting 
its own offspring and of no advantage whatever to the 
human infant, its parasite.'^ Far from protecting 
the baby against disease, there is an astounding mass 
of convincing evidence that cow's milk is frequently 
the medium by which the human infant is infected, 
many of the deadliest diseases being conveyed by 
means of milk, especially among young infants wholly 
dependent on a milk diet. 

Summarizing, briefly, the principal points in this 
discussion thus far, it is evident that as a substitute 
for mother's milk some other milk is desirable, though 
there is no other milk which is as good as mother's 
milk and able to serve the infant in so many ways. 
While foods may eventually be made, consisting 
wholly or largely of vegetable matter, in which the 
proportions of protein and other food elements are 
perfectly balanced, still, they cannot take the place 
of milk, which must form the basis of any satisfactory 



74 THE COMMON SENSE OF THE MILK QUESTION 

infant food. The milk of the cow is generally used 
in this country^ though it is in some respects inferior 
to goat's milk. But whether cow's milk or goat's 
milk be employed, it must be modified to make it as 
nearly like human milk as possible, alike as to its 
nutrient qualities, the manner of its digestion, and 
the content of ferments which aid and stimulate 
assimilation. This is the task to which the modem 
physiological chemist and the physician must address 
themselves. There can be no reasonable doubt tliat 
the standard which Nature sets is the one which should 
be aimed at ; that the nearer we get to human milk, 
the more satisfactory the result will be. 



It is no part of my purpose to provide mothers and 
nurses with a manual of instruction in the practice 
of infant feeding. We are concerned with the prob- 
lem in its social and political aspects only. If many 
of our excursions into the realms of chemistry, physi- 
ology, pathology, and bacteriology seem at first to 
be foreign to that purpose, it will require but little 
reflection to show that these are very important 
phases of the problem we are trying to solve, the 
problem of securing a safe and wholesome public 
milk supply; and, especially, such a system of pro- 
ducing and distributing the milk upon which so many 



WHY cow's MILK? 75 

of our babies must be fed as will stop the needless 
waste of life, the stream of little baby lives that 
flows each year into the great ocean of death and 
loss. It requires no elaborate argument to show 
that a clear comprehension of the problem is the first 
essential condition of its successful solution. 

It is, therefore, not proposed to enter upon a dis- 
cussion of the various milk formulas which have 
been prepared by different authorities upon infant 
dietetics, such as the venerable and learned Jacobi, 
Botch, Chapin, Holt, and others."' Nor will any 
attempt be made to determine the merits of the 
controversy between those who favor a very high 
percentage of fat, using "top-milk" only, or adding 
cream to the milk, and those who favor a low per- 
centage of fat. There is doubtless a danger line in 
either direction, and the milk of the human mother 
is not very likely to be improved upon as a standard. 
For the reasons stated, our concern with the modifica- 
tion of milk for infants is very slight. We have noth- 
ing to do with the technic of its formulas, but only 
with those aspects of it which have a socio-economic 
significance. 

The practice of modifying milk has, in a crude 
way, been carried on from very remote times. Long 
before the rise of a school of physicians devoted 
especially to the study of pediatrics, mothers, find- 
ing that their babies could not retain the milk of 



76 THE COMMON SENSE OF THE MILK QUESTION 

the COW when given in its pure, undiluted state, 
followed their instinct and common sense and diluted 
it by the addition of water. It was a crude method 
of modifying milk, to be sure, and the tally of its 
victims will never be recorded. It is significant, 
however, that the mothers, long before the subject 
received the attention from scientific minds which 
is now common, discovered that, according to the 
age of the child and its strength, cow's milk needed 
some dilution to adjust it to the child's need. But 
among French physicians, led by such men as Budin, 
Variot, and Dufour, there is a very widespread oppo- 
sition to any attempt to lessen the differences between 
human and bovine milk by any process of modifica- 
tion, or, as the English say, "humanization." They 
prefer to give the cow's milk unmodified, even to 
very young infants, but insist that it must be either 
sterilized or pasteurized.'^ In following the other 
method of modifying the cow's milk to suit individual 
requirements, American and English physicians are 
doing in a scientific way what maternal instinct and 
experience used to do in a crude, haphazard way 
with disastrous results. They are minimizing the in- 
evitable differences between natural and artificial 
food, reducing the loss of the bottle-fed baby to the 
minimum. 

In percentage-feeding as practised by such au- 
thorities as Rotch and Chapin and their numerous 



WHT cow's MILK? 77 

foflowers, milk modification has reached its highest 
development thus far. The leadership of American 
physicians upon this question is universally recognized 
outside of France. Indeed, the science of the whole 
milk question is very much further advanced in 
America than in any other country, however back- 
ward we may be in the practical application of scien- 
tific knowledge to our milk supply. We are not, 
after all, a very practical people, much as we love to 
hug the delusion that we are. Social science is 
nowhere making the progress that it is making in 
America to-day, Germany having lost its leadership 
long since. But the practical application of that 
science, actual social experiment, is neglected here 
as nowhere among the gi*eat nations. 

Percentage-feeding is in reality a highly indi- 
vidualized system of milk modification. Starting 
from the idea that the mother's milk is immeasurably 
superior to any other food for an infant, percentage- 
feeding is an attempt to so modify cow's milk that 
it will approximate mother's milk in its composition. 
Under the old haphazard methods, when it was foimd 
that undiluted cow's milk could not be properly 
digested by the infant, it was simply diluted imtil 
it ''seemed to suit the stomach" of the child. It was 
not understood that it was the excess of protein in 
the milk, intended by Nature for a very different 
organism, which caused the indigestion, nor that in 



78 THE COMMON SENSE OF THE MILK QUESTION 

the process of simply diluting the milk with water 
there was danger, not merely that the dilution would 
be carried too far, thus reducing the amount of 
protein below what was actually necessary, but also 
that the amount of heat and energy-producing ele- 
ments^ fat and sugar, was likewise reduced to a degree 
inconsistent with the health and proper development 
of the child.^^ Such babies pined and wasted away, 
with the result that cow's milk was held to be an un- 
suitable food and generally discredited. Very often 
anxious mothers resorted to some of the many pro- 
prietary foods, upon which, owing to the amount of 
sugar contained in them, there was generally a gain 
in weight. Thus the proprietary foods obtained a 
hold upon public confidence. How could the mother 
be expected to realize that the fatness and weight of 
her baby were both deceptive; that its fpod was 
lacking in protein, the element that giyefrStrehgth and 
resisting force ? How could she be expected to know 
that, under such conditions, her child must be ex- 
ceedingly liable to become rachitic, or to succumb to 
the first attack of a serious nature through lack of 
fortifying strength?" 

This very grave defect in prepared foods for infants 
is one reason for the excessive mortality which in- 
variably results from their use. When pigs are fed 
upon a diet that is low in protein, they succumb to 
disease much more easily than do pigs fed upon a diet 



WHY cow's MILK? 79 

containing protein in proper proportion. The pigs 
fed upon the low protein diet may be fatter and 
heavier, l)ut they are loeaker.*^ This is what common 
sense would suggest, of course, in the case of babies 
as well as that of pigs, and demonstrates very forcibly 
how misleading the advertisements of all proprietary 
foods are. Pictures of babies showing them to be 
very fat, and figures showing them to be very heavy, 
may deceive mothers and the lay mind in general; 
but the medical man and the student of physiology 
know that these are not the only conditions of sound 
health. 

One of the great merits of percentage-feeding is 
that a general knowledge of its principles will do much 
to educate the public to a realization of the danger 
which lurks in proprietary foods, even the very best 
of them. The great obstacle at present is the fact 
that the principles have not been simpUfied enough 
to make them popular. They are too complicated, 
and involve too much computation and study, for 
the very mothers who most need to understand and 
practise them. It must not be forgotten that direc- 
tions which appear simple and lucid enough to the 
college woman will seem very complicated and diffi- 
cult to the mind of the poor tenement mother. Quite 
the notost lucid and simple instructions for percentage- 
feeding which I have seen fail in this vital particular. 
The physician who can prepare a truly simple and 



80 THE COMMON SENSE OF THE BULK QUESTION 

popular statement which will enable the average 
mother of the working class to understand per- 
centage-feeding, so as to practise it intelligently, 
without having to imdergo a very complicated 
system of calculation, will confer a great boon upon 
humanity. 

As it is, where mothers are intelligent enough to use 
modified cow's milk they frequently do not under- 
stand that the extent and manner of the modification 
must be determined by two factors mainly — the 
quality of the milk in its imdiluted state and the age 
and physical development of the child whose diet it 
is intended to be. Many of the cases of children fail- 
ing to thrive upon the modified milk provided at a 
low price at the Infants' Milk Depots maintained by 
private philanthropy in this country, and by munici- 
pal enterprise in England, are due to the ignorance 
of the mothers upon these points and the lack of an 
effective supervision of the distribution of the milk 
mixture. Dr. F. M. Fry teUs, in the Archives of 
Pediatrics,^ of a physician who sent an order to the 
Walker-Gordon laboratory, that " four ounces of modi- 
fied milk" be sent daily to a certain address. No in- 
structions were given as to the ingredients desired, 
nor anything said concerning the age of the infant 
for whom the milk was required. Doubtless the 
physician desired and expected good results for the 
baby as a result of the use of modified milk, which 



WHY cow's MILK? 81 

tenn apparently meant to him simply — modified 
milk. 

If it is possible for this to happen in the case of a 
physician, is it at all strange that it should frequently 
happen that mothers fail to appreciate the fact that 
the milk mixture which suited her baby at six weeks 
will not suit it at six or nine months; that merely 
increasing the quantity of the mixture will not do, 
but that its composition must be changed? A lax 
method of distributing modified milk from the depots 
conducted by philanthropic persons and societies in 
many cities is a weakness which must be remedied 
before a maximum of good can be obtained from 
them. 



CHAPTER IV 

FILTH AS infants' FOOD 



Thus far we have considered only those disad- 
vantages in the use of cow's milk as a substitute for 
mother's milk which are inherent in the dififerences 
between the human and bovine species. That the 
very best cow's milk obtainable, modified by the most 
expert physician, is not a perfect substitute for the 
liquid which the lacteal cells of the mother secrete 
from her food, to become the food of her oflFspring, is 
only another way of saying that, so far as we have 
yet progressed, there is always an element of danger 
in the use of any substitute for breast-feeding. The 
danger is by far the greatest when any of the manu- 
factured foods are used and least when the milk of 
the cow or the goat, properly modified by the use of 
diluents containing either alkaline elements or the 
gruel of cereals is used. But at best there is some 
danger. 

Now we must consider some other elements of 
danger which are very important, and which differ 
from those we have been considering in that they are 



FILTH AS infants' FOOD 88 

not due to the differences in the human and bovine 
organisms, but mainly to conditions resulting from 
our ignorance, to the highly dangerous and unscientific 
manner in which we permit the production and dis- 
tribution of milk to be carried on. The dangers which 
we are to colisider under this head are very much 
greater and more numerous than those which are the 
inevitable result of the use of a substitute for the 
natural food of the infant, and which we can scarcely 
hope ever to wholly avoid. But while they are more 
numerous and more frequently fatal, they have this 
hopeful feature: they can all be successfully com- 
bated whenever enough civic interest has been awak- 
ened to a recognition of peril and remedy to insure 
the earnest and intelligent cooperation in remedial 
effort of all the forces in society. Parents cannot 
accomplish the task alone and unaided; physicians 
cannot do it; farmers and milk dealers cannot do 
it ; it cannot be done by the governing bodies of our 
cities and states, or of the nation itself. * But all these 
forces combined, earnestly and wisely working to- 
gether, can do it; and so bring about one of the 
greatest triumphs of life over death, of health over 
disease, ever accomplished in the whole stretch of 
himian history. 

But before there can be any effective movement 
aiming at the attainment of this noble ideal the nature 
of the evils to be attacked must be known; before 



84 THE COMMON SENSE OF THE MILK QUESTION 

we can do anything we must know what there is to 
be done and how to do it. In making a statement of 
the evils to be attacked, therefore, and describing 
some of them with a certain amount of detail, it is 
not my purpose to pander to a demand for morbid 
sensationalism, nor to provide materials for the ex- 
citation of the public mind in the intervals between 
other "exposures" or sensational campaigns. What 
I want to do is to place before the American public a 
calm and dispassionate statement of certain cwable 
ills as a basis upon which to rest an earnest plea for 
action; to waken, if possible, all those dormant and 
neglected powers and impulses for good which need 
to be called into active cooperation in order that the 
evils may be remedied. And, terrible as some parts 
of that statement may be, sickening as some of the 
details are, it is perhaps necessary to assure the 
reader that they fall far short of truth. For a truth- 
ful statement of conditions, that is, a complete state- 
ment of all the evils, given with photographic accu- 
racy, would be unprintable and unreadable. The 
worst that was said about the conditions existing in 
the meat-packing houses of Chicago during recent 
exposures, does not excel, even if it equals, what 
might truthfully be said of the conditions which attend 
the production and distribution of the milk supply of 
our cities. It is a calm and studiously moderate state- 
ment of fact to say that dirt and disease germs are 



al 



♦ •• • 

• « • • • 



• « « • 

• " • 

• • • 



FILTH AS infants' FOOD 85 

fed to the vast majority of bottle-fed babies in this 
country. 

Dirt and disease are the two great perils of our milk 
supply. Dirt from the cow giving the milk, and dirt 
from the human beings by whom the milk is handled, 
and disease from both bovine and human sources are 
distressingly common in the milk upon which we feed 
our infants. To this cause more than to any other 
must the enormous mortality from intestinal disorders 
among bottle-fed babies be attributed. More than a 
century ago, Smollett, the English novelist, himself a 
physician, described the conditions surrounding the 
milk supply of London in terms of unqualified, scath- 
ing denunciation. Who that has read the descrip- 
tion, in Humphrey ClinkeTj of the food dainties of 
Covent Garden can forget the following passage of 
brutal, eloquent realism? 

'' I need not dwell on the pallid contaminated mush 
which they call strawben-ies, soiled and tossed by 
greasy paws through twenty baskets crusted with 
dirt, and then presented with the worst milk, thick- 
ened with the worst flour, into a bad likeness of cream ; 
but the milk itself should not pass unanalyzed, the 
produce of faded cabbage leaves and sour draff, lowered 
with hot water, frothed with bruised snails, carried 
through the streets in open pails, exposed to foul rins- 
ings discharged from doors and windows, spittle, snot, 
and tobacco-quids, from foot-passengers, overflowings 



86 THE COMMON SENSE OF THE MILK QUESTION 

from mud-carts, spatterings from coach-wheels, dirt 
and trash chucked into it by roguish boys for the 
joke's sake, the spewings of infants, who have slab- 
bered in the tin measure, which is thrown back in 
that condition among the milk, for the benefit of the 
next customer; and, finally, the vermin that drops 
from the rags of the nasty drab that vends this 
precious mixture, imder the respectable denomination 
of milkmaid." 

The "literature of exposure" is not a new develop- 
ment. Nothing ever printed concerning the milk 
supply of this or any other time or place, by the most 
sensational of "yellow" newspapers, can outdo this 
account of London's milk supply by Smollett. How 
much of the description we may accept as a fairly 
just account of actual conditions, and how much 
we must ascribe to Smollett's love of exaggeration, 
we need not trouble to fathom. It is enough for us 
to know that the conditions were bad enough to 
provoke Smollett to attack them with all the 
superb, if vulgar, vehemence of which he was 
capable. 



n 



It will be observed by the careful reader that all the 
filthy conditions which Smollett enumerated in his 
sweeping condemnation were of human origin, due 



FILTH AS mrANTS' FOOD 87 

to carelessness and ignorance, and not to any defects 
in the animals from which the milk was drawn. That 
is a fundamental characteristic of the problem every- 
where. In every case, wherever there is impure milk, 
the failure of human intelligence is responsible. When 
milk is contaminated, man is to blame, and not the 
humble animal from which the milk comes. In its 
original state, as contained in the udder of the cow, 
the milk is pure and sweet and free from all foul and 
dangerous matter, assuming that there is no disease 
of the mammary gland or udder.^ Lister showed as 
far back as 1873 that milk, while in the mammary 
gland of the healthy cow, is absolutely free from bac- 
teria and, being sterile, if it could be drawn from the 
udder and kept in that pure state, would never sour 
nor ferment. As a matter of actual experience, it 
may be said that milk is rarely drawn from the cow 
absolutely sterile and free from bacterial life. Bac- 
teria are so numerous and omnipresent, being foimd 
in the cow's teats, on the hairs of the cow, in the milk 
pails in cracks and rims, as well as in the air, that only 
by methods which seem almost miraculous and im- 
possible in ordinary practice is it possible to produce 
milk that is absolutely sterile in its natural state. It 
is by no means uncommon, however, for milk to be 
produced, in small quantities, and under special con- 
ditions, in which no bacteria can be found by the ordi- 
nary methods of microscopic observation. Dr. Park 



88 THE COMMON SENSE OF THE MILK QUESTION 

has examined samples of such milk from one model 
dairy, as well as many others from the same dairy with 
a bacterial comit of less than 100 per cubic centimeter.* 
Dr. C. M. Seltzer, also, has noted similar apparent 
absolute sterility in two or three samples obtained in 
the state of New York, out of a dozen samples ex- 
amined.* At the National Dairy Show, in 1906, milk 
in which no bacteria could be discovered by the 
ordinary methods of microscopic observation was 
obtained.* 

Now, milk that is sterile will keep good for a very 
long time, provided that it is kept under proper 
hygienic conditions, in vessels that are sterilized, and 
kept at a low temperature, say 40 degrees Fahrenheit. 
These are obviously ideal conditions which are not 
always obtainable in this far from ideal world. At 
the Paris Exposition, in 1900, one of the most signifi- 
cant of all the food exhibits was that of American dairy 
products, particularly of milk and cream. European 
authorities were astounded: they simply could not 
understand how it was possible for milk and cream, 
raw and in the natural state, without preservatives 
of any kind, to be shipped all the way from New York, 
New Jersey, or Illinois to France, to be in good condi- 
tion upon its arrival, and to remain as pure and sweet 
as milk freshly drawn from the cow for long periods 
after arriving at the end of the long transatlantic 
journey.* The French agriculturists were dumb- 



FILTH AS infants' FOOD 89 

founded^ for they could not bring their milk a distance 
of little more than a hundred miles and have it in 
good condition for more than forty-eight hours, under 
the most favorable conditions. In the midsummer 
season they were barely able to keep their milk sweet 
for twenty-four hours after its arrival. Major Alvord, 
who was in charge of the exhibit, found it no easy 
matter to convince the milk experts on the jury that 
the milk was in its natural state, uncooked and un- 
doctored; that nothing but "cleanliness and cold" 
was used to attain such wonderful results." 

When milk decomposes and turns sour in a relatively 
short time, as is most common, the decomposition is 
due to the action of bacterial life in the milk, to the 
presence in it of organisms that are not indigenous 
to it, but as foreign as the dangerous chemicals which 
the unscrupulous dealer sometimes adds to his milk 
to keep it from souring, or the coloring that is some- 
times added to give the milk the appearance of having 
more "body" and being richer than it actually is. 
To put the matter still more plainly, when microscopic 
exammation shows the presence of a large number of 
bacteria in milk, regardless for the moment of the 
nature of such bacteria and their influence upon those 
who consume them in the milk, it is indisputable 
that the milk is foul and dirty and fit for the sewers 
rather than to be used as food.^ 



90 THE COMMON SENSE OF THE MILK QUESTION 

in 

Most persons have at some time in their lives been 
fascinated by the observation of a drop of water 
through a microscope. They have seen many forms 
of animal life which were quite invisible to the naked 
eye, and some forms of plant life of a still lower order 
than the animalcula. These are bacteria, exceedingly 
minute little organisms of plant life, belonging to the 
fungi order. Infinitesimal as they frequently are, 
the bacteriologist in his laboratory finds that they 
differ very materially from each other, that there are 
classes of bacteria as distinct as the classes among 
the higher forms of life. Some are in the form of tiny 
spheres, others like little rods, and still others like 
miniature corkscrews. In short, there are many 
variations in shape and general appearance observ- 
able when bacteria are closely examined through a 
very powerful microscope. 

Not only is it possible to note physical diflferences 
in bacteria, but their characters have, to some extent, 
been Ukewise studied. While it is not yet known just ^ 
what effect many of them have upon our food, or 
when they are taken into our system,' other varieties 
have been more successfully studied. This is espe- 
cially true of the varieties of bacteria which are called 
"pathogenic," that is, disease-producing. The chief 
reason why we know more concerning the pathogenic 



FILTH AS infants' FOOD 91 

varieties than concerning others is that in recent years 
the germ origin of disease has been very extensively 
investigated. Many of the worst diseases are caused 
by these tiny bacteria, or bacilli, which have been very 
closely observed in consequence. 

Take, for example, the dread disease, tuberculosis, 
or consumption. As far back as Hippocrates, who 
lived four hundred years before the Christian Era, 
this disease was known as the most fatal of all diseases.' 
Isocrates, also a Greek physician, who lived about the 
fifth century before Christ, wrote of the disease as 
one which was transmissible through contagion.^® 
Thereafter we find in the history of medicine and 
pathology constant and growing recognition of the 
fact that the disease can be transmitted from one 
person to another in many ways. Then, in 1865, a 
celebrated French physician, Villemin, proved that 
tuberculosis could be produced in animals by inocula- 
tion, not in the lungs merely, but in various parts of 
the body." Thus it was demonstrated that the disease 
is transmissible from man to beast, therefore probably 
also from beast to man. It was also evident that the 
disease must be caused by a specific germ, or bacterium. 
This germ was not actually isolated and identified 
until 1882, when Professor Robert Koch, the eminent 
German phjrsician, annoimced the discovery of the 
Bacillus tvbercidosis, a discovery which has since been 
verified by numberless physicians in all lands.^ 



92 THE COMMON SENSE OF THE MILK QUESTION 

Now, when this germ was thus identified its habits 
could be observed. All over the world, physicians 
and bacteriologists began to devote themselves to the 
study of the tiny micro-organisms which ravage the 
world with so much deadly effect. In 1890 Professor 
Gustav Bang, of Copenhagen, demonstrated the 
presence of the germ in cow's milk, showing that, 
without knowing it, all persons who drink milk are 
liable to swallow the germs of the most deadly of 
human diseases, and that we feed such germs to our 
babies when they are fed on cow's milk." Following 
Bang, came Dr. German Sims Woodhead and Pro- 
fessor Macfadyean, who not only foimd the tubercle 
bacilli in milk, thus confirming Bang's discovery, but 
also that a large number of cattle brought to the pub- 
lic slaughter-houses of Edinburgh were tuberculous, 
as were many of the milch cows, so that it was shown 
that people without knowing it were eating the flesh 
of tuberculous animals and drinking the milk from 
them." It will be understood from this brief sketch 
of the history of the tubercle bacillus how one of the 
pathogenic varieties of bacteria came to be so inti- 
mately and carefully studied. 

We do not need to consider in such detail the va- 
rious stages in the study of the germs by which other 
diseases, notably typhoid, scarlet fever, erysipelas, 
diphtheria, and cholera are produced. Our illustra- 
tion will suffice to explain why it is that men of science 



FILTH AS infants' FOOD 93 

have identified a certain number of varieties of bac- 
teria and classified them as being pathogenic, and why 
they believe many other varieties to be harmless and 
incapable of causing disease, having observed them 
very closely and in large numbers without detecting 
any ill efifects from their presence. It will be under- 
stood, too, why it is that they are uncertain about 
some other varieties and do not yet venture to classify 
them as being either pathogenic or harmless. Some 
of the harmless varieties, it should be observed, are 
only harmless from a pathogenic standpoint. They 
do not cause disease, but they are very troublesome in 
many ways. They cause milk to turn sour, for exam- 
ple, inflicting quite severe losses upon the farmer or 
milk vendor sometimes. We are apt to blame the 
souring of the milk upon the weather, particularly 
if there has been a thimderstorm, rather than the real 
culprit, the little micro-organism in the milk. Man 
has even found some of the bacteria useful and cun- 
ningly availed himself of the fruits of their labor, for 
the various kinds of cheese which we consume are all 
produced from milk, partly by bacterial action. Cul- 
tures of bacteria for cheese-making are now regularly 
sold on the market." 

But how, it may be asked, is it possible for bacteria 
to get into the milk in large numbers? To answer 
that question it will be necessary to describe the pro- 
cess of milking the cow, and the transportation of the 



94 THE COMMON SENSE OF THE MILK QUESTION 

milk to the consumer^ somewhat in detail. Let us, 
then, take an imaginary journey to a typical cow 
stable, watch the milking operation as it is carried on 
there, and then follow the milk along some part at 
least of its journey. It is late afternoon in the early 
siunmer and Farmer Jackson's cows are driven across 
the yard into an open shed to be milked. There is 
dirt upon the hind quarters of some of the cows, 
thick, hard cakes of dirt matted in the hair, while all 
the animals are very dusty. We observe that the 
yard also is very dirty and pervaded by a strong odor 
of manure. In the middle there is a big heap of 
cow dung and straw from the stables, upon which 
fowls are scratching and over which flies are swarming. 
Many more flies are buzzing around the cows as they 
stand in the shed, and tails are going in a constant 
swishing motion, whisking them off. It is not a very 
clean sight, this typical farmyard ! 

Presently, along comes Bill, the farmer's man, pail 
in either hand, to milk the cows. He is a slow-moving 
fellow, is Bill, bronzed by his outdoor life, strong as an 
ox, and just as stolid and indifferent to all the world 
outside as the ox is. As he comes out of the farm 
kitchen, he lingers on the step a moment and rinses 
one of the pails with hot water, which he then pours 
into the other pdl, rinsing it in the same way. He 
throws the water away and comes down the yard and 
stops a moment at the well, not far from which is a 



^ 



FILTH AS infants' FOOD 95 

stagnant pool containing a liberal infusion of manure. 
Very deliberately he draws up a pail of water from the 
well and rinses out his milk pails once more, this time 
to cool them. Now Bill comes to the shed : if you ask 
him whether the pails are clean he will tell you that 
they are. Most assuredly they are, for did you not 
see him wash the pails, first with hot water and then 
with cold? How could you expect poor Bill, who 
doesn't know a bacterium from an elephant, to know 
that his pails are not really clean ; that in the angles and 
spaces where they are seamed — for you note that 
the pails are very badly made — there are thousands, 
probably millions, of bacteria? 

Bill's clothes are dirty, it is true, but you cannot 
doubt that Bill himself is an imusually clean sort of a 
person. Did you not see that when he rinsed his pails 
with the cold water he was careful also to rinse his 
hands in the water before throwing it out? True, 
he wiped his hands upon the sides of the legs of his 
trousers, just as he later wiped his nose with the back 
of his hand, but, like chewing tobacco, w)iich Bill 
also does while he works, these are just habits which 
concern Bill and Bill only. When he has properly 
and comfortably seated himself upon a milking stool 
which is filthy, saturated with dirt and teeming with 
bacteria. Bill moistens his hands with spittle and be- 
gins milking. In the case of the first cow, you observe 
that he lets the first "draw" go to waste upon the 



96 THE COMMON SENSE OF THE MILK QUESTION 

ground, but later, when he comes to the other cows, 
he does not pursue the same course. It would be 
interesting to know just why he did it in the case of the 
first cow; perhaps only because that is the custom, 
for it is not to be supposed that Bill knows that there 
are hundreds and thousands of bacteria secreted in 
the teats since the last milking, and that these should 
be "milked out" before any of the milk should be 
allowed to enter the pail. Bill is not a bacteriologist, 
as we have already observed. 

Bill does not know that the cows ought to have been 
very thoroughly brushed; that the udders and teats 
ought to have been carefully washed, as well as the 
tails, in some good antiseptic wash; that his own 
hands ought to have been similarly treated and the 
dirt removed from imder the finger nails; that the 
pails ought to have been differently made in the first 
place and that the very best of pails need to be per- 
fectly sterilized before the milking, preferably by 
steam power. He does not know that as the cows 
whisk the flies away from their own bodies with their 
tails they are filling the milk with bacteria and dirt 
which drop from their own hairs and his clothes; that 
the flies are busy carrying bacteria from the manure 
heap into the milk ; that the shed is not a fit place for 
milking cows in. Bill has been milking cows for up- 
wards of thirty years and he never heard that there 
was any necessity for putting on a nice clean suit to 



FILTH AS infants' FOOD 97 

mak cows in, or to clean his finger nails and wash his 
hands in water containmg boracic acid or some other 
disinfectant. Should you tell him these things, he 
would only think you were tiying to be funny at his 
expense — unless he suspected that you were crazy. 

If a fly goes into the milk, or if the cow should 
whisk a lump of dung into it. Bill is quick to dip his 
fingers in and take it out, if he observes it. And if 
he does not observe it, everjrthing will be all right, 
for, you know, the milk will be beautifully strained 
through the nickel-plated strainer which Farmer 
Jackson bought at the Dairy Show for the purpose, 
and of which he is extremely proud. If you are cu- 
rious enough later on, you can see for yourself the 
round ball of dung and hair which will be cleaned out 
of the milk. Yes, these strainers are wonderful in- 
ventions; they 'Hake out all the dirt and make the 
milk perfectly clean" ! 

Because Bill doesn't know anjrthing about bacteria 
and their manner of increasing, every step he takes is 
an aid to their work and their rapid multiplication. 
His first pail filled, he places it aside, uncovered, 
and begins to fill another. Nobody ever told him that 
there were such things as bacteria in the air, little 
plants similar in many ways to the mushrooms that 
spring up in a night, and that these little plants are 
often very deadly to human beings. And, since no- 
body ever told him, he is not to blame for not knowing 



98 THE COBfMON SENSE OF THE MILK QUESTION 

that when the milk comes from the cow, at a tempera- 
ture of 100 degrees Fahrenheit, it is admirably suited 
to the incubation of these bacteria, that in such a tem- 
perature they will multiply very rapidly, one bacterium 
producing as many as three thousand others in less 
than six hours.^* If he knew these things, and knew 
that to reduce the temperature of the milk would hold 
the bacteria in check, that at a very low temperature 
they increase very slowly, or not at all," he would 
have done his best and taken the full pail out of the 
dust and, in the absence of ice, placed it to stand in a 
tub of cold water from the well. But he does not 
know. And the ignorance of such as Bill is a very big 
factor in the milk problem. 

IV 

If any reader thinks this is an exaggerated descrip- 
tion of an ordinary farmyard, or of milking as it is 
commonly carried on, I have only to say that it is a 
very literal account of an actual case which I know 
to be far from exceptional. An interesting experiment 
may be tried by any reader. Let him go out into the 
country and closely observe conditions for himself, 
checking the various points in the above sketch accord- 
ing to his observations. He will find many farms 
to which my fanciful sketch will not apply, but he will 
find many more of which it is a moderate and re- 
strained description. I know that the inspectors 



FILTH AS infants' FOOD 99 

connected with the health boards of all our large cities 
will bear me out when I say that such conditions as I 
have described are by no means unusual : they are the 
rule, almost, rather than the exception. 

Here, for example, is a terse description of a dairy, 
published by the Bureau of Animal Industry of the 
United States Department of Agriculture : — 

"The herd consists of forty native cows, fed com 
meal and brewers' grains. The stable is poor and 
very dirty, and the cows are filthy and packed closely 
together. A pile of manure as high as the window 
surrounds the stable and the yard is correspondingly 
faulty. Two hundred and forty quarts of milk are 
produced daily. It is carried to the house, nearly a 
quarter of a mile away, and cooled in a tank of ice- 
water, being at 50® to 60® when sold. The well is 
near the house and less than one hundred feet from a 
privy vault. This water supplies the stock and all 
other purposes." " 

Conditions such as these are not peculiar to this 
country, but are more or less common throughout 
the civilized world, wherever cows are kept. Dr. 
Leslie Mackenzie only states the truth very forcibly 
when he says : — 

"To watch the milking of cows is to watch a process 
of unscientific inoculation of a pure, or almost pure, 
medium with unknown quantities of unspecified germs. 
Everywhere throughout the whole process of milking 



100 THE COMMON SENSE OF THE MILK QUESTION 

the perishing, superbly nutrient liquid receives its 
repeated sowings of germinal and non-germinal dirt 
. . . and this in good dairies. What must it be 
where the cows are never groomed and the udders are 
never washed, where the byres are never even approxi- 
mately cleaned, where ventilators are never opened, 
where the pigs are a few feet away, where cobwebs are 
ancient and heavy, where hands are only by accident 
washed, where heads are only occasionally cleaned, 
where spittings are not infrequent, where the milker 
may be a chance comer from some filthy place, where, 
in a word, the various dirts of the civilized human are 
at every hand reenf orced by the inevitable dirts of the 
domesticated cow?" *• 

The British Medical Journal employed a com- 
missioner to investigate the conditions under which 
the milk supply of a number of the large British 
cities is produced, and the following is quoted from 
the report of one dairy: — 

"The operation of milking was in full swing, three 
dirty-looking bo3rs being hidden away behind their 
respective cows. ... I looked about for pails of 
water, soap, towels, or ans^thing which might give 
the lie to the filthy state of the cows' udders and 
the milkers' hands, but in vain. The clothes which 
the boys wore were equally dirty, and the stalls . . . 
were several inches deep in manure and foul-smelling 
straw. . . . The hind quarters of the cows were 






FILTH AS infants' FOOD 101 

coated with filth. ... I was horrified to see the 
filthy state of the milk as it flowed out of his pail. 
It was discolored with grit, hairs, and manure. ' Look 
at that,' I said, pointing to a specially large bit of 
manure. I regretted my zeal, for Tom dipped his 
whole hand into the pail, and, as he brought it out 
said, ' Oh, that ain't nothing; it's only off the cow M"® 
The English Local Government Board issued, in 
1904, a report on the sanitary conditions of cow sheds 
and dairies in Ireland, which enumerated very similar 
evils to those described above.** It may be taken 
for granted that the great majority of milk producers, 
dealers, and retailers know so little as to amount to 
practically nothing at all of the nature of milk and 
the extremely grave perils which result from its 
careless and improper handling. And yet, as Dr. 
F. Lawson Dodd has pointed out," such knowledge 
is essential to the public safety. In some of the 
states the plumber has to pass an examination and 
obtain a certificate before he is allowed to pursue 
his callmg, it being realized that ignorance on the 
part of a plumber may endanger many lives. Doubt- 
less this is a wise provision, a safeguard few persons 
of intelligence would desire to remove; but what of 
the dangers to which we are exposed when the 
dair3anan and the milk vendor are ignorant? That 
these are far greater and more numerous is certain, 
but I know of no state which requires that a milk 



102 THE CX)MMON SENSE OF THE MILK QUESTION 

producer or a milk vendor must be similarly 
qualified. 

I know that I have visited hundreds of farms 
where just such unsanitary conditions and careless- 
ness in the handling of milk as described above were 
observed, and if further testimony upon the point 
should be necessary, I need only refer the reader to 
the various reports upon the milk supply of American 
cities issued by the Department of Agriculture, 
which, despite official reticence and conservatism, 
tell the same story of inadequate equipment and 
gross ignorance and inefficiency. I shall not forget 
one instance which came under my observation, 
because the circumstances were such as to illustrate 
in a very vivid manner the extent of popular igno- 
rance of hygiene in relation to the production of milk. 
Visiting a friend who had acquired a coimtry place 
within seventy-five miles of New York City, I found 
him exulting in the fact that now, owning his own 
cows, he was sure of a supply of pure milk for his 
baby. He was so proud of his new stable and the 
three cows he had purchased that I was somewhat 
anxious to inspect them. I discovered that the 
tuberculin test had not been applied to the cows to 
ascertain whether they were free from tuberculosis. 
Later, at my suggestion, this was done and two of 
the three cows were found to be affected. The 
new stable of which my friend was so proud was 



FILTH AS INFANTS^ FOOD 103 

about as unfit a place for cows to be kept in as hu- 
man perversity could have devised. It was low, ill- 
ventilated, and poorly lighted ; the food storage was 
at one end, quite exposed to all the odors of the 
place; there was no drainage except a very shallow 
wooden gutter, and the floor being of wood such 
a thing as flushing was next to impossible. That 
the floor must be absorbent and soon saturated 
with filth that could not be cleansed was altogether 
too plainly evident. I watched the milking of the 
cows by a very dirty laborer who had only a few 
minutes before been wheeling a barrow, and observed 
that neither did he wash his own hands nor the cows' 
udders. Yet my friend had moved into the country, 
built a stable, and bought cows at considerable ex- 
pense, just to be certain that his baby would be 
getting pure milk and spared the perils which city 
babies are exposed to, and was all the time getting 
milk that was infected as well as dirty. 

Later, when we discussed the matter, and the 
owner of the cows realized for the first time how 
many shortcomings there were in his stable, and how 
many more in the hired man who had charge of the 
cows, he undertook to have the changes made in the 
stable which were necessary to make it as hygienic 
as those belonging to some of the best model dairies. 
But on the labor side he hardly dared hope for im- 
provement. "I can get the stable made over," 



104 THE COMMON SENSE OF THE MILK QUESTION 

he said, "but I cannot get Joe made over." Joe 
was the hired man, reputed to be the best milker 
and stableman for many miles around, and other 
farmers in the neighborhood would be very glad to 
get him if they could, at quite high wages. As for 
getting a laborer who could milk cows and who would 
take all the precautions necessary to insure the purity 
of the milk, understanding why the precautions were 
taken, such good fortime could not be hoped for. 
Why, it would take a college graduate to be a milk- 
man! And truly, the difficulty of getting efficient 
and intelligent labor at any price which the farmer 
can ever hope to pay is an important aspect of the 
problem. 



But let us return to the milk which we saw our 
friend Bill draw from Farmer Jackson's cows. 
Two miles from the farm is the little Erie railway 
station, upon the platform of which the cans of milk 
stand, without anything to keep them cool, waiting 
for the milk train. Then, when the "milk special" 
comes along, they are loaded into close, stuffy re- 
frigerators, very inadequately supplied with ice, and 
taken to the city. And during all this time the 
bacteria multiply as only bacteria can. 

For, as we have already observed, there is no fear 
of race suicide among the bacteria that grow in milk. 



' • • * 



FILTH AS infants' FOOD 105 

They multiply in a manner which makes the Mal- 
thusian fonnula of geometrical increase look ridicu- 
lously like failure to maintain the population. We 
are all more or less familiar with those interesting 
speculations which at one time played such an im- 
portant part in the discussion of the so-called Mal- 
thusian law of population, concerning the number of 
descendants of a pair of pigeons or a pair of guinea 
pigs which would exist in the course of a given number 
of years if nothing interfered to check the increase ; 
but I venture to say that the progeny of the most 
prolific animals ever used as terrifying Maltiuisia^ 
arguments would not, in fifty years, equal the num- 
ber of bacteria produced in milk by a single bacterium 
in as many hours. If there was nothing to interfere^ 
a single bacterium would produce, in twenty-four 
hours, seventeen million others 1^ While this prolific 
rate of increase is probably never actually maintained, 
the normal increase of bacterial population in milk 
having a high temperature is so astounding that it 
defies the mathematical intelligence of an ordinary 
mind. A cubic centimeter, or about fifteen drops, 
as much as a quarter of a teaspoonful, will often 
contain many millions of bacteria. 

It will be understood from this that when the milk 
in which we are interested at this moment reaches 
New York its bacterial content is very high. If we 
could take a sample as soon as it reaches the city, 



106 THE COMMON SENSE OF THE MILK QUESTION 

we should probably find that it contained at least 
five million bacteria for each cubic centimeter, or 
quarter-teaspoonf ul I When the milk was drawn 
from the cow it was contaminated in the process, and 
further contamination has occurred at every step 
since. What was, in the cow's udder, a sterile and 
pure liquid, through human carelessness and ignorance 
is now a polluted, dangerous mixture. But the milk 
is not yet at the end of its journey. Before it reaches 
the child who is to be nourished by it, there are other 
fertile sources of contamination. In the little grocery 
store in the tenement district, and then later, in the 
foulnamelling mockery of a refrigerator in the baby's 
home, millions of new germs will be added to the 
milk by addition from without and by natural in- 
crease ; by unrestricted immigration and by the nor- 
mal excess of births over deaths, so to speak. 

In Mrs. Goldstein's little grocery store, on Allen 
Street, you can buy almost anything, from a pail 
of coal to five cents' worth of cooked meat; from 
a package of pins to a pair of shoes for the baby. 
The long, dark, stuffy little store is, in its way, as 
many-sided as the big department store on Broadway. 
Natiu^y, Mrs. Goldstein sells milk, for only the 
aristocratic and "stuck up" folks can afford to buy 
bottle milk and have it left at the door. Poor folks 
must buy their milk at the store. It costs two cents 
a quart less, and you don't have to buy a quart if 



FILTH AB infants' FOOD 107 

a pint will do. And Mrs. Goldstein is so obliging 
that, if you only have two cents to spare, you can 
buy two cents' worth. The milk is kept in a big can 
in the comer of the store, near to where the coal-box 
and the barrel of pickles are. Sometimes the cover 
is left lying for hours on the little shelf above, when 
Mrs. Goldstein is so busy that she forgets to put it 
right back. The dipper is usually hanging alongside 
of the can, but occasionally one of the Goldstein 
children takes it away so that Mrs. Goldstein has to 
go all over the place to look for it before you can get 
your milk. Of course, millions upon millions of 
bacteria can get into milk in a store like this — 
not to mention some bigger things I — but then, 
Mrs. Goldstein does not know. She never heard about 
bacteria in milk or anywhere else. When the milk 
is placed in Mrs. Jones's pitcher and handed to her 
by Mrs. Goldstein, neither woman kinows that there 
are more than a hundred and thirty-three millions 
of germs to every fifteen drops,* many times more 
than would be found in an equal quantity of sewage 
water. Yet such is the case. 

Now, Mrs. Jones takes the milk out into the street, 
where the air is full of germs, in an open pitcher, 
thus making it possible for more bacteria to enter it. 
Through the long hallway, up three flights of stairs, 

* An actual occurrence. See p. 116. 



108 THE COBIMON SENSE OF THE MILK QUESTION 

she takes it, more bacteria entering at every step. 
Then, being a careful woman, she places it in the 
ice-box alongside the tiny bit of ice, which does not 
suffice to cool the temperature in the box perceptibly 
below that of the kitchen itself. Poor Mrs. Jones I 
she has not got a thermometer, and she would not 
know its use if she had one. It would not help her 
very much, therefore, if you told her that the tem- 
perature in her ice-box is very comfortable for most 
of the bacteria, being about seventy-five degrees 
Fahrenheit.* After a little while the baby cries, 
and you are horrified to see the filthy mixture given 
to the little one in a bottle. Now you can understand 
why Mrs. Jones lost her other two babies and why 
this one looks ill. You can understand, too, her 
fatalistic resignation to the fact that ''Some folks 
alius loses their babies in summer, 'cause they'm 
built that way." 

VI 

All this is, of course, very terrible and exceedingly 
painful. But it is by no means the worst that is 

* There was an outbreak of dlarrhoeal disease in one of the 
New York hospitals, which caused the authorities much worry. 
The most careful investigation of the milk supply failed to 
show anything wrong, and it was not until, in desperation and 
as a last attempt to explain the epidemic, one of the physicians 
placed a thermometer in the refrigerator that the cause was 
discovered. Although apparently plentifully supplied with ice, 
the " refrigerator " had a temperature of over seventy degrees I 



FILTH AS infants' FOOD 109 

to be said of the milk which goes into thousands, 
aye millions, of American homes to be used as a food 
for infants, that it is reeking with filth, some of it of 
an unmentionable character. Much more terrible 
is the fact that much of it is charged with the germs 
of the worst diseases that scourge mankind. To 
go back to our study of the conditions on Farmer 
Jackson's farm for a moment, it was impossible to 
tell from their appearance whether the cows were 
all healthy or not. What if some of them had 
tuberculous udders and milk ducts, so that the milk 
inevitably contained the tubercle bacilli in large 
numbers? Or what if the cows had been wading 
through water polluted by typhoid germs, or if there 
were typhoid germs in the water Bill used to rinse 
the milk pails, and some of these remained in the 
pails to infect the milk and to multiply therein? 
These things happen sometimes, you know. And 
what if Bill's clothing or his person should have in- 
fected the milk with the germs of diphtheria, or scarlet 
fever, brought by accident from the bedside where 
his little daughter tossed and moaned all the night 
before 7 You cannot blame Bill for nursing his little 
girl, nor yet for being ignorant of the fact that he 
might carry the germs of the disease in his clothing, 
to drop later into the milk pail and from thence to 
spread the disease like a plague in some far-ofif city. 
This is a very black picture, well calculated to 



110 THE COMMON SENSE OF THE MILK QUESTION 

frighten any but the most callous. And because it 
is my purpose not to create sensational effect, not 
to draw lurid pictures, but to make a calm appeal 
for constructive, remedial work, I would gladly omit 
it if I could. But it belongs to the description of 
conditions as they are, and I have no right to suppress 
it. If the transmission of diseases like tuberculosis, 
typhoid, scarlet fever, diphtheria, and others by such 
means as I have indicated were rare, so that the 
risk could be regarded as practically non-existent ; 
if the cases of infection by such means were so few 
that they could be ignored, — I would most gladly 
have omitted this painful catalogue of terrors. But, 
as we shall presently see, such is not by any means 
the case. It will be necessary for us to give careful 
attention to a body of well-authenticated evidence 
which proves that the dangers of milk-borne diseases 
are very real and too numerous to be lightly passed 
over. 

But before we proceed to the consideration of the 
part which milk plays in the dissemination of disease, 
at the risk of some repetition, I desire to warn the 
reader against being frightened into a state of un- 
necessary panic by the enormous bacterial content 
of milk indicated by some of the figures used in this 
discussion. To most lay readers the word " bacteria " 
immediately suggests disease, and to permit that 
impression to remain would give a wholly false 



FILTH AS infants' F00» 111 

value to the statistics cited. It is not necessary to 
exaggerate the dangers of impure and infected milk. 

It must be very evident that only a small propor- 
tion of the bacteria in milk can be regarded as actually 
dangerous, otherwise there would be enough dqath 
in a quart of milk to depopulate the nation. When 
it is said that some of the milk sold in our cities and 
used for infants' food contains more bacteria than 
the worst sewage water, serious as such a statement 
is, it must not be interpreted to mean that sewage 
water would be better or less dangerous to an infant, 
that there is more harm in the milk than in the 
sewage water.^ Such an interpretation of the state- 
ment is wholly false and misleading. It is not true 
that sewage would be less injurious than the milk 
that contains such astounding numbers of bacteria, 
for there are important differences in the kinds of 
bacteria which have to be taken into account. But 
the figures do warrant the statement that the milk 
contains a large percentage of matter which ought 
to have gone into the sewers instead of into the milk 
pail. Such milk is as dirty as sewage water, but not 
necessarily as dangerous. 

Now, while it is true that there are many useful 
bacteria upon which we depend for making cheese 
and butter, it is a matter of very grave doubt whether 
these bacteria are useful in milk when it is used as 
milk for food. It is fairly certain, moreover, that 



112 THE COMMON 8ENSE OF THE MILE QUESTION 

bacteria which are in themselves quite harmless to 
man, according to all observations yet made, do, 
when they are present in milk in very large numbers, 
produce toxic changes which to some extent adversely 
V affect the intestines of young children and cause 
Wiarrhceal diseases.^ Recognition of this fact has 
led to various attempts to draw the danger line in 
bacterial content, to fix upon a maximum number 
per cubic centimeter of which it can be said: "Be- 
yond this number there is danger and death. Milk 
with a larger number of bacteria than this standard 
sets must not be given to an infant." If it is true 
that serious gastro-intestinal troubles are caused 
by an excessive percentage of bacteria, even of the 
kinds which, in small numbers, are harmless, wliat 
standard ought to be adopted? 

Upon this point. Professor von Behring has pro- 
claimed that milk which contains more than one 
thousand bacteria per cubic centimeter is never fit 
for infant consumption and should on no account be 
given to a baby.* Most authorities agree, however, 
that, while Professor von Behring's test represents 
a standard of purity that is very attractive as an 
ideal, it is not likely to be attained on a large scale 
for many years to come — some pessimistically 
say that it will never be realized. It is perfectly 
true that milk with an even smaller bacterial content 
has been obtained in many places, in Rochester, 



s s 
a J 



fh/th as infants' food 113 

N.Y., among others.*^ The milk, already referred 
to, which was exhibited at the Paris Exposition, 
easily came within the limit set by von Behring. It 
is certainly possible to attain to the standard set by 
the great physician occasionally and experimentally, 
and personally I am strongly of the opinion that with 
a proper organization of the milk industry upon 
scientific lines it could be done as a general thing. 
It is one thing, however, to get these results experi- 
mentally, under special conditions, and quite another 
thing to get them as a matter of common, normal 
practice. And, in the present state of the milk 
industry, with milk production largely in the hands 
of men ignorant of the most elementary principles 
of hygienic science, it is not possible to maintain 
ansrthing like that standard. 

In connection with the Certified Milk Movement, 
of which Dr. Chapin and Dr. Coit may be regarded as 
the principal exponents, it has been agreed to adopt, 
for the present, standards varying from ten thousand 
to thirty thousand bacteria per cubic centimeter, 
and while that is very far above the limit set by 
Professor von Behring, it is generally acknowledged 
that either of the two standards named would revolu- 
tionize the milk supply of the world if it could be lived 
up to. Compare these standards with those that have 
been adopted by the few American cities in which 
there has been intelligence enough to bring about 



114 THE COMMON SENSE OF THE MILK QUESTION 

the adoption of bacteriological standards as well as 
standards regulating the percentages of fat, and then 
compare them with actual conditions in the world's 
greatest cities. Such a comparison cannot fail to be 
of interest and value. 

Boston is exceedingly proud of the fact that it was 
a pioneer in this important reform. It has a bacte- 
riological standard and reproaches New York for not 
having followed its example. That it is to the shame 
of New York that it has no bacteriological test, that 
it has not advanced beyond the stage where it is ill^al 
to water milk or to adulterate^ it with chemicals, but 
not illegal to pollute it with dirt or to infect it with 
disease germs, so that to sell milk with too little fat 
is a crime, while it is not a crime to sell pus and dirt, 
I cordially agree. But I am not at all sure that 
Boston's standard of ''purity" is not more shameful 
still. For Boston is in the position of having, in the 
name of cleanliness, indorsed a standard which rep- 
resents filth and danger. Boston is satisfied with 
milk that contains not more than 500,000 bacteria 
per cubic centimeter I In other words, Boston accepts 
as sufficiently dean and pure milk containing five 
hundred times the amount of germ life which von Behring 
believes to be the limit of safety for infants' food, and 
mere than fifteen times that accepted by the leaders of 
the Certified Milk Movement as a compromise, a step 
tovoard better conditions I 



FILTH AS infants' FOOD 115 

Cambridge and Brockton, both Massachusetts 
cities^ have adopted Boston's standard of 500,000 
bacteria per cubic centimeter. But Milwaukee does 
much better, with a standard of one-half that of 
Boston, 250,000 per cubic centimeter. Now, I know 
perfectly the arguments which will be adduced in 
defence of these standards; that it will be shown 
statistically and otherwise that good has resulted 
from them, that there has at least been some improve- 
ment. But, giving these claims the fullest possible 
consideration, and allowing them all due weight, 
I cannot resist the conclusion that the harm done by 
the adoption of bacteriological standards which do 
not represent purity but filth, not safety but danger, 
is far greater than the good ; that when a city adopts 
such absmxUy high bacteriological standards immense 
harm is done by creating an impression in the minds 
of the citizens that the goal of purity has been reached, 
that the milk supply is safe and pure. For my part, 
I would prefer no standard at all rather than a decep- 
tive one such as Boston and the other cities named 
have adopted. I speak from experience when I say 
that the average Bostonian is a much more difiicult 
person to interest in the important subject of the 
piuity of the milk supply than the New Yorker, 
simply because he has been lulled into a false sense 
of security by that ''clean milk" standard of 500,000 
germs per cubic centimeter* 



116 THE COMMON SENSE OF THE MILK QUESTION 

The British National Health Society, which has 
among its membership many of the leading physicians 
of Great Britain, at its meeting held at University 
College, London, in December, 1906, under the chair- 
manship of Sir Frederick Treves, had presented to 
it the report of some investigations made into the 
state of the milk supply in some of the chief cities of 
the world. The report showed that the best quality 
London milk, used by those who can afford the best 
that is obtainable in the general market, averaged 
3,000,000 bacteria per cubic centimeter; that in 
Munich, milk which was tested at the farm soon after 
milking and found to contain an average of 200,000 
bacteria per cubic centimeter had, when it reached 
the retail stores, about 6,000,000 ; that in Amsterdam 
the tests showed 2,500,000 soon after milking and 
as many as 10,000,000 when tested, ten hours later, 
in the retail stores. In Warsaw, milk which at the 
farms showed only from 10,000 to 20,000 bacteria per 
cubic centimeter had 4,000,000 per cubic centimeter 
when purchased in the shops. In New York City, 
milk was purchased at one place, a grocery store on 
Allen Street, on thirteen successive days, and showed 
the awful average of 133,233,000 — one hundred 
and thirty-three rniUvms, two hundred and thirty-three 
thousand — bacteria per cubic centimeter 1 *• And 
all these filthy mixtures were fed to infants, not- 
withstanding the opinion of one of the foremost 



FILTH AS infants' FOOD 117 

authorities in the world that 1000 bacteria per cubic 
centimeter marks the limit of safety in considering 
cow's milk as a food for infants ! 

vn 

It 13, of course, true that milk containing very few 
bacteria may be more dangerous than milk containing 
an extraordinarily large number. Among the millions 
it is quite possible that there will not be a single 
pathogenic germ. On the other hand, among the 
bacteria in the milk which contains very few there 
may be no harmless ones, practically all being active 
pathogenic germs. It is quite conceivable, however 
improbable it may be, that a sample of milk might 
contain only a single bacterium, and that prove to be 
one of the most virulent and deadly kind, such as a 
tubercle bacillus ; while, on the other hand, not a single 
bacterimn known to be harmful might be found in a 
sample of milk with a bacterial coimt running into 
the tens of millions. These are all extremely im- 
probable happenings and certainly do not describe 
any conditions ever recorded in actual experience. 

It is also true that many of the worst pathogenic 
germs may be taken into the digestive tract without 
infecting it in any way, just as we breathe millions 
of them sometimes in badly infected air and remain 
uninfected. Impaired digestion, lowered vitality, 
slight intestinal disturbances, predisposing weakness. 



118 THE COimON SENSE OF THE MILK QUESTION 

these and many other factors greatly increase the 
risks of mfection. It is, however, quite evident that 
no matter how much we may be disposed to discount 
the risk of infection, there is an element of danger 
which it is prudent and wise to avoid if possible. 
And it is stiU important that a minimum of bacteria 
be insisted upon, first, because large numbers of 
bacteria in milk always indicate filth and carelessness 
in handling, and, second, because it is reasonable to 
suppose that under such conditions the dangers of 
infection by disease germs will, as a rule, be greatly 
increased. For if a farmer or dairyman is so careless 
and ignorant as to let his milk become so contami- 
nated, he is not likely to be very particular about the 
health of his cows or of those who attend them.'* 

The ancient Hebrews, though they knew nothing of 
our modern science of bacteriology, were thoroughly 
alive to the dangers of impure milk. The elaborate 
Rabbinical regulations concerning the manner of its 
keeping and use indicate that they had a wider 
know4e of imlk hygiene than most modem nations 
possess. Permission to drink milk was by the Rabbis 
regarded as an exception (hiddtish) to the general 
rule which forbade the eating of anjrthing which came 
from the living animal. This was, doubtless, due 
to a keen recognition of the dietetic value of milk. 
It was forbidden to use milk which came from an 
animal suffering from any visible malady, a wise 



FILTH AS INFANTB' FOOD 119 

regulation which anticipated by thousands of years 
the findings of modem science. The extreme im- 
portance attached to cleanliness may be judged 
from the strict regulation which forbade the Jew to 
drink milk bought from a non-Jew, unless the milking 
process had been carried on, or at least watched, by 
a Jew. Milk was one of the seven articles of food 
named as being especially liable to receive impurity 
by exposure and contamination; and it was one of the 
three beverages which, if left over night uncovered, 
should not be used, ''because it is possible that a 
serpent may have left its venom therein." All these 
Rabbinical regulations concerning the use of milk"^ 
are quite in harmony with the requirements of modem 
science, a fact which is in itself a wonderful tribute 
to Rabbinical wisdom and to the Jewish people. 



CHAPTER V 



MILK-BOBNE DISEASES 



It is a commonplace of pathological science that 
milk often plays an important part in the dissemina- 
tion of many of the diseases which assail the human 
race. Not only are many of the diarrhceal diseases 
which are responsible for such an appalling number 
of infant deaths each year due, in many instances, 
to impurities in the milk which set up serious dis- 
turbances in the digestive tract, but there is also 
specific infection from beast to man as well as from 
man to man through the medium of the milk of the 
beast. Epidemics of scarlet fever, diphtheria, measles, 
and typhoid have been traced directly to the milk 
supply, and it is now very generally believed that 
tuberculosis is spread by the same means. 

It is sixty-five years now since Robert M. Hartley, 
one of the founders of the New York Association for 
Improving the Condition of the Poor, wrote The 
Cow and the Dairy, dealing with the relation of impure 
and infected milk to the excessive infantile death-rate, 
a book which became famous as the text-book of 

120 



MILK-BORNE DISEASES 121 

that long campaign against ''swill milk" which cul- 
minated in the enactment of laws against adultera- 
tion by the state legislature, in 1864.^ That was 
our first great public agitation for pure milk. Hartley 
found that the babies of the tenements died at an 
astonishing rate, and his soul rebelled against what 
he termed the "frightful waste of human material." 
He traced the connection between the death-rate of 
infants and the conditions in which cows were kept 
throughout the state. He found that the cows were 
housed in unsanitary stables and fed upon distillery 
refuse. He wondered what sort of milk could be 
obtained from cows so housed and fed. He found in 
one place " in low flat pens over 500 milch cows closely 
huddled together, inhuma/nly condemned to subsist 
on slops smoking hot from the stills," and wondered 
what sort of milk cmia be produced from "this un- 
natural, disgustipg^ood." He found that the dis- 
tillers " would not risk the lives of their own families 
by using the produce of their own dairies," but that 
twenty-five thousand babies in the tenements were 
fed upon it, nevertheless.* 

Hartley at once began an investigation. The death- 
rate of babies was high, frightfully so. It had kept 
on increasing for a number of years, though foreign 
cities reported a decrease in the infantile death-rate. 
Was it a mere coincidence that the period of increasing 
infantile mortality was coincident with the increase 



122 THE COMMON SENSE OF THE MILK QUESTION 

of the practice of feeding milch cows upon distil- 
lery refuse ? Hartley, with true scientific spirit, had 
the milk of the cows fed on distillery grains ana- 
lyzed and found that it was lacking in food value, and 
then, for twenty-three long years, he waged war upon 
the "swill milk,'' succeeding finally, m 1864. The 
fight so well begun by Hartley was not maintained, 
with the result that to-day, more than forty years after 
Hartley's great victory, we are still grappling with the 
same problem. And our great need is for Hartleys, 
— for men with his courage, his intelligence, his 
patience, and his enthusiasm. 

u 

Of all the diseases which aflSict humanity, tubercu- 
losis, suggestively named "The Great White Plague," 
is the most fatal. It has been conservatively es- 
timated that each year there are 1,095,000 deaths 
from this disease throughout the world, representing 
3000 each day, two for every minute.* In the 
United States there are, according to Mr. Frederic 
L. Ho£fman, actuary of the Prudential Life Insurance 
Company, 150,000 deaths annually, at an average 
age of thirty-five years. Each of these deaths repre- 
sents a loss of thirty-two years, so that the loss of life 
measured in time units annually amounts to the start- 
ling total of 4,800,000 years. In terms of earning 
capacity the loss cannot be set down as less than 



MILK-BORNfi DId£Ad£d 123 

S240,000,000 annually, from this one disease in the 
United States alone/ Tuberculosis kills as many 
people, young and old, each year as diphtheria, croup, 
whooping-<;ough, scarlatina, measles, and typhoid 
fever taken together.' It is, therefore, a social prob- 
lem of great magnitude. 

During recent years, it is very gratifying to observe, 
this problem has been receiving an increasing amount 
of earnest attention. Whereas only a few years ago 
it was neglected, practically no social effort being 
made to combat its ravages, every civilized country 
has now its organized movement devoting itself 
to the study of the disease, the spread of information 
concerning it, and the instruction of people how to 
avoid it by adopting proper precautions, and how 
the afflicted may be cured, as well as to the support and 
increasing efficiency of curative institutions. Par- 
ticular attention has been given, both in this country 
and in Europe, to the study of the means by which 
the tubercle bacilli are distributed; and some of the 
principal means, such as reckless spitting, have been 
brought within the provisions of the penal codes of 
the various nations. 

It has long been known that tuberculosis can be 
acquired by ingestion as well as by inhalation and 
inoculation, but the part played by cow's milk in the 
spread of the disease has only recently begun to 
receive serious attention. That many persons, old 



124 THE COMMON SENSE OF THE MILK QUESTION 

and young, have been infected with tubercle bacilli 
through the milk of cows suffering from the disease is 
one of the best-attested facts in modem pathology, 
but the extent to which children are the victims of this 
peril is only now being recognized. Jacobi, a con- 
servative authority, has long held that feeding chil- 
dren upon milk from tuberculous cows is undoubtedly 
one of the causes of infection to which close attention 
should be given. Professor von Behring • goes very 
much further, and says that " the milk fed to infants 
is the cAie/* cause of infection." * 

It may be that the conservatives are right m re- 
garding this opinion of the famous Marburg teacher 
as extreme. It is not an unusual thing for a great 
teacher who finds the bow bent too much one way 
to bend it too much the other in his zeal to set it 
straight, — to adopt the phrase in which Malthus made 
his notable confession long ago. But, while it may 
be true that Professor von Behring makes this mis- 
take when he declares that the milk fed to infants is 
the "chief" cause of tuberculosis, most of the world's 
leading pathologists agree that it is (me of the sources 
of infection, and an important one ; and that, as such, 
it ought to be given careful attention. The British 
Royal Commission appointed to inquire into "The 

* Dr. E. F. Brush, one of our best authorities, regards aU 
tuberculosis as being of bovine origin. See Human and Bovine 
Tuberculosis, by £. F. Brush, M.D., p. 12. 



inLK-BOBNE DISEASES 125 

Effect of Food derived from Tuberculous Animals 
upon Human Health/' consisting of the most eminent 
physicians and physiologists in England, together 
with one of the foremost veterinarians, after careful 
examination of many famous experts, and some of 
the most extensive and thorough experiments ever 
attempted, unanimously reported, in 1895, that they 
believed ''that an appreciable part of the tubercu- 
losis that aflfects man is obtained through his food," 
and that ^^No davbt the largest part of the tvbercvlosis 
which man obtains through his food is by means of milk 
containing tvbercuUms matter.^^ ^ 

Another British Royal Commission, appointed to 
inquire into the subject of '' Controlling the Danger to 
Man through the Use as Food of the Meat and Drink 
of Tuberculous AnimaLs," reported, in 1898, its unan- 
imous agreement with the findings of the former 
commission, quoted above/ And the Royal Com- 
nussion of 1901, appointed to inquire into the ''Re- 
lations of Human and Animal Tuberculosis," dem- 
onstrated conclusively that bovine tuberculosis can 
be transmitted to human beings, that there is no 
essential difference in the tuberculosis which aflSicts 
human beings and that which afflicts bovine and other 
animals.* 

Dr. Jacobi, discussing the dangers of infection from 
milk drawn from tuberculous animals,** quotes the 
case recorded by Dr. Olivier, of Paris, in which thir- 



126 THE COBfMON SENSE OF THE BfILK QUESTION 

teen schoolgirls, belonging to a Paris boarding school, 
were infected. Six of the girls died. It was found 
that in several cases the bowels wei^e first attacked, 
and the outbreak was traced to the milk supply, 
which came from a cow with a badly affected udder. 
He quotes also a case recorded by Johne, a great veter- 
inary anatomist, of the death from tuberculosis of a 
little girl two and a half years old. She had been fed 
upon the milk of a cow which her father, a farmer, had 
specially selected on account of the animal's splendid 
appearance. Later, it was found that the cow was 
tubercular, but not until it was too late, the child 
having died." 

m 

Notwithstanding the mass of such testimony as the 
foregoing, which might be almost indefinitely extended 
were it necessary, there are still many persons whose 
opinions command respectful attention who do not 
believe that there is any danger of tubercular infection 
through meat or milk which comes from tuberculous 
animals. Their theory is that the disease as it is 
found in cattle is very different from the disease as it 
occurs in human beings, and that it is impossible for 
the tubercle bacilli which infects a cow to likewise 
infect a human being, and vice versa. This view has 
been strenuously championed by no less an authority 
than the great Koch himself, to whom the world is 



HILK-BORNE DISEASES 127 

lastingly indebted for the discovery of the bacillus 
tubercuUms. To the splendid fame of Koch the 
theory doubtless owes much of the vogue it has en- 
joyed for a brief period, untU completely discredited 
by numerous conclusive researches and experiments. 

Prior to 1896 the transmissibility of the disease 
from man to the lower animals and from the lower 
animals to man was generally accepted as a fact. The 
Wise Preacher of the Bible had observed many centu- 
ries ago that, in their pain at least, man and beast are 
closely related: ''For that which befalleth sons of 
men befalleth beasts ; even one thing befalleth them : 
As the one dieth so dieth the other; yea, they have all 
one breath, so that a man hath no preeminence above 
a beast." * Villemin, the French physician who, in 
1865; inoculated various animals with tuberculous 
matter from hiunan beings, was led by his exper- 
iments to echo, in the name of science, what the 
Preacher had proclaimed many generations before 
and to say : '' Man shares with cattle the sad privilege 
of perpetuating tuberculosis." " 

In 1896 Dr. Theobald Smith, of the Bureau of 
Animal Industry at Washington, called attention to 
the fact that the hiunan and bovine varieties of the 
tubercle bacillus have certain very marked character* 
istics by which they are easily differentiated.^ The 
discovery attracted a good deal of attention at the 

* Ecdefllastes. 



128 THE COBfMON SENSE OF THE MILK QUESTION 

time and led many investigators^ in Europe and this 
country; to make experiments and investigations along 
the lines indicated by Dr. Smith's work. Few are 
the workers in this field of research who have not 
given special attention to the diflFerences which char- 
acterize the two varieties of tuberculosis, and the 
result of their combined efforts may be briefly summed 
up as follows : There are certain phjrsical differences 
to be noted; the human bacillus being long and slender 
and the bovine bacillus thicker and shorter. The 
bovine bacillus also stains more evenly in the labora- 
tory. The principal difference, however, is not physi- 
cal but pathological. While there are some animals 
which seem to be equally susceptible to the attacks 
of both kind., -nlbly ^ipigs and s*e, - 
other animals are almost invariably more susceptible 
to the bovine variety than to the human. This 
is especially true of monkeys. There seems to be no 
case in which an animal has been found more sus- 
ceptible to the human tubercle bacillus than to the 
bovine, and it is concluded, therefore, that the bovine 
bacillus is much more virulent than the human. This 
is the opinion of our foremost American investigators, 
as well as of the British Royal Commission appointed 
to investigate the subject, imder the leadership of Sir 
Michael Foster, professor of physiology in Cam- 
bridge University." 
The discovery made by Dr. Theobald Smith had 



MILK-BORNE DISEASES 129 

an important and far-reaching influence in many 
directions, but in nothing quite so noteworthy as 
the effect produced upon Professor Koch. Follow- 
ing Smith, Koch developed the comparative study 
of the different types of tubercle bacilli, and in 1901, 
at the British Congress on Tuberculosis, he made 
an announcement which created a great sensation 
in medical circles. With sweeping and startling 
emphasis, he declared the tuberculosis of man and 
the tuberculosis of animals to be different diseases; 
that it is impossible to transmit human tubercu- 
losis to cattle, and, that, consequently, man need 
not fear infection from cattle, either by inhalation or 
ingestion through eating tubercular meat or drinking 
tubercular milk." It was in consequence of the 
sensation produced oy this memorable utterance 
that the Royal Commission on the subject was ap- 
pointed soon after the Congress closed. 

IV ^ 

The sensation which the sweeping, optimistic 
declaration of Professor Koch created will be under- 
stood best by those who are familiar with certain 
earlier experiments in the inoculation of animals of 
different species, made by the same great teacher 
and pointing to a radically different conclusion. 
Chaveau, in 1868, had taken cattle from the Jura 
Mountains, where tuberculosis among cattle seems 



130 THE COMMON SENSE OF THE MILK QUESTION 

to have been unknown, and inoculated them with 
tuberculous material from man, successfully trans- 
mitting the disease." Bollinger followed, in 1879, 
with similar experiments,^^ and since that time there 
have been many workers along the same lines. In 
short, there is probably no fact in the whole range 
of experimental pathology better attested than the 
transmissibility of human tuberculosis to cattle. 
Since the publication of Koch's startling theory 
there have been numerous instances of this trans- 
mission by inoculation, as well as by ingestion. 
Cows and many other animals have been fed upon 
food' containing human tuberculous matter and 
thereby infected with the disease. Dr. Mazyack P. 
Ravenel, the well-known bacteriologist of the Penn- 
sylvania Live Stock Sanitary Board," Dr. Ger- 
man Sims Woodhead and Professor Macfadyean in 
England," and the Commission of the Imperial 
Sanitary Office of Germany** have all done what 
Koch declared to be impossible ; and there are many 
others whose names might be given were it necessary 
to pile up testimony of this kind. 

Not only have these men succeeded in infecting 
cattle with human tuberculosis by laboratory methods, 
but the same thing has been done accidentally many 
times. My friend. Dr. S. A. Knopf, whose work 
in combating tuberculosis has placed him in the 
very front rank of living authorities upon the sub- 



Xn. Ekfect of Raw 


TtiBBRCuLous Milk upc 


» A GtriMKA Pio 






Mr«U!<one«flh.«Li«riiiieuu 


conducted by Dr. 


w™d- 


btxlbr 


b. It»jd l-omn. 


>(un on lliK Effects .if Food d 






Mllkouuktn 


from •Doir witb dlHiacd udd« 




urp«« 


bjPrefB 


«or Rung, and uhkI lo IpoculnM ■ perf«Oy bttilby Rulnu f*g. A 


Inlrm- 


pcrltone. 


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of tb« 


R<iIn»plRli.M<l.y.. Bn 




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brrcle. 


Tl»gl.n 


d> btblnd tha m 


nubrluin ournl .nd iIodk the 


left >ld> or lb« • 




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STealed tubercle 


buUU. 


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MILK-BORNE DISEASES 131 

jecty tells of a charitable institution for constimp^ 
tives where the rules as to expectoration were not 
strict, except as applied to the house itself. When 
the patients went across the meadows for their daily 
walks they were at liberty to expectorate anywhere 
they chose. Now the farmer to whom the meadows 
belonged had bought five healthy cows which had 
been tested with tuberculin. After a little while 
it occurred to him to have them retested, when, 
to his loss, he found that all five were infected. He 
had the animals slaughtered, the stable cleaned and 
disinfected, and forbade the patients of the sana- 
torium to walk upon his property, with the result 
that the disease did not reappear.'^ A very similar 
experience is related by Dr. Thomas Darlington, 
Health Commissioner of New York City, who was 
connected, as visiting physician, with a hospital 
where the consumptive patients were permitted to 
play quoits in a pasture near the hospital. They 
did not use sputum cups at the time, and the result 
was the infection of nine out of a herd of ten cows.'' 
In the same way, fowls have been infected through 
eating food offals from consimiptive patients, and 
their flesh has, in turn, infected healthy persons 
with the disease." 

According to all known laws, if it is possible for 
cattle and other animals to acquire the disease from 
man, it must be possible for man to acquire the 



132 THE COMMON SENSE OF THE MILK QUESTION 

disease from animals. But, obviously, it is not 
practicable to try experiments upon human beings 
in the same way as upon dumb animals. There are, 
however, many cases on record where human be- 
ings have been accidentally inoculated with bovine 
tuberculosis, with fatal result. Ravenel testifies** 
to having personally observed four such cases, two 
of them occurring among assistants in his labora- 
tory. He also quotes a case recorded by Troje, 
which, it appears, was reported to Koch, who agreed 
that there was no flaw in the evidence. It relates 
that a young butcher, of good health, with no heredi- 
tary taint so far as could be ascertained, wounded 
his forearm while working on a tuberculous cow's 
carcass and contracted tuberculosis in consequence.^ 
That human beings can acquire tuberculosis by in- 
oculation from bovine sources seems to be a com- 
pletely established fact. 

Finally, let us consider the possibilities of infec- 
tion by ingestion, by eating meat or drinking milk 
from tuberculous animals. We know very positively 
that healthy cows fed upon food which contains tuber- 
culous matter of human origin become infected with 
the disease ; ^ and it is reasonable to suppose, in the 
absence of conclusive proof to the contrary, that 
human beings can be similarly infected by the inges- 
tion of bovine tuberculous matter. Such would be 
the only warrantable inference, even if we had not 



ihlk-borne diseases 133 

positive cases on record. But here, again, the posi- 
tive evidence is not lacking. The case of Gosse, 
the famous physician of Geneva, is well known. 
His little daughter was infected by drinking the 
milk of a cow upon his own farm and died. With 
rare courage, the physician himself conducted a 
post-mortem examination and conclusively demon- 
strated that the cause of infection was the milk upon 
which she had been fed, and which proved to have 
come from a cow with tuberculosis of the udder.'^ 
Dr. George M. Kober tabulates 86 cases of tubercu- 
losis, showing the transmission of bovine tubercu- 
losis to human beings through milk.'* Added to 
these specific cases and those cited elsewhere in the 
present chapter, is the fact that the bovine tubercle 
bacillus has been found in an active state in the 
intestines of yoimg infants, so that the chain of 
evidence may be regarded as complete in every 
particular. 

These facts, and others of a like nature, are well 
known to physicians. But to laymen they are, 
naturally, not so well known; and since I am ap- 
pealing to the lay, rather than the medical, public, 
I could not avoid this long and, I fear, somewhat 
tedious discussion. It remains only to be added, 
by way of emphasis upon the important inference 
these facts inevitably suggest, that the conclusive 
evidence of the frequent presence of tubercle bacilli 



134 THE COMMON BENSE OF THE MILK QUESTION 

in cow's milk, and the fact that they are sometimes 
fomid in the digestive tract of yoimg infants, point 
to a direct connection between the use of cow's milk 
as food and the spread of consumption. 

V 

The seriousness of this danger is apparent, once 
the foregoing conclusions are reached. Few persons, 
I suppose, outside of a very limited circle of spe- 
cialists, have any idea of the prevalence of tuber- 
culosis among cattle. Some of the statistics upon 
this pomt are terrible in their significance and menace. 
It is not necessary for us to make any elaborate 
siu^vey of these statistics ; a few figures, taken almost 
at random, will probably be quite sufiicient for our 
present pmpose. In the state of New Jersey, during 
the last ten years, particular attention has been 
given to this subject, though it is admitted upon all 
hands, even by the farmers themselves, that the 
inspection is by no means perfect as yet. The tuber- 
culin test is used, except where the condition of the 
animal is such as to make that test unnecessary, 
and fronj statistics issued by the New Jersey Tuber- 
culosis Commission it appears that something like 
16 per cent of the cattle examined have been 
found to be suflfering from tuberculosis. The fol- 
lowing table tells its own story, and needs no 
comment : — 



MILK-BORNE DISEASES 



135 



Tablb V 



Tbax 


NuicBBm OF Oattls 


NVlfBSB Gov- 


Amouvt paid AB OoXPSHtA- 




SzAimisD 


miiiniD 


TIOK 


1895 


760 


140 


9 4,227.46 


1896 


1^19 


159- 


4,149.74 


1897 


865 


134 


3,299.99 


1898 


1,483 


345 


5.093.20 


1899 


1,415 


232 


5,363.25 


1900 


2,338 


339 


7,385.87 


1901 


2,512 


342 


7,260.76 


1902 


2,500 


370 


8,123.62 


1903 


2,450 


473 


11,435.35 


1904 


2,099 


394 


8,663.25 


1905 


2,783 


467 


10,518.00 


Total 


20,309 


3,295 


975,525.48 



Statistics relating to the prevalence of tubercu- 
losis in cattle vary considerably^ according to the 
system of inspection adopted in various countries 
and states and the degree of thoroughness with which 
the work is done, as well as to climatic conditions 
and other causes. The tuberculin test is by no 
means always efficiently employed. Professor Doane '* 
foimd in Southern cities that the test was obviously 
very poorly applied. He found that in Norfolk, 
Va., for instance, less than one per cent of the number 
of cows examined were reported to be infected, an 
incredibly low percentage under any circumstances, 
and all the more incredible when it is remembered 
that most of the Norfolk cows had been imported 



136 THE COMMON SENSE OF THE MILK QUESTION 

from Maryland, where the tuberculin test uniformly 
reveals a high percentage of infected cattle. It is 
not suggested, therefore, that the figures here given 
have any value as showing the comparative distri- 
bution of the disease, but merely as establishing the 
fact that a very considerable proportion of cattle 
are tuberculous. Pearson and Ravenel estimated 
that, in 1900, 3 per cent of all the cattle in Penn- 
sylvania were tuberculous.'® They added that "The 
disease causes more losses than all the other infectious 
diseases of farm animals that exist in Pennsylvania 
at this time." " There is good reason for believing 
that the disease is much more prevalent than would 
be indicated by the estimate of these two careful 
observers.* 

In Saxony, no less than 30 per cent of all cattle 
are believed to be infected by this disease." In 
Copenhagen, Professor Bang has shown the disease 
to be very prevalent, making it a matter of vast 
importance in a country so largely dependent upon 
dairy farming. Some years ago the percentage of 
tuberculous animals in Denmark was estimated at 

* Professor Bang pointed out that in large herds of fifty head 
of cattle and above as many as 60 per cent were tuberculous. 
He goes so far as to say that, in dealing with large herds in 
which tuberculosis has existed for many years, it is a waste of 
time to test with tuberculin the full-grown animals, as they are 
practically all affected. Quoted in The Suppression of Tti6ercu- 
losis, by Professor E. von Behring, p. 5. 



IfflLK-BOBNE DISEASES 137 

about 17 per cent,** or little more than the New 
Jersey figures.* That percentage has been very 
materially lowered, however, as a result of the strenu- 
ous efforts made by the Danish government to stamp 
out the disease. In Leipzig, Germany, out of 22,918 
cattle over one year old slaughtered in 1895, the 
enormous number of 7,619, or more than 33 per cent, 
were found to be tuberculous." 

These figures are by no means exhaustive, but 
they sufi&ciently indicate the prevalence of bovine 
tuberculosis to be so great as to warrant the serious 
attention which we have given to the subject. The 
prevalence of the disease among dairy cattle is no 
doubt due mainly to the conditions imder which 
the animals are housed during a great part of the 
year. Tuberculosis is essentially a house disease, 
and the housing of cattle has been of the most unsani- 
tary kind, extremely favorable to the propagation 
of the disease. Man, then, has brought tuberculosis 
to the cow by his careless and ignorant management ; 
and if the cow, in turn, spreads the disease among 
human beings, it is nothing more nor less than a 

* During the ^ear 1906-1907 the New York State Agricul- 
tural Department tested 2753 cattle with the tuberculin test, 
with the result that 23.81 per cent responded to the test and 
were killed. According to Dr. Verenus A. Moore, of the New 
York State Veterinary College at Cornell University, no less 
than 72 per cent of all the herds in the State are infected and 
30 per cent of the milch cows. See Nevo York Times, 
Dec. 19, 1907. 



138 THE COMMON SENSE OF THE MILK QUESTION 

terrible retribution. It is a well-known fact tiiat 
the disease is comparatively rare among cattle kept 
in the open air, as, for example, in Jersey and Fin- 
land." The cattle in both these places are almost 
wholly exempt from the disease. That this exemp- 
tion is not due to any inbred inmiunity is seen from 
the fact that they are just as susceptible as any 
others when brought within the area of infection, 
and placed under the conditions which prevail where 
the disease is common."* As Oliver Wendell Holmes 
says: — 

" God lent his creatures light and air, 
And waters open to the skies ; 
Man locks him in a stifling lair 
And wonders why his brother dies.'' 

It is probable, also, that a certain number of cases 
are due to the infection of calves by ingestion, through 
being fed upon tuberculous milk. At least, the 
Royal Commission of 1895 came to that conclusion 
and recommended that all milk should be boiled 
before being given to calves."^ Finally, it has been 
suggested by a writer in the New York Times *^ that 
one important factor in the production of tubercu- 
losis among dairy cattle is the breeding of young 
and immature animals. It is common to permit 
early breeding, the average age at first breeding 
being from two to two and a half years, whereas it 
ought not to be permitted before the cow is fully 



MILK-BORNE DISEASES 139 

three years old. Several breeders, dairymen, and 
veterinarians to whom I have submitted this point 
have unanimously concurred in the opinion that 
early breeding does, in some degree, contribute to 
the spread of tuberculosis among dairy cattle. 

VI 

It is not believed that there b any very great 
danger of infection through drinking the milk of 
cows afficted with pulmonary tuberculosis. Pru- 
dence and common sense alike suggest the avoidance 
of milk coming from animals known to be afflicted 
with tuberculosis in any form, but the element of 
danger is not very great unless the udders and milk 
ducts are affected.*' In many instances experiments 
have been tried with a view of ascertaining whether 
the milk of cows suffering from pulmonary tuber- 
culosis is dangerous, when fed to other healthy ani- 
mals. So far as I am aware, none of these experi- 
ments have shown the danger to be very great, though 
isolated cases of infection have been reported by 
various observers, in which cows suffering from pul- 
monary tuberculosis only, and free from any disease 
of the udders, have given milk that has infected 
other healthy animals. 

But the danger from the milk of cows affected 
with tuberculosis of the udder is very real and grave, 
as the experiments of Martin and numerous other 



140 THE COliMON SENSE OF THE MILK QUESTION 

investigators prove. Reporting to the Royal Com- 
mission on the Effect of Food derived from Tuber- 
culous Animals on Human Health, Dr. Martin writes : 
"The milk of cows with tuberculosis of the udder 
possesses a virulence which can only be described 
as extraordinary;"** and Dr. Woodhead, confirm- 
ing this opinion, shows that butter made from such 
milk is equally virulent and dangerous — a fact of 
vital significance when it is remembered that milk 
that is condemned as unfit for use, as milk, is fre- 
quently made into butter.** Where there is infec- 
tion of the udder the result b uniformly bad in the 
butter and cheese no less than in the milk from which 
it is made. 

When the staid and conservative British Medical 
Journal published an article bearing the sensational 
caption, " Pus as a Beverage," ** there were a great 
many unfavorable comments. Many persons who had 
not read the article felt that the title was too brutal 
and alarming. The article referred to a very serious 
outbreak of sore throat, often accompanied by ab- 
scesses in the neck, at Woking, England. The 
Medical (Mcer of Health traced the epidemic to 
the milk of a number of cows that were suffering 
from inflammation of the udder. Pus from the 
diseased udders entered the milk in considerable 
quantity, and there was no difficulty in accounting 
for the sore throats and abscesses of the imhappy 



MILK-BORNE DISEASES 141 

victims. " Pus as a Beverage " is not a very attrac- 
tive title, but of the terrible truthfulness of the 
phrase there can be no doubt. 

Wherever there are tuberculous cows such con- 
ditions must prevail to a greater or lesser degree. 
From a score of American cities I could quote in- 
stances of conditions quite as bad as those set forth 
in the Woking report. I content myself with a 
single illustration of the use of pus as a beverage, 
and, it is safe to infer, as a food for little children: — 

''In the Department of Health in Buffalo . . . 
we have a bacteriological examination of three hun- 
dred samples of milk every month. On the 19th 
of October (1906) the bacteriological examination 
showed streptococci and pus in a sample of milk 
sent in from the country. I sent a man out there 
the next day and he reported that one of the cows 
had a dilation of the udder and that there was 
pus in the milk. ... On November 13, another 
sample very much the same was reported to me as 
containing streptococci and pus. I sent an inspector 
in whom I had the greatest confidence to the farm 
and he came back with this report: That he found 
one cow with one of the teats giving a milk which 
was almost transparent, like water; the other three 
a milk which to the ocular inspection and to taste 
looked and seemed perfect. He, however, brought 
tfaM milk in to be examined. The cow^s udder was 



142 THE COMMON SENSE OF THE MILK QUESTION 

perfectly healthy (sic); there was no sore nor any 
ulcer of any kind. The cow was in good flesh, but 
yet there was a large amount of pus and streptococci 
in this milk. Thai had never been discovered in the 
city of Buffalo before this year, becatise we never had 
a bacteriological examination of milkf and we have 
been drinking (hat hind of milk ever since we have had 
milk coming into the city. If that cow vxis tubercular, 
if the lacteal ducts contained tuberculosis, people drink- 
ing that milk were very likely to be infected wUh tuber- 
culosisJ^ *■ 

This quotation from an address which I was privi- 
leged to hear Health Commissioner Greene, of Buffalo, 
make at a Milk Conference in the Academy of Medi- 
cine, New York, in November, 1906, is a very mild 
description of a condition which is widespread and 
common, almost beyond belief. Not long ago, I 
heard of a wealthy man in New Jersey who kept 
several high-grade Holsteins, of which he was very 
proud. One of the animals, a particularly fat and 
fine-looking cow, was specially selected to provide 
the milk for his infant daughter. But when the 
tuberculin test was applied, it was found that each 
of the cows was affected. The owner could not 
believe the report and was only with difficulty per- 
suaded to have his favorite cow slaughtered and a 
post-mortem examination made. Not only were 
there abundant evidences of generalized tubercu- 



laLK-BORNE DISEASES 143 

losiSy but, to his horror and amazement, more than 
a pint of pus was taken from the cow's udder. These 
are typical of numerous cases which might be cited 
to prove the prevalence of these dangerous condi- 
tions. 

From the foregoing risumi of the most important 
parts of the mass of evidence which has been gath- 
ered, the reader will be able to understand the una- 
nimity with which investigators have come to regard 
milk as one of the most important factors in the 
spread of tuberculosis. An imposing list of medi- 
cal and other scientific commissions and congresses 
which have given official expression to this opinion 
might be compiled, but I enumerate only a few of 
the most important. They are: The Royal Com- 
mission on the Effect of Food derived from Tuber- 
culous Animals, 1895; The Royal C!ommission on 
Administrative Procedures for controlling Danger 
to Man through the Use as Food of the Meat and 
Milk of Tuberculous Animals, 1898; The Royal 
Conmiission on the Relations of Human and Animal 
Tuberculosis, 1906; the International Medical C!on- 
gress, Paris, 1907; and the Intematioiud Milk Con- 
gress, Brussels, 1907. 

vn 

So much for the spread of tuberculosis by the 
milk of diseased cows. We must not forget, however, 



144 THE COMMON SENSE OF THE MILK QUESTION 

that even the milk of perfectly healthy cows may 
spread the disease when it is contaminated and 
infected by human bacilli. Persons attending the 
COWS, milking them, or handling the milk at any 
stage, may infect it, and so spread the deadly germs. 
This is important in view of the fact that very many 
tuberculous persons take up farming and dairy work 
in the hope that they will be benefited by the open- 
air work and the simple, wholesome life which we 
associate with fanning. The consiuner should be 
protected against the danger of infection by human 
tubercle bacilli conveyed in the milk, as well as against 
infection by bovine bacilli. 

Nor is tuberculosis the only disease that is dissemi- 
nated by means of infected milk. There have been 
many epidemics of diphtheria, for example, traced to 
an infected milk supply.** Whether, as contended 
by some English authorities, diphtheria is directly 
transmissible from cattle to human beings, or whether 
in all cases where the epidemics have been traced to 
the milk supply the latter was first infected with 
material from some human sufferer, subsequent to 
the milking, is a disputed point upon which we need 
not dwell. All authorities are agreed as to the fact 
of the spread of the disease through the medium of 
infected milk. The first positive discovery of this 
fact seems to have occurred in 1878, when there was 
a severe outbreak of the disease at St. John's Wood, 



MILK-BORNB DISEASES 145 

England, which was traced beyond the possibility of 
reasonable doubt to the milk supply. Over two hun- 
dred and fifty persons were attacked, of which num- 
ber thirty-eight died.** Since that time numerous 
outbreaks of the disease have been traced to infected 
milk. While, as stated, the existence of bovine diph- 
theria is still a moot question, there can be no doubt 
as to the spread of the germs of the disease through 
the medium of infected milk. And it has certainly 
been shown by epidemics of sore throat, such as that 
at Woking already referred to, and many others, that 
a very slight disease in the cow may produce a very 
severe epidemic of sore throat among the users of 
its milk. 

Of typhoid epidemics, so many of the worst have 
been traced to infected milk that the moment an out- 
break of the disease occurs the milk supply is at once 
suspected. To-day, as these lines are being written,* 
the afternoon paper contains an account of an out- 
break of the disease in a neighboring village. The 
newspaper report contains the very significant state- 
ment by the local health officer that steps are being 
taken to see "that all milk cans in which milk is 
brought ... are cleaned thoroughly and that no 
water which might contain typhoid germs is put into 
them." It is a lamentable fact that it always takes 
an outbreak of disease, more or less serious, to cause 

• November 15, 1907. 



146 THE COMMON SENSE OF THE MILK QUESTION 

such elementary rules of hygiene to be adopted. Why 
should it take an epidemic of tsrphoid to make the 
authorities of a city or town see that "milk cans 
are cleaned thoroughly and that no water which 
might contain tj^hoid germs is put into them''? 

Cows do not suffer from typhoid; therefore the 
tjrphoid baciUi, which in milk tnililtiply with alarming 
rapidity, must enter it from an outside source, after 
it is drawn from the cow. They may enter the milk 
through the use of infected water to dilute the milk 
or to cleanse the utensils ; from some person suffering 
from the disease, — an attendant, for example, whose 
infection has not been discovered, or one who has 
returned to work too soon, — or from some one who 
has come in contact with a typhoid patient and borne 
some of the germs away upon his clothing or person, 
which afterwards accidentally get into the milk. 
These are the principal means of infection. An illus- 
tration of the ease with which typhoid may be spread 
through infected milk was seen in the epidemic of 
the disease in Allentown, Penn., during February, 
1907. It was shown that a case of typhoid occur- 
ring in the home of a milk dealer was concealed, with 
the result that cases later occurred in twenty-five 
houses at which that dealer delivered milk.^ * 

* No attempt has been made to burden these pages with 
cases of typhoid and other diseases which have been definitely 
traced to the milk supply. The reader who is interested in this 



lOLK-BOBNE DISEASES 147 

Toward the end of January, 1907, a great epidemic 
of scarlet fever and diphtheria swept over the city of 
Chicago like a mediseval plague. Altogether, in a 
month, more than ten thousand cases of infectious 
diseases were reported, including several hundred cases 
of diphtheria and more than four thousand cases of 
scarlet fever. There were over three himdred deaths. 
It was proved that the outbreak was due to infected 
milk, which came from two small places in Wisconsin 
where there were cases of diphtheria and scarlet fever, 
namely. Basset Station and Genoa Junction.'^ The 
former is a dairy-farming district where for months 
scarlet fever had been prevalent, yet milk was regu- 
larly shipped, without warning of any kind, to Evans- 
ton and Chicago, with terrible results. The milk, it 
is interesting to notice, was shipped by way of Genoa 
Junction, where an outbreak of the disease took place, 
thirty-two cases being reported out of a total popula- 
tion of something like seven hundred. From these 
two places the epidemic which assailed Chicago spread 
with awful virulence. 

In connection with this Chicago epidemic it is 
worth noticing that, in the bottling house of one of 



phase of the subject wfll find much information in the Report 
en the Origin and Prevalence of Typhoid Fever in the District of 
Columbia (Hygienic Laboratory, Bulletin No. 35), and the 
Beport of a conference on Sanitary MUk Production — Bureau 
of Animal Industry, Circular 114. See Appendix 1. 



148 THE COMMON SENSE OF THE BfiLK QUESTION 

the largest dairy companies in the world, a man was 
found working, notwithstanding that he was visibly 
suffering from scarlet fever, the characteristic ''rash" 
being evident. Milk was also being received by the 
same company from two farms in which there were 
cases of scarlet fever. Inter alia, in view of the fact 
that this great company has been successful largely 
on account of the reputation for cleanliness and care 
established by its founder more than half a century 
ago, and so many are thereby lulled into an altogether 
imwarranted feeling of safety, it may be well to men- 
tion the fact that, on April 2, 1907, or only two 
months after the Chicago epidemic, which ought to 
have been a solemn warning to the company, milk 
was left at my own house by the agents of this great 
concern in which there were thousands of visible 
creatures, many of them as large as millet seeds, and 
not unlike them in appearance. My wife was pre- 
paring to pasteurize the milk for our baby, when, in 
the course of gently rocking the bottle to properly 
mix the contents, she observed the unusual con- 
ditions. 

Without opening the bottle, we called for the agent 
of the company and showed him the milk. At first 
he tried to persuade us that what we saw were "little 
bits of slag, blown in the glass," whereupon I opened 
the bottle in his presence and, with a probe, moved 
many of the creatures, taking one of them out. 



MILK-BOBNE DISEASES 149 

Later, over the telephone, the local management in- 
formed US that nothing to equal it had ever been seen 
in the office, and that "somebody would get into 
trouble for putting the milk into a foul bottle." But 
that, it is needless to add, would be of little benefit 
to our baby or ourselves if we had given that poison- 
ous, filthy liquid to the little one.* 

The responsibility of impure milk for a very large 
proportion of infantile diarrhoeal diseases has already 
been touched upon in a previous chapter. In bring- 
ing to a close this catalogue of the perils attendant 
upon the use of cow's milk, and closing this indict- 
ment, of which I have barely sketched the evidence, 
I desire only to add that epidemics and individual 
cases of infection properly traced to the milk supply 
constitute only a small part of the awful sum of dis- 
ease for which impure and infected milk must be held 
responsible. There are, it can scarcely be doubted, 
many fatalities which are never recorded against im- 
pure and infected milk. Coimtless baby graves might 
be marked with the epitaph, "Slain by Foul Milk," 
if we only knew the truth in every case — and had 

* I have since seen three samples of bottled milk, supplied 
by three dififerent companies, exactly like the one described 
above. One of these was shown me by Inspector Burton in 
the office of the Health Department, New York City. Mr. Bur- 
ton discovered that the creatures were maggots which breed in 
decayed food. Their presence in the bottles points to unsani- 
tary conditions in the cow bams, to carelessness in cleaning the 
bottles, and to bottling the milk near where the feed is kept. 



150 THE COMMON SENSE OF THE MILK QUESTION 

the courage to express it. How many of the cases 
of fatalities from eating "poisoned candy" of which 
one reads are in reality due to poisonous milk, will 
never be known.* And then, too, as Dr. F. Lawson 
Dodd observes, "the evil is by no means all recorded 
in the deaths J ^ ^® Among those who barely manage 
to survive the milk-borne diseases of infancy and 
childhood, there are probably many physically in- 
competent to meet the issues of the great life struggle, 
— men and women of enfeebled health and dwarfed 
phsrsique, whose miserable state is due to the same 
subtle and unseen dangers which lurk in the infant's 
bottle and the milk can. 

I' As an instance of this I note the case of the alleged poison- 
ing by means of candy of the children of three families in 
Brooklyn, N.Y., in July, 1906, which was due, not to poisonous 
candy, but to poisonous and infected milk, according to the in* 
vestigation made by Dr. Lederle. See Tk6 Evening Mail, New 
York, August, 1906. 



CHAPTER VI 

A BBIEF SUMBIABY OF THE PROBLEM 



In the preceding chapters we have touched upon 
many phases of a very complex and difficult problem, 
or, to be accurate, of a number of related problems 
which in the textiu^ of life are bound together by 
intricately woven threads of vital phenomena. Be- 
fore we enter upon the quest for a solution and discuss 
remedial measm^es, it may be well to make a brief 
summary of the evidence, to recapitulate the most 
important and significant facts, so that we may de- 
cide wisely upon the action that needs to be taken 
for the cure of the ills which confront us. It is only 
in this spirit that we can hope to succeed, conscious 
that 

*' Tb thus the spirit of a single mind 
Hakes that of multitudes take one direction." 

Our concern is with the milk supply as it affects 
the public health generally, but more particularly as 
it affects the health and lives of the babies who are 
wholly, or almost wholly, dependent upon it for food. 

161 



152 THE COMMON SENSE OF THE MILK QUESTION 

Whether the milk which we ourselves drink is clean 
or unclean; whether we take into our sj^ems only 
nourishment when we drink a glass of milk, or the 
germs of virulent diseases which may at any time 
find in some weak spot the soil fitted for their para- 
sitic existence, so that they blossom in deadly ill- 
nesses; whether we drink only a pure, life-giving 
beverage or a polluted mess, reeking with the filth of 
sewers, — are questions of very great importance. We 
wake to a recognition of their terrible significance only 
when disease and death ravage our cities, when great 
epidemics of tjrphoid or some other milk-borne dis- 
ease menace our lives. 

But epidemics come and go, and with their going 
we are prone to forget that the enemy is ambushed 
and always ready to make a new attack. We forget 
that it comes silently and swiftly and that ''eternal 
vigilance is the price of liberty" in this as in every 
other human struggle. During the epidemic which 
raged' in Chicago less than a year ago, I talked with 
a citizen of that city who was in a perfect rage over 
the peril which had come to every door in the city 
as a result of the neglect of the milk supply by the 
authorities. A few months later, I met the same man 
again and spoke of the importance of milk inspection. 
But he was not interested as before. Then he was 
literally afire with indignation and protest, but on 
the second meeting he was apathetic and cool. The 



1 



A BRIEF 8XTMMART OF THE PROBLEM 153 

scourge had passed away, and he was apparently con- 
tent to let things take care of themselves^ trusting to 
Providence and the Health Board. 

Among the babies there is always an appalling 
death-rate compared with which the worst epidemics 
that assail adults are slight. There is a plague that 
is universally endemic and which preys upon the 
cradle. It claims more victims than any of our epi- 
demics, more than the great medisBval plagues of 
which the old chronicles tell in terms we read to-day, 
after the lapse of centuries, with blanched cheeks and 
throbbing hearts. Sometimes, it Is true, there are 
epidemics of infantile diseases, such as that of infant 
paral3^is lately so alarmingly prevalent, by which we 
are terrified as we see the little funeral processions 
in the streets or read the statistics of mortality in the 
papers. But we ought not to forget that the epi- 
demic diseases which rage during more or less brief 
periods separated by long intervals are not nearly so 
terrible as those diseases that are always present, 
which year after year continue to sweep the babies 
from their cradles into graves. 

Why is it that we inure ourselves to great plagues 
and almost ignore them, while we are alarmed beyond 
measure by outbreaks of disease that are relatively 
unimportant 1 IS ten babies in any one of our cities 
should die in a week from some unusual disease, — if, 
for example, there were ten cases of anthrax poison- 



154 THE OOHMON SENSE OF THE MILK QUESTION 

ing among infants fed upon cow's milk, — there would 
be general consternation and alarm. But should a 
hundred babies die of diarrhoeal diseases in the same 
city the fact would pass almost unnoticed, even though 
the hundred deaths could be as surely ascribed to 
cow's milk as the ten cases of anthrax. Mr. Nathan 
Straus says truly: "When a few cases of cholera find 
their way into one of our ports, there is a great out- 
burst of public excitement, and money is lavishly 
spent to ward off 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 nearly seventy-five years. 

It is a well-known fact that in this country, not- 
withstanding all our boasted progress, one-third of 
all the babies bom die before they reach the age of 
five years. Suppose, then, that one could mass all 
the infants in the country on a given date in one vast 
throng, and then go through the throng selecting 
the victims destined to die within the five-year period. 
Taking the first and second and setting them aside, 
one might say : " You may have your chance to live ; 
your chance to run aU the dangers which mock our 
civilization. Live long, if you can." And then, tak- 



SLAUOHTBR OF [« CONS II ORE 

BABIES W C/ryij||||y|.j||m,u|f 

li MIV TM iM .-— — - 



m^^ tUf > Wi i awTwr.TwtetMlini;lnMOMl». BiMy-ftv r^ Cmt dttt NM 
AnVlwi,3tTlMtatl 



•*F{|BIMnK;"miFT _ . 

■J!!5'"" MILK SOURCE 



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REEZINa , 

BUI DmuIi« poiti nx igus 



TUBERCULIN 
TEST NOT 
APPUEO 



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itllfeiTn*. 



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PRJCEHrnHOCCnTflEPIITSFilll 

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'*"J'Jjy^ TEN Tmanuis 

VIM ,,«. 



OFCHICABO'S 
EPIOEMICS 



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mil 



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EPIDEMC TRACED 
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JERSEY MAKES WAR 
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HUNDREDS OF BABES I'm i 
2 * 



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BESPONSIBLE 



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NUFMNCIttT 



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HAUETINfi CERTIFIED IIU 



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lEillb Mffccr of Thb Clfr. Mm New Tirt Slili 
r —'« toycoaii.atllot>MHt 



WAR IN ENGLAND 

ON MILK TRUST 



ti 

OlM 



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al Am CflMlat S mid ii a( 



S:^ ! CANDY, MADE 



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Milk CAUSES! 

EPIDEMIC OF 
TYPHOID 



IN RAW MILK !i!'Jr'iJ^St 



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P/T FOR BABIES bi$osc OErminLY tiuccd 

TO oac ouov 

Or. Pwi ol Itapia IMt«i4at«^ gl fiwww 



XIV. A Study in Hsadlinbs 



A BRIEF SUMMARY OF THE PROBLEM 155 

ing the third child, one might brand it; setting upon 
its brow the mark of death. When all the children 
had thus been sorted out; and one-third of them aU 
gathered into a multitude of branded victims, each 
wearing the death symbol, would there be a single 
man or woman in the land with soul unstirred by 
grief? Would there be a human heart that did not 
throb with the agony and shame of the carnage ? 

And yet; in a less dramatic fashion, that very thing 
b happening every year. One-third of all the babies 
are taken by death before they reach the age of five 
— and the nation hardly heeds the fact. Why? 
Apparently because the dramatic element is lacking. 
There are no stage effects. There is no great holiday 
devoted to a slaughter of the innocents; the babies 
are not massed in one great throng, but scattered over 
the land, lying in a hundred thousand cradles or play- 
ing in tens of thousands of homes ; there is no brand 
upon their brows to mark them off from other babies. 
Of course, there is less that is dramatic when babies, 
instead of being set aside and branded with a death- 
mark, just pine and die in their tenement homes. 
But they die, nevertheless; and I cannot think of our 
frightful infantile death-rate as being anything less 
than terribly; shamefully wrong; every citizen shar- 
ing in the crime and shame who does not work for 
better conditions. 

It is not merely that one-third of the babies die 



156 THE COMMON SENSE OF THE MILK QUESTION 

before they reach the age of five years. That is bad 
enough, but it does not reveal all the awful truth. 
The death toU is not so evenly and impartially ex- 
acted, from rich and poor alike, as it would be if the 
babies were massed and every third baby chosen for 
the fatal branding. There would be in that case a 
splendid, inflexible justice and the tears of the rich 
and proud would mingle with the tears of the poor 
and humble in a gi-eat democracy of grief and bitter 
acknowledgment of the supremacy of death. "The 
gods always throw the dice impartially," declared 
Sophocles, the profound thinker who raised the Greek 
drama to its highest intellectual level, and modem 
science is coming more and more to that view. The 
gods are impartial. Ninety per cent of all the babies 
born into the world are, at the time of their birth, 
fairly healthy and well nourished. When they come 
into the world, the babies of the rich are in their 
physical inheritance no richer than are the babies 
of the poor.' Hereditary diseases, like syphilis and 
alcoholism, are fairly equally spread over all classes. 
But, unlike the gods, man is partial and, to use the 
simile of Sophocles, plays unfairly with loaded dice. 
So there are vast diiTerences in the death-rates of the 
babies. There are streets in all the great cities of 
the world where instead of one-third, one-half of the 
babies bom perish during the first five years, or even 
during the first year; there are courts, alleys, and 



A BRIEF SUMMARY OF THE PROBLEM 157 

tenements where the infantile death-rate is higher 
stiU." 

n 

In. another place * I have suggested that at least 
30 per cent of the infantile death-rate in the United 
States might be prevented; that out of every hun- 
dred deaths occurring during the first five years of 
life at least thirty are due to socially preventable 
causes. This means that as a nation we permit some- 
thing like 95,000 babies to die annually. I say we 
"permit" them to die, to express very deliberately 
the thought that is in my mind, that the deaths of 
those 95,000 babies each year ought to be set down 
as due to murder permitted by society. 

Terrible as I know the figures to be, nothing is 
more certain than the fact that the estimate is a very 
modest one. Most physicians who have carefully 
studied the matter would, I think, agree that it could 
be said conservatively enough that 50 per cent of the 
infantile death-rate represents a needless sacrifice of 
precious human material. And that would raise the 
nimiber of victims whose tiny graves bear witness to 
our social shame and crime to m4>re than 158,000 ! It 
has been estimated by French authorities that three- 
fourths of the infantile deaths in that country might 
be prevented ; that in five years France lost 220,000 

*In 7^ Bitter Cry <^ the Children, eh. i. 



158 THE COMMON SENSE OF THE MILK QUESTION 

lives, equal to the loss of an army corps of 45,000 
annually, through ignorance and neglect/ Suppose 
that we knew that so many infants were actually 
murdered in France during that time ; should we re- 
gard the French people as being civilized ? Or should 
we be regarded as civilized if we slew, with knives and 
axes, 95,000, or the larger total, 158,000, babies a 
year? And yet, why should we not face the truth 
that it is not necessary to use knives or axes in order 
to do murder — that it is just as easy to murder 
babies with artificial foods that are poisons, or with 
milk that is reeking with germs and filth, as with any 
other weapons — just as easy and just as wrong? 

That impure and infected milk is one of the chief 
factors in the causation of excessive infantile mor- 
tality is not questioned, so far as I am aware, by a 
single living authority. Whether we take Russia 
with its terrible death-rate of 272 per thousand* of 
infants under one year old, Austria with its 227 per 
thousand,* or New Zealand with its 82 per thousand,^ 
it is universally admitted that the frightful mortality 
among bottle-fed babies as compared with breast 
nurslings is due largely to diarrhoeal diseases caused 
by dirty and contaminated milk, or to other diseases 
caused by the ingestion of pathogenic bacilli con- 
tained in milk drawn from mfected cows or handled 
by infected persons. And the fact of a univer- 
sally declining birth-rate adds to the gravity with 



A BRIEF SUMMARY OF THE PROBLEM 150 

which a needlessly high death-rate must be re- 
garded. 

That infantile mortality would be greatly reduced 
if all babies were breast-fed is certain. Wherever 
the relation of infant feeding to infant mortality has 
been investigated, it has been demonstrated that the 
baby fed at its mother's breast has a better grip on life, 
a much better chance to survive, than the baby fed 
upon cow's milk or any other substitute for its natural 
food. Such investigations have been made in many 
cities, especially with reference to deaths from diar- 
rhoea! diseases, and uniformly point to the conclusion 
that maternal breast milk is the safest, as it is also the 
most natural, food for a baby. And when some great 
event has occurred in any large city to liberate many 
mothers from industrial pursuits, so that they might 
nurse their babies as Nature intended, the death-rate 
of infants has been enormously reduced. That was 
what happened in Paris, in 1871, during the great 
siege, when the infant death-rate was decreased by 
40 per cent.' That was what happened, too, during 
the great strike in the cotton mills of Preston, Eng- 
land, in 1853, and during the great Lancashire "cot- 
ton famine" caused by our own CSvil War.* To some 
extent it happens whenever a strike occurs in which a 
large number of women are engaged for a considerable 
period. And where private philanthropy or public 
funds have been devoted to the encouragement of 



160 THE COMMON SENSE OF THE BULK QUESTION 

breast-feeding the results have been very gratifying. 

Those who have read, or seen a performance of, 
Ibsen's play, The Master Builder, will remember 
that one of the most touching moments is when Hal- 
vard Solness, the master builder, tells that elfin-like 
creature, Hilda Wangel, the story of the calamity 
which wrecked his wife's life and made her the pa- 
thetic wraith of a woman she is. He laments that his 
wife has lost her vocation ; for she, too, was a builder. 
Her vocation was to build up the souls and bodies of 
little children, and that vocation she has lost. In all 
the tragedy which enters into this problem of infantile 
mortality, nothing seems quite as terrible as the 
lost vocation of motherhood — the fact that so many 
mothers who ought to be the builders of the souls 
and bodies of little children, inspirers and nourishers 
of the race, are giddy human moths flitting around 
the flame of social pleasure, at one end of society, or 
industrial slaves, at the other end, bound to wheels. 

That the education of a woman who refuses to nurse 
her baby has been radically defective is obvious, what- 
ever the remedy may be. And it is not less obvious, 
I think, that there is something radically defective 
in a social system that takes a mother away from the 
most important service she can possibly render to the 
state, and makes her care for a machine in a factory; 
denies her the opportunity to pursue with wisdom and 
love her vocation as a builder of divine temples of 



XV. BArTKRIA 1! 



■8 on Hemtr Str«i, ■ crowded 
« sbowB the nlatlrs puritT of 
Id SUty-«UUi Slreel, 



A BRIEF SUMMARY OF THE PROBLEM 161 

perfect manhood and womanhood, and compels her 
to be a drudge m an office, a mere adjunct of a machine, 
a maker of paper bags in a sweatshop, or a charwoman. 
Whenever we become sufficiently civilized to properly 
evaluate human life, to regard the matter of dividends 
as being of infinitely less consequence than the mat- 
ter of infant mortality, our present attitude toward 
motherhood will be a hideous memory of days that 
we shall not fail to pronounce barbaric. 

But it seems to be a well-established fact that, in 
addition to the mothers who will not nurse their 
babies, preferring to purchase pleasure at the cost of 
the little infant lives, and to the mothers who cannot 
nurse their babies because they are needed in the 
industrial world to furnish ''cheap" labor, — which is, 
from a social viewpoint, very costly labor, — there are 
many who cannot nurse their babies because the lac- 
teal function itself is atrophied in them. They are 
physically unable to be mothers in the full sense of the 
word "motherhood." And thus it is that artificial 
infant feeding becomes more and more common, 
and the importance of securing a proper substitute 
for mother's milk is constantly increasing. 

m 

Startling figures, terrible in their impressive elo- 
quence, condemn the patent foods which fiood the 
market, tempting the mother who is unable for any 



162 THE COBIMON SENSE OF THE MILK QUESTION 

reason to nurse her baby. Professor Rotch is well 
within the truth when he says that these foods are 
'' kept in the market by the physician rather than the 
manufacturer. The latter is only doing what any 
capitalist interested in a business venture would do. 
The former, it seems to me, is, perhaps uninten- 
tionally, aiding the business ventures' of others at 
the expense of his own reputation as a scientist/' ^^ 
There is absolutely no necessity to-day for the use 
of a single one of the infant foods which are so exten- 
sively advertised. They are practically all inferior 
to the best grades of condensed milk — and equally 
as harmful as the worst grades. Personally, I wish 
that it were possible to enlist the women of America 
in a great crusade against these '^ foods" to the extent 
of boycotting the physician advising their use and 
every newspaper and magazine publishing advertise- 
ments of them. 

For the milk of the mother the best substitute is 
the milk of some animal, such as the goat or the cow, 
modified to resemble the hmnan milk as closely as 
possible. Of the two animals the goat is in many 
respects superior, but for various reasons it is not 
generally used as a milk provider, and the cow is 
practically the only animal so used in this and many 
other countries. Superior though the goat may be, 
it is extremely improbable that it will assume the place 
of the cow as the wet-nurse of the American baby at 



A BRIEF SUMMARY OF THE PROBLEM 163 

any time which may be regarded as belonging to a near 
future. And since we are not here concerned with the 
milk supply of a far-off future, but with that of the 
living present, our problem resolves itself into one of 
getting the best result from cow's milk and of over- 
coming its limitations and disadvantages as a substi- 
tute for the milk of the human mother* To that end 
we need both science and 

" Good flense, which only is the gift of Heaven, 
And though no science, fairly worth the seven. " 

Science lays an unerring finger upon the disadvan- 
tages of cow's milk. It watches the infant human 
stomach at work trying to digest what was intended 
for an infant of a very different species, and a flood of 
light is shed upon some of the most difficult aspects 
of the problem of substitute feeding. By means 
which in other ages would have been called miraculous, 
science reveals the secret of each drop of milk ; and 
where the layman, like another Peter Bell, sees only 
a drop of milk and nothing more, the man of science 
sees a little world teeming with life and wonders as 
profound as any in the imiverse. He finds in the air 
we breathe myriad living forms which no human eye 
unaided can see. He notes the manner in which many 
of these infinitesimal creatures enter man's food, and 
how some of them carry disease and death wherever 
they go. He takes a single drop of milk which is fair 
and pleasing to the eye, divides the drop, and spreads 



164 THE COMMON SENSE OF THE MILK QUESTION 

its parts upon his gelatin plates and then, by the aid 
of his microscope, shows that the smallest division of 
a drop is full of life, mysterious life in which good and 
evil are at war as in all the great universe. 

A baby dies and the scientist finds in the little body 
sores and lesions which he does not understand until 
he has learned by repeated observation that in every 
sore and lesion there are numerous little living micro- 
organisms, exactly like some of those contained in the 
drop of milk, and that there are very similar sores 
and lesions in the body of the cow from which the milk 
was drawn. Or a number of babies die as a result 
of an epidemic of some gastro-intestinal disease for 
which there seems to be no explanation, until the 
scientist, examining the digestive tract in each little 
body, finds in each a number of these micro-organisms, 
bacteria of various kinds, which are similar in all 
respects to those found in the dirt of the stables where 
the cows upon the milk of which the babies were fed 
are kept, or to the bacteria that are present in the dirt 
found in the babies' homes. Dr. Booker, of Balti- 
more," found thirty-three different kinds of bacteria 
in the intestines of little victims of that deadly foe 
of babyhood which mothers call "summer com- 
plaint" and the doctors call "cholera infantum." 
This is only one of a great many illustrations tend- 
ing to prove that the diarrhoeal diseases which kill 
so many babies — half of those that die in the big 



A BRIEF SUMMARY OF THE PROBLEM 165 

cities — are due to the presence of dirt in the milk. 
It is natural that the mothers who swelter in the 
tenement homes of our cities during the torrid sum- 
mer heat; as they watch their babies pine and wilt like 
flowers in parched earth, should think the heat respon- 
sible for the suffering and death of their little ones. 
But the heat is not the only cause, nor even the most 
important cause, of summer diarrhoea, though it 
doubtless is a factor. That this is the case can be very 
readily seen by comparing the niunber of deaths from 
acute diarrhoeal diseases in New York State in the 
two years, 1900-1901, in the period from May 1 
to November 1, inclusive. The summer of 1901 
was exceptionally hot, but the deaths from diarrhoeal 
diseases in the state, outside of Greater New York 
City, numbered little more than half of the deaths 
recorded during the same period, in the same area, 
in 1900, when the heat was much less intense. On the 
other hand, the nimiber of deaths in Greater New York 
and suburbs from the same diseases was very nearly 
doubled. The figures were : — 

Table VI 

Deaths fbom Acute Diarrhceal Dibeabss, Mat 1 to 

November 1, Inclusive 





1900 


1001 


Country Districts 

Greater New York and Suburbs . 


8202 
3867 


1898 
6116 



166 THE COMMON SENSE OF .THE MILK QUESTION 

It is very evident from such figures as the foregoing 
that heat is not the sole cause of summer diarrhoea 
among infants. Dr. Chapin suggests that the reason 
for the tremendous increase in the number of deaths 
from this cause in Greater New York in 1901 was the 
presence of an unusual amount of dust and dirt; con- 
taminating matter of all kinds, in all parts of the city, 
owing to the fact that from one end of the city to the 
other streets were torn up, and sewers constantly 
being opened, in course of the construction of the sub- 
way." The explanation seems to be a good one, but 
whatever the reason may be, there is no disputing 
the facts. It is likewise indisputable that diarrhoeal 
diseases are much more common among bottle-fed 
babies than among babies that are breast-fed, and 
there have been numerous observations which war- 
rant the assertion that such diseases are largely due 
to bacterial contamination of the milk upon which 
they are fed. Science and good sense both proclaim 
the undesirability of filth as a food for infants. 

With regard to the transmission of tuberculosis, 
tjrphoid fever, scarlet fever, diphtheria, measles, sore 
throat, and many other specific diseases of both 
human and bovine origin, science has conclusively 
shown that numerous perils attend the use of milk 
that is drawn from diseased cows or brought into con- 
tact with the germs of any disease, either human or 
bovine in its origin, no matter whether the method 



4 
'I 

II 
^1 



* • • • 



• •• • 

• •• 



A BRIEF 8UMMART OF THE PROBLEM 167 

of infection is through tubercle bacilli from the cow's 
udder, bacilli accidentally carried into healthy cows' 
milk in small particles of the droppings of other, 
diseased, cows,* or disease germs conveyed to milk 
from the clothing of persons handling it, or in infected 
water. Whatever the method of infection, the danger 
is very real. We know, as surely as we know any- 
thing in the whole range of pathology, that tubercu- 
losis, typhoid, scarlet fever, diphtheria, and some other 
virulent diseases are spread by means of infected milk. 
Science and good sense again unite, proclaiming 
that milk that is infected with the germs of disease 
18 not a safe food, either for infants or adults. It is 
the chief advantage of the man of science over the lay- 
man that he has the power, though often only at great 
expense, to discover the danger. He is thus in a posi- 
tion to guard against dangers which to the layman 
are invisible. 

IV 

In this hasty summary of the disadvantages and 
perils of cow's milk as a substitute for mother's 
breast milk, there is one which we have not touched 
upon, and which is too important to be wholly ig- 

* Shroeder has shown that if into a pail of milk drawn from 
absolutely healthy cows a very small portion of dung from a 
tubercular cow is dropped and the milk at once strained, a few 
drops of the milk injected into a healthy giiinea-pig wUl sue- 
oessfuUy inoculate it with tuberculosis. 



168 THE COMMON SENSE OF THE MILK QUESTION 

nored. We have noted the difficulties due to the 
physiological differences which characterize a human 
infant and a calf, and the serious dangers arising from 
the susceptibility of milk to contamination^ and from 
the ignorance of the most elementary principles of 
hygiene on the part of those who have much to do 
with its production and distribution. Likewise we 
have observed the very great dangers indicated by the 
presence in milk of pathogenic germs in large numbers, 
and the numerous, well-authenticated instances of 
the transmission to human beings of the diseases of 
cows in their milk, and the transmission of disease 
from one human being to numerous others through 
the accidental infection of cow's milk. Finally, to 
close our catalogue of difficulties and dangers, we 
must add a few words concerning adulteration and 
the use of preservatives. 

We are all more or less familiar with the ancient 
jests at the expense of the dairyman whose most 
profitable animal was "the cow with an iron tail," 
and the milk pedier who raised the price of milk 
because of an advance in the price of chalk. These 
stories express in jests the common notion of the 
methods by which milk is adulterated. The addition 
of chalk and similar substances is rarely, if ever, re- 
sorted to in actual life ; but the addition of water, 
removal of a part of the cream, or mixing skimmed 
milk with good milk are, on the other hand, forms of 



A BRIEF SUMMART OF THE PROBLEM 169 

adulteration that are very common. Although most 
communities have drastic laws making these practices 
illegal, the laws are not always well enforced. Pro- 
fessor Doane found that in some of the cities in which 
he investigated the conditions of milk production 
and distribution these forms of commercial dis- 
honesty were very common. The ethical opinion of 
the public was at such a low stage of development 
that this petty cheating was commonly tolerated. 
One dair3rman told a group of his fellow-citizens, some 
of whom were his customers, that he always added 
water to his milk in common with every Qther man in 
the business, the rate of adulteration being one gallon 
of water for every four gallons of milk ! " 

Now, adulteration of this sort is chiefly objection- 
able because the consumer does not get the amount 
of food value represented, and, in the case of added 
water, there is always the danger that the water itself 
is not pure. As Professor Pearson says, " If a dairy- 
man is dishonest enough to water his milk, he will 
probably not be careful about the purity of the water 
added." " In most places the commoner forms of 
adulteration are practised to a more or less serious 
extent. Even where, as in New York and Ohio, 
the authorities are alert and aggressive, punishing all 
such offences with impartiality and vigor, there can be 
no doubt as to their extensive p^Btice. 

The use of preservatives is a form of adulteration 



170 THE COMMON SENSE OF THE MILK QUESTION 

which may be sharply distinguished from the forms 
of petty dishonesty above described. The dairyman 
or dealer who adds water to his milk, or mixes skimmed 
milk with milk of good quality, is deliberately robbing 
his customers. He Lb a petty thief of a very odious 
type. But the dairyman or dealer who puts ''pre- 
servatives" into his milk is commonly actuated by no 
such dishonest motives. It is not because he is 
desirous of cheating anybody that he adds chemical 
compounds to his milk to keep it from turning sour. 
Speaking generally, he desires to please his customers 
by supplying a milk that will keep sweet a long time ; 
to avoid expensive purchases of ice and the more or 
less frequent loss of profits caused by having quan- 
tities of milk become sour and unsalable. Fre- 
quently he bujrs a preparation which has been seduc- 
tively advertised or personally recommended to him, 
bearing some such fine name as '' Iceline," " Freezine," 
'' Preservaline," and so on through a long list of com- 
pounds, most of which contain chemicals that are 
injurious to the digestive organs, especially of infants. 
The average milkman does not know that '' Iceline" 
and ''Freezine" contain dangerous quantities of that 
powerful germicide, formaldehyde; that "Preserva- 
line" of one brand contains boracic acid, while other 
brands contain salicylic acid, sodium sulphite, ben- 
zoic acid, and formaldehyde, the latter varying from 
1.99 per cent to 10 per cent in different samples of 



A BRIEF SUMMARY OF THE PROBLEM 171 

the same brand I ^ He does not know that the sour- 
ing of the milk is caused by bacteria most of which 
have entered it as a result of unhygienic conditions. 
Of course, he may have heard of the requirements of 
the Board of Health — better stables, new-fashion 
milk pails, white duck suits for milkers, washing cows' 
udders and tails, and many other ^'new-fangled 
notions'' which he disbelieves in and regards con- 
temptuously as fads of the "young doctors." Such 
things were never heard of until lately, and people 
have used cow's milk for ages I 

He really does not know that the use of salicylic 
acid grew to be so common in France that the public 
health was affected and that a commission appointed 
by the government to inquire into the matter re- 
ported emphatically that, ''The addition of salicylic 
acid or its derivatives, even in the most minute 
amounts, to foods, solid or liquid, should not be 
authorized." ^* He does not know that the United 
States Dispensatory says, "Salicylic acid has been 
used for the preservation of various articles of food, 
but the employment of it should be interdicted." " 
He is quite ignorant of the fact that formaldehyde 
has been shown to impair the digestibility of the 
casein in milk, causing serious intestinal diseases 
in young babies.^' He does not know these things 
— and if he did, there is the great economic motive. 
Milk so pure and clean that it will not sour for a very 



172 THE COMMON SENSE OF THE MILK QUESTION 

long time is, for him, an unattainable ideal. He has 
not the money to spend on the necessary improve- 
ments; he has not the education and knowledge 
required. He represents in his person and in his 
particular interests the old and outgrown, facing the 
coming of a new era, and resisting it with aU his 
powers. 

You cannot wonder, therefore, that preservatives 
are used, despite all laws to the contrary. The 
chances of detection are frequently remote, and the 
saving is great. Sometimes the dairyman himself 
adds '^Iceline," and the wholesale dealer, not know- 
ing that fact, adds ''Preservaline"; while, later on, 
the retailer, guarding his own interest, adds to the 
same milk some "Milk Sweet" or "Freezine." Such 
a case is reported by the Department of Agriculture, 
discovered as a result of the illness of several children 
who drank the "milk." " The use of preservatives 
is prohibited by the laws of many states, as well as 
by the national food and drugs act, the so-called 
Pure Food Law, of June 30, 1906. What the effect 
of the last-named law will be remains yet to be seen. 
The state laws have not sufficed to put a stop to the 
pernicious practice, even in those states where the 
greatest activity has been displayed in enforcing 
them. 

Such then, briefly stated, are the principal dis- 
advantages and dangers attendant upon the public 



s i 






• % • 



• •• 



'•-•• 



A BRIEF 8UMMABT OF THE PROBLEM 173 

milk supply of the average American city. The 
careful reader will have observed that the perils 
are practically all hidden ones. It is impossible 
to tell from the appearance of milk, or from its taste, 
whether it has the deadly germs of tjrphoid in it, 
tubercle bacilli, or other pathogenic germs, or whether 
it has been "doctored" by the use of dangerous 
chemicals. Science alone can reveal the dangers 
lurking in the milk can or bottle. The average man 
is helpless: to test milk chemically and bacterio- 
logicaUy is a long, difficult, and expensive process, 
beyond the powers of the layman. A formidable 
list of dangers has been compiled by science, and now 
comes the questioning of the layman : — 

''O Star-eyed Science I hast thou wandered therSi 
To waft ufl home the message of despair? " 



CHAPTER Vn 

REMEDIAL THEORIES AND EXPERIMENTS 



In most progressive communities the public water 
supply has been brought under public control. The 
evolution of the public water supply may, for the 
purposes of this discussion^ be divided into three 
periods, as follows : (1) The ante-organization period, 
with private springs and wells used by individual 
families and by groups of families ; (2) first organiza- 
tion period, with private companies, operating under 
agreements made with public authorities, supply- 
ing water from some central source at a given price; 
(3) second organization period, in which the service 
is undertaken by the public authority in place of the 
private company.* 

Now, one of the most potent factors in bringing 
about the organization of the water supply was the 
fact that polluted wells occasioned a great many 
serious outbreaks of disease. It was practically 
impossible to guarantee the safety and purity of the 
water supply under the old system of individual 
wells. In like manner the need for a more rigid and 

174 



REMEDIAL THEORIES AND EXPERIMENTS 175 

efifective supervision of the quality of the water 
supply has had much to do with the change to mu- 
nicipal ownership and control.' Whatever may be 
said of the prevailing demand for the municipalization 
of certain public monopolies, and whatever charges 
may be brought against municipal ownership by its 
opponents, retainers of vested interests and others, 
it is incontestable that the change to municipal 
ownership in the case of the water supply has had 
the beneficent result of reducing the dangers of 
epidemics from polluted water. 

Nor can it be denied that, in this country at least, 
private ownership of the water supply is frequently 
attended with serious dangers that menace the health 
of the communities in which such private ownership 
prevaUs. Outbreaks of typhoid are much less com- 
mon where the water supply has been for some time 
in the hands of the municipalities than where it is 
privately owned and controlled. And it is noticeable 
that where, under municipal ownership, the death- 
rate from t3rphoid is high, it is much easier to get 
effective steps taken toward remedying the condition 
than in the case of similar conditions existing under 
private ownership. The case of Ithaca occurs to 
mind as showing the fact that when the water supply 
of a city is in private hands and managed for private 
profit, many of the most influential citizens, who 
would otherwise be found fighting for betterment. 



176 THE COMMON SENSE OF THE MILK QUESTION 

are invariably on the side of evil. In Ithaca's case 
the authorities of a great American university, who 
should have been in the very vanguard of the fight 
for better conditions, were either actively defending 
the private company or indifferent to the public 
welfare. If, as a great American physician has said, 
" every time there is a death from tjrphoid somebody 
ought to be hanged for murder/' it is safe to say that 
in Ithaca the application of that drastic rule would 
have taken away many of the ''good citizens" and 
seriously depleted the ranks of the faculty of the 
university in that city." 

As Dr. F. Lawson Dodd has said, '' It was epidemics 
and not epigrams that caused the municipalization 
of the main sources of our water supply," * a remark 
as applicable to this country as to England. So far 
as the relation of the milk supply to the public health 
is concerned, there is no argument which can be used 
in support of the municipalization of the water service 
which is not equally valid and forcible when used in 
favor of municipal milk. The perils involved in the 
use of infected or impure milk are, as regards infants, 
very much greater than those involved in the use of 
polluted water, for the very simple reason that babies 
in many cases are wholly dependent upon the milk 
supply for food. Moreover, water, so far as is known, 
never carries the germs of tuberculosis, while, as we 
have seen, milk very commonly does. 



BEMEDIAL THEOBIES AND EXPEBIMENTS 177 

These considerations have led many very earnest 
reformers to advocate the municipalization of the 
entire milk supply of our towns and cities. During 
the Chicago epidemic there were a great many per- 
sons, by no means disposed to call themselves Social- 
istS; who supported the demand of The Chicago 
Socialist for the mimicipalization of the milk supply, 
and agreed that the milk trade should be a social 
monopoly.* The London Fabian Society, which, 
contrary to current opinion m this country, is a very 
conservative organization, officially puts the case 
for municipalization more cogently than I have seen 
it elsewhere, in the following words: — 

''If we want good milk, let' us establish our own 
dairy farms in the coimtry and our milk stores in 
the city. Many of our large towns have spent 
enormous sums of money to provide their citizens 
with water; why should they not also provide them 
with milk? The arguments in favor of mimicipal 
water apply with greater force to municipal milk. 
We want municipal dairy farms in the country, 
managed by dairy experts, and supervised by medical 
officers and veterinary inspectors. We want care- 
fully selected, healthy cows to give us milk; and we 
want them kept under proper conditions. On our 
municipal dairy farms we could see that these con- 
ditions were fulfilled. A municipality would have 
no interest in adding dirty water to milk to make 



f 



178 THE COMMON SENSE OF THE MILK QUESTION 

two gallons look like three. Milk municipalization 

would be a comparatively simple business. No 

powerful companies would have to be bought, and no 

compensation for loss of license could arise. Milk 

production does not require the use of complicated 

and costly machinery. The milk trade pays well, 

and its concentration would give rise to an increased 

economy in working. We should get cheaper as 

well as better milk. On the municipal farms we 

could insist that the laborers were paid a fair rate of 

wages," • 

n I 

As a matter of pure theory there is no disputing 
most of the claims made by the Fabian Society. 
That the difficulties are beautifully minimized by 
the writer is evident. If the Fabians really be- 
lieve the milk business, conducted as it ought to be, 
is such a simple one, a time of disillusionment awaits 
them. On the contrary, the scientific production 
of milk is a very complicated and delicate business, 
as any one who has ever closely watched the many 
processes, and observed the almost innumerable 
precautions, necessary to the production of good 
milk, such as is produced on the best experimental 
farms, could tell them. Comparativdy speaking, 
the distribution of water is a very easy matter. 
Doubtless milk ought to be distributed by the muni- 
cipality as water frequently is, and for precisely 



REBfEDIAL THEORIEB AND EXPERIMENTS 179 

similar reasons. Such^ at least, is my personal 
conviction. It is idle, however, to expect that any 
large municipality in America will be persuaded to 
undertake the production and distribution of its 
milk supply for a long time to come. 

In the first place, the industry itself must first 
undergo great changes in the direction of concen- 
tration before such a plan will become practicable. 
It is a well-established law of economic evolution 
that collective ownership and control follows when 
the organization of the machmery of production 
and distribution has been more or less perfected 
under capitalistic ownership and control. There 
are exceptions to this, as to every other rule, but 
only enough to establish its general validity. Now, 
economically, the milk trade is one of the most prim- 
itive and undeveloped of all our great industries, 
as it is also scientifically the most backward. Milk 
prodvctUm has scarcely been touched at all by the 
tendency to concentration manifested in so many 
other branches of industry. It is an unorganized, 
petty industry, carried on by a large number of 
small capitalists, many of whom are little better 
off than ordinary wage-workers. Skilled labor, 
though it has been shown to be absolutely neces- 
sary to the realization of good results, has not yet 
been introduced into the industry, and, in fact, does 
not exist. Mechanical appliances, such as milking 



180 THE COMMON SENSE OF THE MILK QUESTION 

machines, are as yet in the experimental stage. In 
short, the production of pure milk is up to the pres- 
ent a laboratory achievement, not an industrial and 
commercial result, ripe for collective ownership and 
control. 

In many of our smaller towns and cities, and in 
rural districts, a considerable proportion of the milk 
used is a home product, many families keeping cows 
for their own service. In such cases, as a general 
rule, the conditions under which the milk is produced 
are even worse than are common in the commercial 
production of milk. Adulteration and the use of 
preservatives are, naturally, practically never known 
when people own their own cows: but the stables 
are often filthy in the extreme ; the animals are not 
well cared for, are specially subject to tuberculosis 
as a result of being badly housed; the equipment is 
often of the poorest kind, and the ignorance of milk 
hygiene so great that the contamination of the milk 
to an unusual extent seems to be almost inevitable. 
Furthermore, there is practically no inspection of 
the milk produced in these cases, no check upon the 
quality either as regards the content of fat or of pus 
and dirt. The most thoroughgoing advocates of the 
municipalization of the milk supply would not, pre- 
sumably, go so far as to insist upon the suppression 
oT this private production for' home consumption, so 
that their plan would still leave very seriouis avenues 



REMEDIAL THEORIES AND EXPERIMENTS 181 

of danger open. True, other means might be taken 
to regulate these and so secure proper conditions. 
But once that is admitted, it seems to me, from a 
hygienic standpoint, there is no reason why similar 
methods of control, without ownership, should not 
be applied to the whole mdustiy. This is, of course, 
the theory of our present system of milk inspection, 
which has so signally failed to accomplish the desired 
result. 

So much for the production of milk. When we 
come to examine its distribution, we find that there is 
a certain measure of organization and concentration. 
Except in very small centres of population, few 
dairymen retail the milk produced upon their farms. 
For the most part milk is sold to dealers who, in turn, 
supply the retail trade. Then there are great dis- 
tributing companies, so-called ''milk trusts," some 
of them operating upon a national scale, which are 
often oppressive to producer and consumer alike. 
Many of these concerns have so organized the dis- 
tribution that they are receivers, wholesalers, and 
retailers. It has been estimated that from 80 to 
90 per cent of the milk sold in New York City is 
handled by 125 dealers, and the tendency is un- 
deniably toward further concentration.^ The busi- 
ness of milk distribution is much more nearly ripe 
for collectivism than is that of milk production, but 
there would, obviously, be very little advantage. 



182 THE COMMON SENSE OF THE MILE QUESTION 

from a health point of view, in having the municipality 
take over the business of supplying milk of doubtful 
quality, distributing ever so efficiently impure and 
disease-breeding milk. 

m 

The municipalization of the general milk supply, 
for the reasons stated, seems to me a proposition 
of little more than academic interest at present. 
Eventually, I believe, we shall come to that, but 
first of all there must come the concentration of 
production, with the inexorable crushing out of the 
small and inefficient producers and dealers, — the 
creation of conditions which will make municipaliza- 
tion practicable. 

It does not follow, however, that no part of the 
mUk supply should be brought imder municipal 
management and control. On the contrary, there 
are very urgent and convincing reasons why, in 
nearly every city, some parts of the milk supply 
should be immediately mimicipalized. So far as the 
municipality itself is a consumer of milk it should 
aim to supply its own needs. In almost every city 
a certain quantity of milk is used in connection with 
municipal institutions, such as hospitals, asylums, 
sanatoria for consumptives, and so on. The common 
practice is for the public authority to contract for 
this milk supply, generally by public tender. Practi- 



REMEDIAL THEORIES AND EXPERIMENTS 183 

cally all such contracts insist upon a certain standard 
of composition^ that used by the Department of 
Agriculture being frequently adopted. In some cases 
there is also a bacteriological standard stipulating 
that the milk supplied must not contain more than 
a certain maximum of bacteria, the number ranging 
from 100,000 to 500,000 per cubic centimeter. There 
seems to be no good reason why this should not 
become a municipal function. 

Why should not every town and city in which there 
is need for it have a municipal farm, stocked with 
perfectly healthy cattle, and conducted upon scientific 
principles throughout, for the supply of all its public 
institutions now depending upon a commercial 
product of very doubtful purity at best? Indeed, 
there is no apparent reason why the municipality 
should not supply from its farm those institutions of 
a public character not conducted by the city, such 
as hospitals, maternities, cricheSf kindergartens, diet 
kitchens, and all similar philanthropically conducted 
institutions, in which the purity of the milk supply 
is a matter of vital importance. Such milk could 
and should be supplied at cost. 

Now, this is not a theoretical proposition, novel 
as it may appear to many American readers, but one 
that has been thoroughly tested in actual practice 
in several European cities. For example, the city 
of Nottingham, England, keeps about a hundred 



184 THE COMMON SENSE OF THE MILE QUESTION 

milch cows upon its own farm and supplies its hospitals 
and asylum; in addition to which it sells milk and 
butter to the value of something like $12,500 per 
annum." The city of Reading conducts a dairy farm 
in connection with its sewage farm,® as also does 
the city of Birmingham, which sold in 1903-1904 
over sixty thousand gallons of milk, valued at about 
$9470.*® These English cities have, it seems to me, 
begun at the right end. Instead of attempting the 
impossible task of municipalizing all the milk trade, 
they have started by supplying their own wants and 
selling only the surplus. The result of these ex- 
periments has been that, in addition to securing 
a safe and wholesome supply for the municipal and 
other hospitals and similar institutions, they have 
provided private producers with a useful object 
lesson, a standard of cleanliness and scientific methods 
of the highest value. 

No matter how carefully drawn the contracts 
which our public institutions make with farmers 
and milk dealers may be, nor how honest and com- 
petent the system of inspection employed, these 
are not sufficient. They have not proved sufficient 
either in this country or in Europe. All the processes 
involved in the production of the milk used in such 
important institutions ought to be under such direct 
control and supervision of the sanitary authority 
as is impossible, except at a ruinous and needless 



REMEDIAL THEORIES AND EXPERIMENTS 185 

waste of money, under the present system." The 
municipal farms would serve a double purpose, it 
must be remembered, not only providing pure and 
safe milk for the institutions where milk is largely 
used for dietetic purposes, but setting up a standard 
which private enterprise would be compelled to emu- 
late. It is not difficult to see that a city producing 
milk having an exceedingly low bacterial content 
would be able to enforce the observance of a bacterio- 
logical standard otherwise impossible of realization. 
Even if such a farm did not pay, — though there 
is no honest reason why it should not if properly 
managed, — the influence for good which it exerted 
upon the private dairies would probably equal, in 
any fairly large city, what could be accomplished by 
several inspectors. 

rv 

That there should be established In every American 
city having a population of 25,000 or over municipal 
depots for the supply of milk intended especially for 
infant consumption is, I believe, one of the most 
vitally important lessons which we have to learn from 
the many experiments that have been tried in this 
country and in Europe. That the infantile death- 
rate can be very materially reduced by such means is 
unquestionable; and that is only another way of 
saying that our cities to-day are directly responsible 



186 THE COMMON 8ENSB OF THE MILK QUESTION 

for a considerable proportion of the awful yearly 
loss of babies — that, to put it plainly, our civic 
authorities stand in the position of murderers and 
accessories to the murder of thousands of infants every 
year. 

Infant milk depots have been pretty thoroughly 
tested, in this country and in Europe, so that in 
advocating their establishment upon a more generous 
scale, as a municipal duty, I am not putting forward 
a beautiful theory which is likely to prove disap- 
pointing in actual practice. Had we nothing to guide 
us but the experience of Mr. Nathan Straus, and his 
magnificent record of successful life-saving in New 
York City by means of his infant milk depots, and 
the splendid results obtained in the city of Rochester, 
New York, under Dr. Goler's fine leadership, there 
would be little or no excuse for the failure of any city 
of 25,000 inhabitants or over to establish such depots.* 

* Perhaps I ought to explain here that it is not suggested 
that such depots are unnecessary in smaller cities and towns. 
The milk supply in the small towns is often worse than in the 
big cities, and the infantile death-rate ia frequently very high. 
But while I am fairly certain that any city of 25,000 inhabit- 
ants, or over, should make such provision for its infants' milk 
supply, I know that some smaller towns could not successfully 
maintain special depots for the supply of milk for infants. In 
some cases, too, they can deal with the milk problem as a whole 
in a satisfactory manner along other lines which would render 
special infants' depots almost, if not quite, superfluous. Per- 
haps I need scarcely add that the standard of 25,000 is, neces- 
sarily, somewhat arbitrarily chosen, merely to provide a proper 
basis for discussion* 



S 1 



«J 



REMEDIAL THEORIES AND EXPERIMENTS 187 

Instead of which we have the experience of hundreds 
of other cities, in many different lands, to guide and 
inspire us. 

It is not essential that we should enter into a de- 
tailed history of the movement for the establishment 
of milk depots for infants. Other writers, notably 
Dr. McQeary,^* have done this work with a fair degree 
of thoroughness, and, moreover, a very brief outline 
will be enough to give the reader a fair idea of the 
various types of depots and the principles underljdng 
their management. There are many Variations in 
these institutions, but in a general way they may be 
said to conform to three t3rpes, which may be briefly 
described as follows : — 

(1) ConstUtations de Naurriasona.^ The first of 
these institutions was established in 1890, by Profes- 
sor Herrgott, who in that year founded at Nancy 
U(EuvTe de la Matemiti, a charitable maternity 
hospital. All children bom in this hospital were 
required to be brought back for medical examination 
at the end of the first month, when, providing satis- 
factory progress had been made, the mothers were 
rewarded with small sums of money. Some idea of 
the scope of the work done by this institution may be 
gathered from the fact that in the ten years, 1890- 
1900, the amount distributed was 25,382 francs and 
the number of maternity cases 2052. Professor 
Herrgott's idea was nothing more than to encourage 



188 THE COMMON SENSE OF THE MILK QUESTION 

as far as he could the very poorest of mothers to make 
the best of exceedingly adverse conditions in caring 
for their babies. 

Two years after the beginning of Herrgott's Nancy 
experiment, in 1892, Professor Budin, of the ChariU 
Hospital, Paris, started a Carusidtation de Nourris- 
sons upon a somewhat more carefully studied plan 
in connection with that institution, and this proved 
so successful that he has since established others 
in connection with the MatemiU Hospital, 1895, and 
the Clinique d^ Accouchement Tamier, 1898. As there 
are many of these Consultations de Nourrissons in 
Europe, usually maintained by pubUc-spirited ac- 
couchers and philanthropic societies, all conducted 
upon the same broad Unes, though differing in details 
of management, a description of those conducted by 
Professor Budin will suflBiciently describe them all. 
Where they differ in very important particulars from 
others, the nature of such diflferences will be pointed 
out. The Considtations of Professor Budin are at- 
tached to maternity hospitals and limited to the 
children born in them. The mothers are admitted 
to the maternity institutions free of charge, but they 
must agree before entering the institutions that after 
their discharge they will bring their babies to the 
hospital for examination at least once each week 
xmtil the end of the second year. At childbirth the 
mothers are carefully examined to see whether they are 



REMEDIAL THEORIES AND EXPERIMENTS 189 

physically able to nurse their infants, and all the 
influence of the medical staff is exerted to persuade 
them to do so where it is not clearly a physical im- 
possibility. The encouragement of breast-feeding is 
the primary purpose of the work. 

At birth and during their stay in the hospital prior 
to the mothers' discharge, the infants are weighed 
and their weights and measurements and general 
physical conditions carefully noted and recorded. 
Then, after the mothers have been discharged, they 
have to bring the babies to the hospital weekly for 
further examination, so that week by week the record 
of growth is kept and the physician knows exactly 
the progress any child is making. The number of 
infants who are bottle-fed is relatively small, for the 
proportion of mothers who are unable to nurse their 
infants at the breast through physical disability is, 
in view of other statistics upon the subject, surpris- 
ingly small. According to Dr. Maygrier, of the 527 
infants cared for at the Cliniqve d^ Accouchement 
Tamier during the years 1898-1902, no less than 
448 were breast-fed and only 79 bottle-fed. But we 
must not forget, in considering these figures, that the 
women were all charity patients, coming from the very 
poorest classes, among whom the decline in nursing 
ability is commonly least marked. Where breast- 
feeding is impossible, the Consultations de Nourrissons 
supply sterilized milk for the infants in bottles daUy, 



190 THE COBiMON SENSE OF THE MILK QUESTION 

each bottle containing enough for a single meal and no 
more, the quantity depending upon the age, weight, 
and physical condition of the child and bemg pre- 
scribed by the examining physician. Sometimes, 
following the lead of Professor Herrgott's Nancy 
experiment, gifts of food or money are made to en- 
courage breast-nursing. This description of the work 
of the C(msiUtation8 de Naurrisaons established by 
Professor Budin in Paris applies to almost all others, 
except that in some instances they are not attached 
to maternity hospitals, existing as separate institu- 
tions, and are free to aU infants, no matter where 
born. In some cases, also, the milk given to the 
infants that must be bottle-fed is pasteurized instead 
of sterilized, and, in a few places, modified. 

It will be seen from the foregoing description that 
the Consultations de Nourrissons can hardly be clas- 
sified as milk depots, except incidentally. Their 
primary purpose is to discourage bottle-feeding as 
much as possible. Naturally, they do a great deal 
in the way of lessening the death-rate among the very 
limited number of infants with which they deal. 
When one thinks of the careful, devoted, and highly 
efficient skill which surrounds them when they are 
bom, and then of the expert and conscientious weekly 
exammation during the first two years of life, bio- 
logically the most important years of all, it is evident 
that these pauper infants are in many ways to be 



RBHEDIAL THEORIES AND EXPERIMENTS 191 

envied, being far better cared for than many infants 
of the rich and well-to-do classes. 

Nevertheless they are paupers. Interesting as the 
Ccnsidtations de Novrrissona are, viewed as an ex- 
periment, it is quite obvious that they do not solve the 
problem of getting a milk supply for infant feeding 
that is safe and pure. They are well-intentioned, 
and highly illuminating, efforts made to improve 
the lot of the worst-conditioned classes of infants. 
Our need in America is not the establishment of such 
charities, though it would doubtless be a good thing 
if, in connection with well-managed infants' milk 
depots, at which people of all classes could buy safe 
and wholesome milk for their infants, we had a similar 
system of advising mothers and supervismg the health 
of their infants. 

(2) OouUes de LaH}^ As their name unplies, 
the OotUtes de Lait are primarily milk depots. Like 
the ConsuUoHons de Naurrissons, they encoiurage 
mothers to suckle their offspring wherever that is 
possible, and, like them, they exercise a good deal of 
supervision over the child during the nursing period. 
But they provide principally for the babies who must 
be artificially fed, and it is a rare occurrence for a 
mother who is able to nurse her baby to take it to the 
GauUe de Lait. The first of these institutions was 
founded in 1892 by Dr. Variot, in connection with the 
Belleville Dispensary, Paris. It was an offshoot, or 



192 THE COMMON SENSE OF THE MILK QUESTION 

perhaps it would be more correct to say a modifica^ 
tion, of the Consultation de Nowrrissons which Budin 
had established shortly before at the ChariU Hospital. 
In 1894 Dr. L^on Dufour established a similar depot 
in Fecamp, the first to have an independent existence 
of its own, being unconnected with any other institu- 
tion. Dr. Dufour named his depot Goutte de Lait, 
and the name has been generally adopted throughout 
France. 

There are to-day GouUes de Lait in over a hundred 
French towns and cities. In Belgium they are com- 
mon institutions, under the name of Laiterie Mater- 
neUes, and in Spain, under the name of the Gota de 
LecA«, we find the same mstitution flourishing. Under 
various names, there are similar depots in St. Peters- 
burg, Odessa, and other Russian cities ; in Roumania, 
Bulgaria, Italy, Germany, Switzerland, Denmark, 
Holland, Norway, Sweden, Portugal, and England, 
among European countries; as well as in Canada, 
the United States, Argentina, and Morocco. Some of 
these are very small institutions, incapable of mate- 
rially affecting the death-rate. It would be quite 
impossible to present statistics of the work of these 
depots upon anything like a uniform plan, for the 
reason that in some cases none have been kept, and the 
vital statistics of difi'erent countries are not fairly 
comparable in many instances. It is only fair to say, 
however, that wherever records have been kept, the 



REMEDIAL THEORIES AND EXPERIMENTS 193 

infantile death-rate has been lowered in consequence 
of the work of the milk depots. 

As a rule, the French GouUes de Lait have served 
as the models for other countries. They are usually 
philanthropic organizations, supported by voluntary 
contributions and managed by volunteer committees. 
Frequently they are subsidized by the municipalities 
in consideration of the economic value of their work, 
while in some instances, notably Nantes and Elbeuf, 
they have been altogether taken over by the mu- 
nicipalities. Three classes of children are served at 
most of the Gouttes de Lait : (1) Those whose parents 
are too poor to pay anjrthing, for whom milk is pro- 
vided free of charge ; (2) those whose parents can pay 
some part of the cost, usually one-half; (3) those 
whose parents are perfectly able to pay the full price, 
and who use the milk supplied by the depots simply 
because they recognize its superiority over the com- 
mercial product. Often very wealthy persons avail 
themselves of this advantage. The proportion in 
which the three classes are found among those served 
at the GouUes de Lait varies greatly, according to the 
localities in which they are situated. In thus cater- 
ing to the indigent as well as to those who can 
afford to pay, the French system is very much like 
that adopted in this country at the Straus depots. 

At the Fecamp GoiUte de Lait, which has served as 
the model for hundreds of others in all parts of the 



194 THS COMMON SENSE OF THE MILK QUESTION 

worlds the milk is modified and then sterilized. The 
formula used is, one part of water to two parts of 
milk, with 15 grammes of centrifugal cream, 35 
grammes of lactose, and 1 gramme of salt added t^ 
each liter of the milk and water mixture. This mix 
ture is bottled and then perfectly sterilized, being 
kept at a temperature of 102 degrees centigrade for 
forty minutes. In some of the GotUtes de Lait, in-^ 
eluding, I believe, practically all those in Paris and 
Havre, the milk is sterilized but not modified ; while 
in places like Beauvais and Pol-sur-Mer the milk is 
pasteurized and unmodified. Upon the whole, as 
noted in an earlier chapter, the French are opposed 
to the modification of milk. 

Most of the philanthropic infants' milk depots in 
this and other countries may be said to belong to the 
class of GouUes de Lait here described. The depots 
established and maintained in New York City by Mr. 
Nathan Straus belong to this class ; so also do those 
in Philadelphia, Chicago, Yonkers, N.Y., and some 
other cities. The milk is generally pasteurized and 
modified, following the leadership of the Straus 
depots. While there are some very poorly managed 
GouUes de Lait in France and Belgium, I should say 
that, speaking generally, the methods of distribution 
in those countries are far better than anything we have 
in the United States. InsufBcient care is exercised in 
distributing the milk in our American charity depots, 




REMEDIAL THEORIES AND EXPERIMENTS 199 

80 far as I have observed or been able to ascertain. 
Anything more incompetent than the management 
of some of them it would be impossible to imagine, 
and I seriously question the value of the work some 
of them are doing. 

Elsewhere * I have called attention to the fact that 
there is no efficient supervision of the distribution in 
connection with some of these charities. I observed 
in Yonkers that the modified milk mixture was sold 
in drug stores to whoever applied for it. There was 
no registration of the children receiving it, some 
babies receiving it more or less regularly, others only 
occasionally. little children, often not more than 
seven or eight years old, sent to the drug stores for 
''modified milk," got whatever the person serving 
them thought fit to give them. There was nothing to 
prevent a three-months-old baby getting a mixture 
intended for a year-old baby, or vice versa, and, of 
course, no medical supervision of the babies or sys^ 
tem of advising the mothers. Inquiry showed that 
these conditions were not exceptional ; that they were, 
on the contrary, pretty general. Even in the work 
of the Straus depots, as Mr. Straus perfectly realizes, 
there is lack of efficient supervision of the distribution 
and of a proper medical system of examining and 
watching the progress of the infants. And where the 

•In The BiUer Cry qf the ChOdren, pp. 237-288. 



196 THE COMMON SENSE OF THE MILK QUESTION 

modified milk from the depots is distributed through 
the medium of such voluntary agencies as some of the 
smaller social settlements and charitable societies, 
conditions are worse still. In short,^ there is a good 
deal of bungling in connection with the distribution 
of modified milk by some small charities and room 
for great improvement in connection with the very 
best. As a whole, our methods of distribution lack 
the efficiency of the French. This is all the more 
regrettable as I believe we have a much better supply 
to distribute than the French have. 

(3) MunidjxU Infants' Milk Depots. These require 
no special description. In the French and Belgian 
cities where there are municipal depots the only dif- 
ferences between them and the depots maintained by 
private philanthropy subsidized by public funds is 
that their maintenance is a public function and they 
are controlled by the municipal authorities. Fre- 
quently the volunteer committees are retained to 
assist in the distribution of the milk, visiting the homes 
of the children, and so on. The difference is one of 
fiscal policy mainly. Less hampered by lack of funds 
than those dependent on voluntary contributions, 
they are sometimes more efficient and generally better 
able to meet the demands for service. 



BSMEDIAL THEOBIES AND EXPERIMENTS 197 



Several English municipalities have established 
depots for the supply of infants' milk. The move- 
ment began with the city of St. Helens, Lancashire, 
which, under the able leadership of the Medical Officer 
of Health, Dr. F. Drew Harris, adopted a plan some- 
what similar to the GouUes de Lait of Paris, in the 
summer of 1899.^^ I was residing at the time in Gla- 
morganshu^, and I remember with what interest we 
followed the new experiment. Every indication of a 
lowering of the infantile death-rate was regarded as 
a sure sign of the early triumph over needless infant 
mortality, and I recall with what enthusiasm I lec- 
tured upon the new movement and secured the adop- 
tion of resolutions in its favor. Since that time the 
idea of providing a special milk supply for infants 
as a part of the business of the municipality has made 
rapid progress. After two years' successful experience 
at St. Helens had demonstrated that infants' milk 
depots were not to be pooh-poohed and scorned, but 
must be seriously regarded, the cities of Liverpool, 
Ashton-under-Lyne, and Dunkinfield established de- 
pots. That was in 1901. The year following Bat- 
tersea opened a depot and was followed in 1903 by 
Leith and Bradford and in 1904 by Burnley, Glasgow, 
and Dundee. This is not a complete list of the mu- 
nicipal infants' milk depots in Great Britain, but it 
sufficiently indicates the great progress of the idea 



198 THE CX>MMON SENSE OF THE MILK QUESTION 

and the fact that the cities adopting it are among 
the very first in importance.* 

In most of these British depots the milk is modified, 
or, as they prefer to say in England, "hmnanized." 
The milk mixture is sterilized, as a rule, and sold at 
something less than the actual cost of production, the 
deficit being met out of the municipal funds. Gen- 
erally the municipal authority, through its Medical 
Officer of Health, or a committee elected for the pur- 
pose of controlling the depots, makes a contract with 
some farmer for milk of a certain quality in quantities 
which must be either increased or decreased within 
reasonable limits at very short notice. Ciows have to 
be tested with the tuberculin test and the stables 
and dairies to be subject to very strict supervision. 
The udders and tails of the cows have to be thoroughly 
washed, utensils scalded, and the kind of food to be 
fed to the cows is prescribed. In most instances, 
though there is no rule that I am aware of which 
forbids the sale of the milk to whoever asks for it, the 
children who get the milk get it as a result of medical 
advice." The vast majority of the infants supplied 
are sick when they begin to take the milk. This is a 
imiversal condition and must be taken into account 
when the relation of the milk depots to infantile 

* There are several private philanthropies in EIngland which 
carry on work very similar to the GouUea de LaU, notably one 
at York, led by Mr. Seebohm Rowntree. 



REMEDIAL THEORIES AND EXPERIMENTS 199 

mortality is considered. In Paris, it is the mother 
whose baby does not thrive upon the proprietary 
foods or the ordinary cow's milk that seeks the GoiUte 
de Lait. In New York CSty such mothers go to the 
Straus depots, and in Liverpool or Battersea to the 
municipal, depots. As a rule, the children who 
manage to get along with ordinary milk are not taken 
to the infants' milk depots anywhere. 

Most of the British depots have some system of 
registration, and the homes of children receiving milk 
from them are from time to time visited by lady 
visitors, sometimes paid, but often volunteer workers. 
The depots are in charge of women, in many cases 
trained nurses, and it is their duty to advise the moth- 
ers to nurse their babies at the breast if possible and 
to keep a record of the children's progress. Natu- 
rally, however, they can only make a very superficial 
examination of the children, by no means equal to 
that customary in connection with the French de- 
pots, where there are regular medical examinations. 
It is not insisted upon, moreover, that the children 
be brought to the depots for regular examination. 
This phase of the work is done in a manner that is 
far from satisfactory, a fact which is recognized very 
clearly by the authorities themselves. There is a 
growing desire for the adoption of a system of medical 
supervision in connection with the depots, somewhat 
similar to that obtaining in France. The more pro- 



200 THE COBOfON SENSE OF THE BfILK QUESTION 

gressive leaders of the movement, like Dr. McCleary 
of Battersea, are also urging the necessity of controlling 
the whole process of production as well as the distribu* 
tion of the milk^ — regulating and managing every step 
taken, from "the cow to the child's bottle." " 

In Battersea and some other places the mothers 
are provided with cards upon which to record the 
changes in the weight of their babies, and they are 
urged to bring them to the depots to be weighed at 
least once a week. It seems, however, that British 
mothers do not as yet take kindly to this idea, and very 
few infants are brought to the depots for that pur- 
pose. Possibly they could, by means of simple lec- 
tures and friendly talks in their homes, be interested 
in this and awakened to a realization of its importance ; 
or something might be done in the way of stirring 
up a healthy local rivalry among mothers, for it is 
well known that, once they are started, mothers are 
very proud of the gains made from time to time in the 
weight of their babies. 

So far as I know, there is no municipal infants' 
milk depot anywhere which is entirely self-sustaining. 
The aim is to supply milk at a very low cost and of a 
high standard of excellence. Naturally, there is a 
good deal of expense attached to the bottling and clean- 
ing of bottles when, as is generally the case, the milk 
is put up in small bottles, each holding the proper 
amount for a single meal. Wire baskets are supplied 



REMEDIAL THEORIES AND EXPERIMENTS 201 

for carrying a day's supply, forming quite an item 
of expense. Then, too, there are breakages, which 
also involve considerable expense. The losses di£fer 
greatly, according to the scope of the work, the 
amount spent upon visitors' salaries, and the number 
of children served, varying from a weekly loss of less 
than $1.50 in Leith,^" to a loss of more than $10,000 
a year in Liverpool." The deficit in Liverpool seems 
very high and has been the subject of much criticism. 
It must be understood, however, that the yearly 
expenditures are so made up as to include cost of 
machinery, alterations of buildings, and other items 
usually charged to capital stock, and also that the 
Liverpool depot is the largest of its kind in England, 
and, I believe, in the world. The average yearly 
deficit of the St. Helens depot during the foiu* years 
1900-1904 was about $875 and the average number 
of children on the books about 240, whereas Liverpool 
had in two and a half years 6295 infants on its books 
who were supplied from the depot during that time. 
It is interesting in connection with this question of 
finances to observe that in some cities, notably Brad- 
ford and Ashton-under-Lyne, unmodified sterilized 
milk for older children is sold in pint bottles at a profit 
which helps to reduce the loss on the infants' supply.^* 
Bradford also sells milk wholesale to the municipal 
hospitals and cream and eggs to the public at the 
depot, the profits on which reduce the deficit on the 



202 THE COMMON SENSE OF THE MILK QUESTION 

infant milk supply.^^ This is, of course, a considerable 
step in the direction of municipalization advocated 
earlier in the present chapter. 

VI 

Now let us compare, briefly, the formulas of some 
of the more important depots, philanthropic and 
municipal, at which sterilized or pasteurized mixtures 
are distributed. 

In the French Gouttes de Laii, it may be well to 
repeat, modification is unusual, the practice being to 
give milk of full strength, even to very young babies, 
but either to sterilize it, as in Paris and Havre, or to 
pasteiuize it, as in Beauvais and Pol-sur-Mer. In 
Fecamp, however, modification is practised, the for- 
mula being : " — 

Water One part 

Milk Two parti 

with 

Centrifugal Cream 16 grammes 

Lactose 85 grammes 

Salt 1 gramme 

to each liter. 

This is heated to a temperature of 102^ centigrade, 
and kept at that temperature for forty minutes. 

In the Straus depots. New York CSty, the following 
formulas are chiefly used, all mixtures being pas- 
teurized by heating to a temperature of 167° Fahren- 
heit, and exposing it to that temperature for twenty 
minutes." Formula No. 1 was prepared by Dr. 



REMEDIAL THEORIES AND EXPERIMENTS 



203 



Rowland 6. Freeman and Formula No. 2 by Dr. A. 
Jacob!. 

Formula No. 1: 

Sugar of milk, 12 oonoes 
Lime-water, one half -pint 
Filtered water up to one gallon 
Milk, one gallon 

FoBMULA No. 2: 

1 gallon milk 

1 gallon barley water 

8 oonoes white (cane) sogar 

} onnoe salt 

In the English municipal depots a very different 
system of modification is adopted. As will be seen 
from the subjoined tables, showing the formulas of 
the Liverpool and Battersea depots, they approximate 
percentage-feeding, as it is termed in this country. • 
Furthermore, in most cases, when requested by medi- 
cal men, the usual formula is altered to suit indi- 
vidual requirements.** 

Table VII. Modified Milk Foricula — Battersea Depot 







No. or 


AjioiniT 


Akoubt 


A«s or Child 


MODIFXOAflOS 


Bonun 


PSB 


PBS 






Dailt 


BOTTLS 


Day 


During Ist fortnight 


Milk 1 part» water 2 parts 


9 


l|oz. 


134 oz. 


Daring 2d fortnight 


Milk 1 part, water 2 parts 


9 


21 OZ. 


224 oz. 


Daring 2d month 


Milk 1 part, water 2 parts 


9 


24 OK. 


224 oz. 


During dd month 


Milk 1 part, water 1 part 


9 


3oz. 


27 oz. 


Daring 4th month 


Milk 1 part, water 1 part 


8 


4oz. 


82 oz. 


During 5th month 


Milk 2 parts, water 1 part 


7 


0OZ. 


86 oz. 


Daring 6th month 


Milk 2 parts, water 1 part 


7 


6oz. 


85 oz. 


Daring 7th month 


Milk Ukmoditued 


6 


6oz. 


86 oz. 


Dnring 8th month 


Milk Unmodified 


6 


7oz. 


42 oz. 



204 THE COMMON SENSE OF THE MILK QUESTION 



Cream and sugar are added to the modified milk to 
bring the proportion of fat and sugar to about 3.2 
and 6 per cent respectively. The dilutions and 
amounts given were based upon a leaflet issued by the 
Medical Committee of the Great Ormond Street (Lon- 
don) Hospital for Sick Children. Since 1904 unmodi- 
fied milk has been given to children over six months 
of age, and the change has been beneficial. 

Having been filled into sterilized bottles^ this mix- 
ture is heated to 212^ Fahrenheit, in a sterilizing 
chamber, where it is kept for a period of from fifteen 
to thirty minutes. The bottles are then taken out 
and rapidly cooled. The milk is given out in wire 
baskets, each containing a supply for twenty-four 
hours, from six to nine bottles. In the winter time 
the supply for Sunday is given out on Saturday, but 
in the summer time it is prepared on Saturday evening 
and given out on Sunday morning. ^ 

The Liverpool preparation is as follows: — 

Table VIU. Modified Milk FoitMULA — Liverpool 

MuKiciPAL Depot 



AOB 


OirxoM or Pvbs 
Milk ih 84 Hoitbs 


Watbb nr Ouvobb 


1-2 weeks 

2--8 weeks 

2-8 months 

8-5 months 

6-7 months 

Over 7 months 


181 

20} 

80 

86 

36 


181 

lOi 

IS 

12 

12 



To each gallon of mixture add i oz. cream, 1| oz. sngar, and 1 oz. salt. 



REMEDIAL THEORIES AND EXPERIMENTS 205 

As in the case of Battersea and most other English 
depots, Liverpool sterilizes the mixture sold at the 
infants' depot. The mixture is bottled and then ster- 
ilized, the temperature of the sterilizer being 210^ 
Fahrenheit and the exposure from twenty to thirty 
minutes. 

vn 

A municipal infants' milk depot of a very different 
kind from either those of England or any of the coun- 
tries of Continental Europe is the one in Rochester, 
N.Y., which deserves special attention because of the 
fact that it has discarded pasteurization and achieved 
remarkable results through supplying clean, raw, 
modified milk. The fame of Rochester's infant milk 
depot * has spread throughout the world, so that to- 
day its Health Officer, Dr. George W. Goler, is probably 
even better known to the leaders of the medical pro- 
fession throughout Europe than in this country." 

To imderstand the "Rochester System " of supplying 

* Throughout this discuasion I have used the singular noun 
for the sake of simplicity. In some cities there is a single de- 
pot, i.e., one place where milk is distributed. In other places 
there are several. When I speak of the " Liverpool depot/' 
the " Rochester depot/' and so on, the reader will please bear 
in mind that there are sometimes several depots in some cities; 
while in others, as in Rochester, there is a central station, or 
depot, with a number of branch distributing stations. I could 
not get the number of these branches in every case, — and, 
anyhow, the ntunber varies from year to year, — so I judged it 
best to use the singular noun with this explanation. 



V 



206 THE COMMON SENSE OF THE MILK QUESTION 

clean, raw, modified milk for infants it is necessary to 
know something of the city and the steps by which 
the system has been developed. Rochester is a city 
of nearly 200,000 inhabitants. There is something 
of the freedom and progressiveness of the West about 
it, shot through with the conservatism of New Eng- 
land. With about five thousand births per annum 
there must be at all times nearly twenty thousand 
children under five years of age in the city. Its 
daily milk supply is drawn from something like seven 
hundred farms, all lying within a radius of fifty or sixty 
miles. It is distributed by two hundred and twenty- 
five retailers, each of whom is licensed and pa}rs an 
annual fee of $2. Its milk problem is, therefore, 
radically diflFerent from that of our greatest cities, 
like New York or Chicago, and is much more typical 
of the average American city. 

They have no legally established bacteriological 
standard for milk in Rochester. It is part of the 
Rochester creed that a high bacteriological standard, 
say of 500,000 per cubic centimeter, is a good deal 
less desirable than none at all. If they had a city 
ordinance forbidding the sale of milk containing 
more than 100,000 bacteria per cubic centimeter, 
it is probable that they could not successfully en- 
force it, and the result would be general demorali- 
zation. But they have in Rochester a very active 
and progressive Milk Commission, established in 1900 



Hi 
ill 

i I 



«i 



• • • « 



• • , 



HBMEDUL THEORIES AND EXPERIMENTS 207 

by the Rochester Academy of Medicine, that certi- 
fies milk of a specially good grade which, as '' certified 
milk," readily sells for a few cents a quart over the 
average price paid for city milk. The require- 
ments of the Milk Commission are very rigid, and 
its certificate is a guarantee to the consumer of : — 

(1) Character of stables and feed of cattle, health of 
milkers, and care of utensils used. 

(2) A negative tuberculin test. 

(3) A bacterial standard not greater than 10,000 
bacteria per cubic centimeter. 

(4) A nutritive value of 12^ per cent solids, of 
which 4 per cent must be fats. 

The influence of this Ccmunission extends far be- 
yond the small proportion of the milk supply which it 
certifies as fulfilling these requirements. The Com- 
mission has, among other things, created a good deal 
of public interest in the milk supply, which has been 
of enormous advantage to Dr. Goler and his assistants 
in their efforts to get a city milk supply with a bac- 
terial count not greater than 10,000 per cubic centi- 
meter. 

Moral suasion is the force upon which the greatest 
reliance is placed. Dr. Goler has wisely recognized 
all the conditions resulting from the ignorance of 
milk producers and retailers, and set himself to teach 
all who are teachable how to produce a better class of 
^ilk. In order to do this he has had to show them 



208 THE CX)MMON SENSE OF THE MILK QUESTION 

the importance of cleanliness in producing and han- 
dling milk to the public health, a gigantic task in 
which he has been splendidly suded by his assistants. 
When moral suasion fails, as it sometimes does, then 
resort is made to sterner measures, such as arrests, 
fines, and revocation of licenses. 

As a backgroimd to the infants' depot, then, we have 
in the first place the Milk Commission with its edu- 
cational influence, and, secondly, the Health Bureau 
with its alert and progressive officials working as 
follows : (1) examining four or five thousand samples 
of milk annually for nutrient value; (2) making 
bacteriological examinations of about one thousand 
samples of mUk annually; (3) inspecting dairies and 
stables for cleanliness; (4) registering against the 
name of each milkman the number of families with 
infectious diseases to whom he supplies milk, so that 
the danger of the milkman's carrying scarlet fever, 
diphtheria, or typhoid fever to his customers may be 
minimized; (5) through ordinance and license and 
educational means trying to get the milkman to raise 
his standards, and when these fail resorting to sterner 
measures. It will be seen, therefore, that Rochester 
is an exception among cities in the intelligence and 
breadth of the measures adopted for the improvement 
of its milk supply. 

Prior to 1897 the infantile death-rate in Rochester 
was, as in most cities, very heavy, notwithstanding 



REMEDIAL THE0BIE8 AND EXPERIMENTS 209 

the many physical advantages of the city. There was 
a system of milk inspection, it is true, but it was wo- 
fully inadequate and inefficient, as is customary in 
American cities. There were one or two inspectors 
with whom sobriety was not a strong point, and they 
were known to "borrow" money occasionally from 
milkmen. That they should protect the milkmen in 
return for these favors was a natural result. From 
1888 to 1896 inclusive, a period of nine years, the 
number of children under five years of age dying from 
all causes was 6629. I put the figures this way, giving 
the total number of deaths imder five years of age 
from all causes, because it is the Rochester way of 
looking at the question. It is part of the Rochester 
creed that whenever a child under five years of age 
dies from any cause not accidental or violent, the 
death may be assumed to have been due, partly at 
least, to the dirty and unwholesome character of its 
food. 

In 1897 Dr. Goler established an infants' milk 
depot for the two months, July and August, during 
which the tide of infant mortality always rises. The 
work began in a very primitive way, and the total 
cost to the city was $300. A store was rented in a 
very thickly populated district and fitted with running 
water, gas stoves, counters, and shelves. Two of the 
hospitals of the city each placed a nurse at the dis- 
posal of Dr. Goler, and they pasteurized the milk, 



210 THE COMMON SEN8B OF THE MILK QUESTION 

cooled and bottled it, and sold it at cost to the mothers 
who came for it. A little pamphlet, a model of wis- 
dom, brevity, and lucidity, entitled "How to take 
Care of Babies," was printed in four languages and 
freely distributed. We know now in a general way 
just how the money was spent. The results are 
roughly indicated, but not scientifically measured, 
by the statistics which follow.** In order to get 
the fairest possible idea of the influence of the infants' 
milk depot upon the mortality of infants in the summer 
months, I have divided the period from 1888 to 1896 
inclusive into three three-year periods and ^ven 
the mortality of infants in each of the years for the 
months of July and August. Then, for purpose of 
comparison I have given sinular figures for the three 
years, 1897 to 1899 inclusive, the period during which 
the milk sold at the infants' depot was pasteurized. 

Tabls IX. Showing Total Deaths of Childben under 
6 Tears of Aoe in the Summer Period before and 

AFTER THE ESTABLISHMENT OF InFANTS' DePOTS FOR 

THE Supply of Pasteurized Milk. 



▼VAK 


JCTLT DSATBB 


August Dbaths 




Under 1 Yaftr 


lto5Ytwi 


Undtf 1 Y«tf 


lto5YMn 


1888 .. . 

1889 . . . 

1890 . . . 


90 
188 

88 


28 

18 
18 


118 
88 

94 


25 
24 

18 


Totals . 


811 


64 


296 


e7=s787 



KKMWDTATi THE0BIK8 AND EZPEBOIENTS 



211 



Tbax 


JULT DbAVU 


AVGTOT DbATBB 


UnOmlYmr 


ItoSTMra 


UndarlTaw 


Ito&Tflus 


1881 . . • 

1882 . . . 
1888 . . . 


81 

101 

88 


15 
26 
16 


83 

104 

85 


17 
84 
18 


Totals • 


281 


67 


282 70 = 680 


1884. . . 
1886. . . 
1888 • • • 


82 
82 

108 


12 
16 
18 


72 
56 
68 


28 
11 
17 


Totals . 


282 


46 


187 67 = 672 


1887 .. . 

1888 . • . 
1888 . . . 


48 

47 
61 


7 
11 
88 


44 
47 
44 


18 
10 
18 


Totals . 


141 


61 


136 41 = 868 



The year before the establishment of the infants' 
milk depot the total number of children imder five 
years of age dying during the months of July and Au- 
gust was 202, but the number during the same period 
of 1897 was 107. But if we take the average of 
July-August deaths for the nine-year period, 1888 
to 1896, we find the number of deaths to be consid- 
erably higher than in 1896, the number being 222. 
Now, whether we compare the 107 deaths recorded in 
1897 with the number recorded during the same period 
in the year preceding it, or with the average niunber 



212 THE COMMON 8SNSE OF THE MILK QUESTION 

recorded during the same months in the nine-year 
period, the result is to show a remarkable decline. 
Perhaps, however, the fairest comparison would be 
between the three years, 1897 to 1899 inclusive, and 
the three years, 1894 to 1896 inclusive. In the latter 
period there were 572 deaths of children under five 
years of age recorded in the months of July and Au- 
gust, as shown in the preceding table. In the three 
years, 1897 to 1899 inclusive, the number of such 
deaths was 368, a decrease of over 35 per cent ! 

It is not contended that the remarkable decrease 
of infant mortality indicated by these figures was due 
entirely to the distribution of milk from the infants' 
depots. It is never possible to completely separate 
the factors entering into mortality statistics. Doubt- 
less the distribution of simple instructions to mothers 
on the care of their babies and the friendly advice 
given by the nurses helped a good deal, while the 
improvement in the general milk supply of the city 
and the intelligent public interest in the subject were 
also factors of very great importance. Rochester's 
system must be considered as a whole if we would 
understand it. 

There were a good many wiseacres who thought 
that the irreducible minimiun of infant mortality 
had been reached, that further progress could not be 
expected. I suppose that most men would have been 
satisfied with so great an achievement, but not so Dr. 



REMEDIAL THEORIES AND £2a»£RIMENT8 213 

Goler. While satisfied with the return made for a 
ridiculously small sum of money invested, a dividend 
in human lives rarely equalled, he would not, could 
not, believe that the limit had been reached. An idea 
obsessed the mind of this earnest and far-seeing offi- 
cial: "Pasteurization is good for dirty milk — dead 
disease germs are less harmful than living ones ; but 
why have filth in milk at all — why not aim at clean 
milk which needs no pasteurization?" That simple 
idea of cleanliness has made Rochester famous wher- 
ever men and women are seriously trying to grapple 
with the problem of keeping the babies alive. It is 
the essence of the political economy of saving babies' 
lives. 

So, in 1900, instead of pasteurized milk for the in- 
fants. Dr. Goler tried clean raw milk. A contract was 
made with a farmer for all his milk at so much per 
quart, upon condition that he would observe all the 
hygienic directions of Dr. Goler and his assistants, 
which were purposely made as simple as possible, de- 
manding a minimum of outlay. A portable labora- 
tory, consisting of an old, discarded election booth, 
was set up on the selected farm. Outside the house, 
under canvas, a sink and running water were set up 
for washing the bottles. Then there was a tent for 
sterilizing purposes, with sterilizers each containing 
two gross of nursing bottles — for here, instead of 
sterilizing the milk, they sterilize the bottles and cans. 



214 THE COBIMON SENSE OF THE UILK QUESTION 

Another tent was provided for the nurse in charge to 
sleep in; the entire ''plant" costing between $500 and 
$600. Strangely enough, this very simplicity of the 
system, which is its strongest feature, is the feature 
which I have heard most disparaged; visitors are 
frequently disappointed that there is nothing to see 
except a shed, some tents, and people trying to be 
clean in handling milk. 

The result of the experiment was watched with 
great interest that first season ; could Dr. Goler main- 
tain the low death-rate attained as a result of pas- 
teurizing the infants' milk sold at the depots, or was 
he gambling with the lives of babies ? Many were the 
dire prophecies made concerning this vital matter. I 
recall receiving a letter from an interested observer 
of the Rochester experiment which dolorously ended 
somewhat as follows: " Dr. Goler's decision is unfor- 
tunate. Failure is inevitable, and the work of years 
will be thrown away. C!ould not something be done 
to dissuade him 7 " But, fortunately. Dr. Goler was 
not dissuaded. He had counted the cost and pinned 
his faith to clean milk as a result of profound study. 
His policy was revolutionary, but it was vindicated 
when it was shown that, not only had the gains made 
during the three preceding years been maintained, but 
actually improved upon. I give the figures for the 
six years, 1900 to 1905 inclusive, divided into three- 
year periods for the purposes of ready comparison. 



BEICSDIAL THEORIES AND EXPERIMENTS 215 

Table X. SnowiKa Total Deaths of Children undeb 
5 Teabs of Age in the Summer Period under Pas- 
teurization AND Clean Mils Methods 



Tkab 


JVLT Dbatsb 


AvovtT Dbatbs 




Under 1 Tear 


1 to STMT* 


Under 1 Teer 


1 to 6 Teen 


1897-1899 


141 


51 


185 


41=868 


1900 
1901 
1902 


50 

87 
26 
82 
15 
58 


16 
12 
5 
16 
11 
10 


54 
88 
48 
84 
48 
60 


14=184 
8= 95 
20= 94=228 


1908 
1904 
1905 


18=100 
6= 75 
13=186=811 


Totals for 
six years 


218 


70 


272 


79=684 



When it is remembered that these figures give the 
total number of deaths, and that the population of 
Rochester is an increasing one, the remarkable char- 
acter of the statistics becomes evident. During the 
period 1894-1896 inclusive, there were 572 deaths, 
an exceptionally favorable showing under the old 
conditions. During the period 1897-1899 inclusive, 
when the milk depots were in operation, supplying 
pasteurized milk, there were 368 deaths recorded dur- 
ing the same two months for the year; in the period 
1900-1902 inclusive, with infants' depots supplying 
clean, unpasteurized milk, the number was 223, 
a remarkable decline in view of the decline made dur- 



216 THE COMMON SENSE OF THE MILK QUESTION 

ing the preceding period. During the next three 
years, 1903-1905 inclusive, the number was greater, 
311, but still appreciably less than in the pasteuriza- 
tion period. 

Looked at in another way, the figures make an even 
more remarkable showing. During the nine years, 
1888 to 1896 inclusive, there were 1999 deaths of 
children under five years of age in the months of July 
and August ; but during the period 1897 to 1905, the 
following nine years, distinguished by the work of 
the infants' milk depots, the number of deaths in the 
same months was only 1000 ! The number of deaths 
vxis just half, notwUhsianding that the population had 
increased something like twenty per cent! I know of 
nothing to equal this record in the history of any city 
in the world. And the cost of this great work to the 
city has been barely a thousand dollars a year, less 
than the salary of a good inspector. 

In the manner indicated by our analysis of the 
statistics it is possible to obtain an approximate idea 
of the extent to which the mortality of infants has 
been reduced, but no figures can ever show the gain 
to society through the prevention of needless suffer- 
ing, or the number of children who have been enabled 
to start life fairly, without the handicap of weakened 
constitutions, as a result of the work done by the 
city in providing them with a safe and wholesome food 
at a critical period in their infancy. Nor can the 



REMEDIAL THEORIEB AND EXPERIMENTS 217 

effect of the work upon the ordinary milk supply of 
the city be properly measured. Each year, for edu- 
cational reasons, a different farm has been selected, so 
that each year one farmer has had practically two 
months' personal instruction in milk hygiene. Gradu- 
ally the farmers are learning the lesson; learning to 
trust the man who pooh-poohed their smart copper 
and nickel appliances, their silver-plated centrifugal 
machines which gathered balls of dung and hair from 
the milk. They are learning that it is better and more 
economical to keep their bams and stables clean, to 
wash the udders of theu* cows, to see that the milkers 
are clean; they are learning that when these things 
are done, and all utensils are perfectly sterilized, less 
babies die in the city. 

vm 

There are still some persons who believe that there 
is no necessity for the establishment of infants' milk 
depots. Their position is that, bad as conditions un- 
deniably are, the proper thing to do is to secure a 
better general milk supply; that the ordinary milk 
supply of any city can be so improved as to do away 
with the need of making special provision for infants. 
The objection seems plausible enough at first, but I 
have yet to learn of any city, either in this country or 
abroad, having such a milk supply. There is not in 
the world, so far as I know, a single city with a milk 



218 THE COMMON SENSE OF THE MILK QUESTION 

supply 80 pure as to be a safe food for babies. The 
question arises, what is to be done in the meantime; 
are we to go on letting the babies needlessly die until 
such time as we have perfected our milk supply? 

Personally, I do not believe that the yoimgest 
reader of these pages will live to see the time when 
the ordinary milk supply of any large city will be 
satisfactory for infant feeding. With Dr. Brush, I 
believe that we need a separate diury for producing 
milk fit for infants' food, that we need to separate 
the production of milk for infants entirely from the 
commercial milk supply.*^ As Dr. Brush has pointed 
out, the dairy cow is a tuberculous animal, and as a 
rule, the tuberculous cow is a more abundant milk- 
giver than the non-tuberculous cow.*' The reason for 
this is that we have bred cows solely for dairy pur- 
poses, inbreeding to an extent which has weakened 
them. One can go into almost any large dairy estab- 
lishment when animals are condemned for slaughter 
as a result of the application of the tuberculin test, 
and discover for himself that the condemned animftlg 
are, in many cases, among the best and most abun- 
dant milk-givers in the herd. Everjrthing has been 
sacrificed to getting an abundance of milk containing 
a high percentage of fats and solids at the cheapest 
possible rate. Very often the cow that is undesir- 
able for ordinary dairy purposes, her milk being of 
small quantity and deficient in fats, would make a 






* • • 



t 



BEMEDUL THEORIES AND EXPEBIMSNTS 219 

most desirable animal for supplying milk specially 
intended for infants. 

Further, to get a really satisfactory milk for infant 
feeding, we must have what Dr. Roby has called " the 
application of surgical principles to the milk busi- 
ness.'"* The Certified Milk Movement has shown, 
however, that it is practically impossible to get any 
considerable number of milk producers to observe 
its requirements, and then only at a price which makes 
the milk an unattainable luxury for all except the 
favored few. They have one or two farmers pro- 
ducing such milk for Rochester, but when the best 
city milk was sold for six cents a quart, the certified 
milk was sold for nine cents a quart. In Newark, 
N.J., under the direction of Dr. Coit, they have a 
Milk Commission which certifies the milk from one 
farm. But when the best grades of bottled milk 
were sold in the city for eight cents a quart, the certi- 
fied milk brought fifteen cents a quart. Fifteen cents 
is the usual price of certified milk in New York City, 
but there are some firms that charge twenty cents, as 
against eight cents for the best grades of bottled milk 
supplied by the ordinary trade. It is not surprising 
that the quantity of certified milk sold in any city 
should be as ''a drop in a bucket," that out of 
1,500,000 quarts of milk consumed in New York 
City each day not more than 8000 quarts should be 
certified. 



220 THE COMMON SENSE OF THE MILK QUESTION 

I am firmly of the opinion that it is the duty of the 
municipality to undertake the production and distri- 
bution of milk specially intended for infant con- 
sumption, equal in quality to the very best that can 
be produced by private producers, at a price within 
the reach of the people, a price which would not be 
greater than the average price for ordinary market 
milk, so that no child might be exposed to danger as 
a result of the abQity of its mother to buy "cheaper" 
milk. Whatever deficit might be incurred by this 
means would, of course, be a public charge to be met 
as ail other such charges are met. Further than this 
I do not believe any eleemosjmary features should go. 
We do not need infants' milk depots as charitable in- 
stitutions, but rather as common, public necessities 
to be used by all classes in the community as the 
public schools now are. For the indigent, those who 
cannot pay anything or only part of the price, some 
system should be adopted by means of which all 
charged with the relief of poverty could issue orders 
for milk, to be paid for by the public department, 
charitable organization, or individual issuing the order. 

If I appear to lay undue stress upon the opinion that 
the infants' milk depot should be a municipal enter- 
prise, and not a charity conducted by some voluntary 
philanthropic agency, it is because, in the first place, 
I believe that, outside of very narrow limits, which I 
propose to indicate, such philanthropies are morally 



REMEDIAL THEORIES AND EXPERIMENTS 221 

indefensible, and detrimental to the development of a 
spirit of civic righteousness. Investigation and ex- 
periment are very proper spheres for voluntary action 
such as that which led to the establishment of hos- 
pitals, cricheSf maternities, milk depots, and so on 
through a formidable list of social services which have 
been assumed by voluntary agencies. It was emi- 
nently right and proper for Mr. Straus — to use a 
concrete illustration — to establish milk depots for 
infants in order to find out whether the excessive in- 
fantile mortality could be reduced by such means. 
On the other hand, it is decidedly wrong and im- 
proper, in my judgment, that the city of New York 
should allow the work to remain in the hands of Mr. 
Straus, or any other individual or society. Not only 
is the work inadequately done and its continuance 
dependent upon too slender a thread, but, far more 
important, a great city is demoralized to the extent 
of shifting its collective responsibility on to other 
shoulders than its own. In the case of an individual 
we readily enough recognize the demoralization of 
this kind of thing, but, for some reason not obvious, 
we do not recognize it in the case of a commimity. 

Then, also, there are the more immediately prac- 
tical objections, that nobody ever has a means of 
knowing readily whether the work is adequately or 
efficiently done, and that voluntary agencies, as Sir 
John Gorst points out *^ as the result of a long and 



222 THE COMMON SENSE OF THE BULK QUESTION 

intimate experience with them^ become, almost in- 
variably, conservative and hostile to progress. There 
are several reasons for this. In the first place, it is 
perfectly natural for people who have organized them- 
selves into an association for doing certain work, 
when it is proposed that the work shall be done by 
the community as a whole through its constituted 
authorities, to say: " That is our work. We are doing 
it as well as it can be done. If the public want it 
better done, let them support us more liberally." 
That is the most humble and the least arrogant posi- 
tion they ever take. 

The more common position is that the work is 
being done and there is no further need. This feeling 
is fostered by interested secretaries, directors, collec- 
tors, and other officials, who feel, rightly or wrongly, 
that they have vested interests to protect against 
attack. For example, take the Society for the Pre- 
vention of Cruelty to Children and its attitude 
toward juvenile probation in this state. I am a 
member of the Board of Directors of the Westchester 
County S.P.C.C, and, it is superfluous to add, thor- 
oughly in sympathy with the aims of the organization. 
But everybody knows that the leaders of the society 
have consistently opposed the appointment of pro- 
bation officers other than its own officials and thwarted 
the development of a very important work, partly 
from jealousy, and partly also as a result of the agitar 



REMEDIAL THEORIES AND EXPERIMENTS 223 

tion carried on by interested officials. Infants' milk 
depots have passed the experimental stage ; and there 
is no good reason why the cities should shirk their 
responsibility in this matter and leave the work to 
private enterprise to be done well or ill, completely 
or incompletely, according to the will or the mental 
or physical equipment of those imdertaking it. 

IX 

There has been so much statistical juggling with 
regard to the influence of infants' milk depots upon 
the infantile death-rates, alike by friends pleading 
their cause and opponents attacking them, that I am 
tempted to leave the matter alone, except in so far 
as it has been touched upon in preceding pages. I 
know of no subject in connection with which figures 
have been used with more recklessness than that of 
the influence of infants' milk depots upon the mor- 
tality of infants. So many factors, which no statis- 
tician can properly evaluate, enter into the infant 
mortality rate that unless the greatest care is exer- 
cised wrong conclusions are almost inevitable. For 
example, in a certain city there has been, during a 
period of five years say, a marked decline in the 
number of infant deaths, and it happens that the 
period of decline is coincident with the period during 
which an infants' milk depot has been in operation. 
It is not unnatural that in such circumstances the 



224 THE COMMON 8ENBE OF THE MILK QUESTION 

milk depot should be given all, or nearly all, of the 
credit for the decline, especially by its enthusiastic 
advocates. But the student must move slowly and 
take . account of many other matters. What, for 
example, were the climatic conditions? Was there 
any improvement in the sanitary system ? Were the 
streets kept cleaner than formerly? Was there a 
general decline throughout a large part of the coun- 
try, due to a marked freedom from epidemics ? Was 
there any industrial change which enabled more 
women to care for their babies? Were there other 
agencies beside the depot in operation, such as crichea 
and day nurseries, district nursing, children's hos- 
pitals, or dbpensaries ? In a word, the student must 
take into account all the facts. 

Again, figures are sometimes published in connec- 
tion with criticisms of infants' milk depots, professing 
to give the mortality among children fed upon milk 
supplied by the depots and invariably showing a high 
rate of mortality. Such figures are quite deceptive, 
for the reason that, as stated elsewhere in this chap- 
ter, most of the infants brought to the depots are 
more or less sick and debilitated already, so that the 
mortality rate, like the mortality rate among hospital 
and dispensary patients, would naturally be high. 
Further, the number of infants receiving milk from 
the infants' milk depots in many cities is too small to 
have any appreciable effect upon the mortality rates. 



HFiMTiDTAL THEORIES ASV SXPERIMENTS 225 

Take the French depots, for example. Dr. Peyroux, 
a keen critic of the GovUes de Laity has pointed out 
that they have not very materially reduced the in- 
fantile death-rate, so far as can be ascertained from 
the complete mortality returns of some of the cities 
where they are established.'^ But it could hardly be 
expected that a depot should materially affect the 
infant mortality rate of the city, when the number of 
children attending it is ridiculously small in propor- 
tion to the total infant population. In Paris, for 
instance, there is an infantile population of over 
40,000, but not more than 800 or 900 are cared for 
by the Consuitaiions de Naurrissons and GauUes de 
Lait.^ At Grenoble, to cite the case of a smaller city, 
the average number of births during the years 1891- 
1901 was 1357, but only 72 infants per annum were 
fed from the GauUe de Lait.^ That these depots do 
prevent a considerable nimiber of infants from dying 
is unquestionable, I think, by any person who has 
studied them. At the same time, they touch only a 
very small proportion of the infantile population. 
Professor Budin has compiled statistics to show that 
at his Considtation at the Clinique Tamier during 
five years the death-rate shown among the children 
attending was only 46 per thousand as against 178 
per thousand for the whole of Paris.*^ Unfortunately, 
the figures are rather inconclusive, for the very vital 
reason that the death-rate of 178 per thousand cited 



226 THE COMMON 8BNSE OF THE MILK QUESTION 

for Paris applies to children under one year^ while 
some of the children attended the Consultation up to 
two years of age. The Consultati^m, moreover, can- 
not be fairly classed with the infants' milk depots. 
Turning to the English depots, we are confronted 
by the same difficulties. Either too few children are 
connected with the depots, statistics are not intelli- 
gently kept, or they are open to serious question 
owmg to the fact that many factora are unaccounted 
for. Some figure^ were published in connection with 
the Liverpool and Battersea depots three or four years 
ago which will go far to illustrate the latter point. 
From 1896 to 1900 inclusive, the average death-rate 
per 1000 bu-ths of children under one year old was 
188. In 1901 the first Liverpool depot was opened, 
and the rate for that year was also 188 per 1000 births. 
In 1902 a second depot was opened and the work 
greatly extended in its scope. That year the death- 
rate of infants was only 163 per 1000 burths, and m 
the following year there was another decline, to 151 
per 1000 births." Battersea's depot was opened in 
1902. Prior to the opening of the infants' milk depot, 
the average mortality among infants under one year 
old, during the five years immediately preceding, was 
161.8 per 1000 births. In 1902, the year of the open- 
ing of the depot, the number fell to 136 and the follow- 
ing year it again declined to 135 per 1000 births.*" 
These figures by themselves would indicate an u&- 



BBUEDIAL THEORIES AND EXPERIMENTS 227 

qualified success on the part of the mfants' depots, 
but, as a matter of fact, while it is believed the depots 
helped, climatic conditions were especially favorable 
in those years, and there was a general decline in the 
infantile death-rate throughout the country, so that 
the depots can only be credited with a part of the 
decline, a part not to be determined and separately 
set out. 

Dr. Newman, in the most serious study of the prob- 
lems of infantile mortality published during recent 
years, ^ves a very careful account of the Finsbury 
infants' milk depot and shows the mortality among 
children attending the depot, during the first year of 
life, to have been equal to 59.1 per 1000 births as 
compared with a mortality of 148.6 for Finsbury, but 
only 169 infants used the milk. There were among 
these 13 deaths, equivalent to a death-rate of 76.9 
per 1000 births, but as three of the children. were 
d]dng when first brought to the depot; so that theu* 
case was hopeless from the first, these should properly 
not be counted.'^ Now, small as the numbers are, 
when it is remembered that 75 per cent of the children 
were ill when they were brought to the depot, such 
results are astonishing. Dr. Newman quotes, with 
apparent approval, the claim made for the depot at 
Fteamp, France, of a death-rate of 121 per 1000 births, 
as compared with 240 for the city as a whole, and the 
claims of St. Helens of a mortality of 103 per 1000 



228 THE COMMON SENSE OF THE MILK QUESTION 

births as coDfipared with 173 per 1000 Wrths for the 
city, and Liverpool of a mortality among depot 
babies of only 89 per 1000 births.*' As a matter of 
fact, the Liverpool figures are even more favorable 
to the depot than that. Dr. Hope published par- 
ticulars concerning 4453 babies kept under close 
observation, showing a mortality of 78 per 1000 births 
as compared with an average of 167.3 for the city as 
a whole.** 

Upon the whole, the figures show plainly enough 
that the infants' milk depots do lessen the mortality 
of infants, their influence upon the total infimtile 
death-rate of a city depending, naturally, upoii the 
proportion of the infantile population supplied by 
them. The difficulties which confront us when we try 
to separate the influence of the depots' from other 
influences are perfectly natural. We can no more 
hope to determine the exact share of each individual 
agent in the progress that is made, than we can hope 
to determine the exact share of every unfavorable 
condition in forcing the death-rate of infants up to 
such distressing heights. The remedial forces, like 
the forces of ill, are blended and interwoven. There 
is no means whereby we may weigh each factor, 
either in the sum of ill or the sum of good. 

Much more satisfactory are the statistics relating 
to the experience of Rochester, already cited. In 
thiis.case, also, we are aware that othdt factors bestde 



• ■ • . 



• •• » 






• «• • 



REMEDIAL THEORIES AKD EXPERIMENTS 229 

the infants' milk depot contributed to the splendid 
advance made in the direction of reducing the in- 
fantile death-rate to a minimum. It is significant 
that in connection with the work at Rochester and 
the work of the depots conducted by Mr. Nathan 
Straus we have the most emphatic and satisfactoiy 
evidence of the enormous reduction which can be 
made in the infantile death-rate thi'ough the estab- 
lishment and maintenance of wisely managed infants' 
depots. We must conclude our siunmary with a 
brief examination of some important facts established 
by the Straus depots. 

I do not propose to enter upon any discussion of the 
claims made from time to time as to the influence of 
the Straus depots in reducing the infantile death-rate 
in New York City. I content myself by saying that 
I am firmly convinced that the work of the depots has 
been a very important factor in bringing about that 
reduction, a statement which wiU not be seriously 
disputed by anybody who has given an hoiur to the 
study of the subject and who is candid and unbiassed. 
To my mind, the most exacting test to which any 
such institution has ever been put is furnished in the 
figures which relate to the work done by Mr. Straus 
on Randall's Island some years ago. That experi- 
ment and the investigations made by Drs. Park and 
Holt are universally regarded as being among the 
most important, if not altogether the most important, 



230 THE COMMON BENSE OF THE MILK QXTE8TI0N 

tests of the value of infants' milk depots yet made. 
Mr. Straus himself , in a paper read at the Congria 
International des Gouttes de Lait, held in Paris, in 1905, 
has cited statistics which show that in New York 
City during the ten years, 1894-1904, there was an 
annual saving of 6982 infant lives, and I believe that 
of all the factors contributing to that great result, 
the most important single factor was the work of the 
Straus depots. 

The experiment on Randall's Island is important 
because it affords much more direct and convincing 
testimony upon the influence of a carefully super- 
vised infants' milk depot upon the rate of infant 
mortality. The experiment was conducted under 
test conditions practically, so that we are able to 
judge the effect of the milk depot without having to 
make discounts in favor of other factors. In the 
early nineties the death-rate among the infants in 
the Infant Asylum at Randall's Island was so high 
as to become a matter of very serious reproach to 
the city. The death-rate among these tiny victims 
of poverty and crime became the shame of the city. 
The babies died like flies, and it became a grim 
pastime among the attendants when a child was 
brought to the hospital to estimate its chances of 
living. The officials attacked the problem with 
seriousness and intelligence, but made painfully slow 
progress. The death-rate among the babies was 



BEICBDUL THEOBIBS AND EXPERIMENTS 231 

42 per cent in 1895, 39 per cent in the year following, 
and 44 per cent in 1897. The death-rate seemed to 
remain in the neighborhood of 40 per cent as if fixed 
by some terrible fatalism. 

In consequence of the results obtained through the 
depots he had established in various parts of the 
city during the two or three years previous, Mr. 
Straus, who had formerly been president of the 
Board of Health, secured permission to establish a 
complete pasteurization plant on the island in con- 
nection with the asylum. That was early in 1898. 
Immediately the spell was broken and the terrible 
death-rate of babies began to show a well-marked 
decline. Mr. Straus was proving to the great city 
and to the world that the power which exacted a 
death-toll of 40 per cent was the power of ignorance. 
As stated, the death-rate in 1897 had been 44 per 
cent, and in 1898, the first year of the experiment, the 
rate dropped to less than 20 per cent I The follow- 
ing table shows very clearly the results attained dur- 
ing a period of seven years, proving that the decrease 
was not a temporary or accidental one. It should be 
said that, while there were some changes in the later 
years, during the first two years at any rate, there 
were no other changes of any kind, either in respect 
to hygiene, management, or feeding. So far as human 
intelligence could perceive, the improvement was due 
solely to the better milk supply. 



232 THE COMMON SENSE OF THE MILK QUESTION 

Table XI. Showing the Ikfakt Death-rate oir Ban- 
D all's Island, New Yobk Citt, from 1895 to 1905 
Inclusive 



before the establishment of the STRAUS St'STBM 



TULK 


NUVBBB OP ChXL- 
DBIM TbBATBD 


NCTMBn OF 

Dbatbs 


Dbatb-batb 

FKB ObITT 


1895 

1896 

1897 


1216 
1212 
1181 


511 
474 
524 


42.02 
39.11 
44.36 



AFTER THE ESTABLISHMENT OF THE STRAUS SYSTEM 



1898 


1284 


255 


19.80 


1899 


1097 


269 


24.52 


1900 


1084 


300 


27.68 


1901 


1028 


186 


18.09 


1902 


820 


181 


22.07 


1908 


542 


101 


18.68 


1904 


845 


57 


16.52 



Now, it is a very simple matter to reckon the sig- 
nificance of these figures. During the seven years, 
1898-1904, there were 1343 deaths, but had the 
death-rate been the same as during the three years 
previous to the establishment of the infants' milk 
depot in connection with the asylum, the number 
would have been 2604, In other words, out of a 
total infant population of 6200, 1261 lives were saved 
through the establishment of a proper milk supply. 



REMEDIAL THEORIES AND EXPERIMENTS 233 

a saving of more than 20 per cent of the total number 
of children/® Such figures as these do not need to 
be enforced by weighty aigument. They are elo- 
quent and impressive preachers of a social lesson of 
vast significance^ and, above all, of sublime inspira- 
tion to all who seek to save the children of the 
nation from needless suffering and death. 

The investigations conducted by Park and Holt 
have been so often described, and the detailed, results 
are so accessible to the general reader/^ that it is un- 
necessary to do more than summarize them here. 
The object of the investigation was to study the 
manner of feeding infants in the tenements and its 
relation to infant mortality. Ten phjrsicians, work- 
ing under the direction of Drs. Park and Holt, dur- 
ing the summers of 1901-1902 and the intervening 
winter, kept a number of children under close obser- 
vation for an average period of three months. The 
total number of children observed was 632, of which 
number 340 were six months old or under, 265 rang- 
ing from seven to twelve months, and 47 a little over 
twelve months. Care was taken to select perfectly 
healthy children to begin with, and each child was 
visited by a physician twice every week. The weight 
of each child was taken at regular intervals and other 
physical conditions noted. It need scarcely be said 
that this medical inspection of the children, and the 
special interest in their children which the doctors' 



234 THE COMMON SENSE OF THE MILK QUESTION 

visits awakened in the mothers, were unusually 
favorable to all the children. Since the children fed 
upon milk from the Straus depots would in any case 
be under some supervision, a fact noted in the report 
of the investigation, it is fair to assume that there 
was a balance of advantage in favor of other kinds of 
feeding; in other words, that they were tried under 
particularly favorable conditions. 

The result of the investigation was to show that, 
m summer, the worst results of all, the highest mor- 
tality and the greatest amount of illness, occurred 
with the dirtiest milk, that which was purchased at 
grocery stores in the neighborhood. The next poor- 
est results were obtained from condensed milk ; while 
by far the best results of all were obtained from the 
milk supplied by the infants' depots. In addition 
to the statistics summarized in the accompanying 
table, which speak for themselves, the unanimous 
opinion was expressed that, '' Of methods of feeding 
now in vogue, that by milk from central distributing 
stations unquestionably possesses the most advan- 
tages, in that it secures some constant oversight of the 
child, and since it furnishes the food in such a form 
that it leaves the mother least to do, it gives her the 
smallest opportunity for going wrong."** The es- 
tablishment of more numerous depots, by the munici- 
palities, at least during the summer months, was 
unanimously recommended. 



REMEDUL THEORIES AND EXPERIMENTS 235 

Table Xn. Iixustratihg the Results of Different Kihds 
OF InFANT Feeding as found bt Drs. Park and Holt 



Hatubb or Foo9 


SUMIBB ObMB- 
TATIOHt 


WmTBB Obus^ 
▼ATIOHB 


Good 
ReBolU 


Bad 
RMolta 


Good 

RMalto 


Bad 
ReanlU 


StoieMilk . 


M 


44 


96 


4 


Bottled Milk .«.«.«. 


61 


81 


94 


6 


Condensed Milk 


60 


40 


92 


8 


Milk from the Infants' Depots . 


81 


19 


98 


7 



One of the most serious objections yet urged against 
the establishment of infants' milk depots is that they 
tend to discourage the practice of breast-feeding, 
whereas society should do everything in its power to 
encourage mothers to suckle their infants at the 
breast.^ Theoretically at least, the objection is of 
the greatest importance, and if it can be shown that 
the depots do have such a result the wisdom of estab- 
lishing them is open to very serious question. But 
do they? Not a single fact has ever been cited to 
prove that they do. The objection is based entirely 
upon a priori reasoning. As a working woman I 
talked with on the subject at one of the depots said 
to me, ''The doctors as says that only guess what 
they'd do themselves if they was women." 

It would, I know, be almost impossible to bring 



236 THE COMMON SENSE OF THE MILK QUESTION 

direct evidence in support of such an objection, owing 
to the extremely delicate nature of the investigations 
which would have to be pursued in order to obtain 
it. I have submitted the matter to upwards of fifty 
physicians in England and this country and received 
replies from forty-three. Of this number nine did not 
"care to express an opinion"; two thought "such a 
result likely/' but had no personal knowledge of any 
case in which such an effect had been produced; one 
was "opposed to all such socialistic folly" as infants' 
depots ; the other thirty-one were unanimous in say- 
ing that they had no fear of such a result. All the 
physicians questioned were, men whose practice gives 
them an opportunity to note the work of the infants' 
depots, and, while the consensus of their opinion is 
not conclusive evidence, it has, I think, considerable 
value. It is scarcely likely that such effects could be 
produced in any considerable number of cases with- 
out being noticed by some of the men whose repUes 
are included in the above smnmary. 

And if we may meet a priori argument with a 
priori argument, it seems highly improbable that the 
infants' depots discourage breast-feeding in any way. 
In practically every case, when a mother makes 
application to have her child supplied from the in- 
fants' milk depot, she is questioned as to her reasons 
for not nursing the baby herself, and warned that the 
milk supplied by the depot is only a poor substitute 



REMEDIAL THEORIES AND EXPERIMENTS 237 

at best for the baby's natural food. She is ghren 
simply worded literature pointing out the great ad- 
vantages of breast-feeding and the dangers of all 
other kinds of food for infants^ and physicians and 
nurses urge the same truths upon her. This is the 
normal, everyday practice of nearly every infants' 
milk depot I have ever known of, and it seems not 
unlikely that the depots are producing a result the 
very opposite of that feared by many critics. 

That the influence of society should be exerted to 
encourage breast-feeding is true, of course. Possibly 
we shall yet be able to develop our school system in 
this country along lines making for physical effi- 
ciency as advocated by Dr. Gulick,^ and, in the last 
years of school life, do what we can to educate our 
girls so that they may not enter upon wifehood and 
motherhood so utterly unequipped as they now do. I 
have no doubt that a great deal could be done to 
educate mothers upon this and many other matters 
of vital importance — that much could, and there- 
fore should, be done. But what are we to do with 
the women, rich and poor, who decline to nurse their 
babies, and with the babies themselves? Shall we, 
like that ruler of Finland who, in 1755, issued a Ai>yal 
edict prescribing a fine of ten dollars to be imposed 
upon mothers who through neglecting to suckle their 
babies for at least half a year lost them,^ make a 
-mother's refusal to nurse her baby a criminal offem^? 



238 THE COMMON SENBB OF THE MILK QUESTION 

And, whatever we may or may not do to the mothers, 
the question of providing for the children must be 
faced. Are we to join the mothers in a conspiracy 
against the children, or are we to protect the interests 
of the child when the mother fails ? 

And what of the working mother, who, even though 
physically able to nurse her baby, cannot because she 
must work away from home 7 The Austrian peasant 
woman who left her own baby to take its chances 
upon a diet of ''horrible pap" and went out to act 
as wet-nurse for the child of a wealthy woman ^ 
had no objection to nursing babies, apparently. It 
is fsdr to assume that she would rather have nursed 
her own baby. The women of Finland who suspended 
horns filled with sour milk over their babies' cradles 
and let them take theur chances, might have nursed 
their babies but for the fact that they had to work 
in the fields and woods, or starve/^ So, too, with the 
factory worker and the charwoman. Are we pre- 
pared to subsidize breast-feeding, to make mother- 
hood an occupation under the control of the State? 
And if not, if we are not prepared to do something 
like this, to do upon a big scale what Ck)logne and a 
few other European cities do on a small scale, what is 
to be done for the children? Finally, what of the 
children whose mothers cannot nurse them because 
of physical reasons? No matter whether the cause 
of their inability to nurse their young is the accumu- 



REMBDUL THEORIBS AND EXPERIMENTS 239 

lated sins of their ancestors, or environmental con- 
ditions into which they have been forced by powers 
as remorseless as Fate ; no matter, even, if the cause 
of their inability to nurse their babies is their own 
ignorance and folly, against which there was none to 
warn them, — the fact remains that the babies must 
be provided for. Do whatever we may to encourage 
breast-nursing, we cannot escape responsibility for 
the babies that languish and die because they are 
fed upon dirty and disease-producing milk, or sub- 
stances more deadly still. 

For more than ten years I have been haimted by 
the terrible consciousness that thousands of baby 
lives are needlessly sacrificed every year in the great 
cities of the world, while we boast of the progress of 
our civilization. For more than ten years I have 
grappled with the problems of infantile mortality 
according to my ability and strength, patiently and 
carefully studying the results of investigations made 
by others and making investigations on my own 
account. For more than ten years I have watched 
the experiments made by earnest men seeking to 
find the remedy for the evil of excessive infant mor- 
tality, mourning at every failure and glorying in 
every gain, however slight it might be. As a result 
of these years of study I feel entitled to say with 
assurance that impmre milk is one of the most pow- 
erful factors making for a high infantile death-rate, 



240 THE COliMON BE^SE OF THE MILK QUESTION 

that its victims are more numerous than the victims 
of the great plagues, and that it is possible to save 
tens of thousands of baby lives each year, in the United 
States alone, through the establishment of infants' milk 
depots conducted upon scientific principles. Private 
philanthropy has shown the way; is there civic 
enterprise to follow ? 



CHAPTER Vm 

PURE VERSUS PURIFIED MILE 



From the foregomg summary of the remedial ex- 
periments made in this country and in Europe it 
will be seen that the advocates of reform in the 
methods of producing and distributing the public 
milk supply may be roughly divided into two classes. 
While the nomenclature may be open to criticism, 
for the purpose of this discussion these classes may 
be defined as radical idealists and opportunists : the 
one class demanding a pure milk supply and decrying 
every proposal which stops short of that ideal; the 
other class taking the conservative view that in this 
far from ideal world pure milk is impossible as a 
general rulCi — a very beautiful ideal, but unattain- 
able, except for a favored few, for many years to 
come, if ever at all. And because they believe this, 
they urge that, while aiming at absolute purity, it 
is necessary in the meantime to purify the milk. 

This broadly defines the issue upon which the re- 
formers of the milk supply of the great cities have 
split into separate and sometimes bitterly hostile 

E 241 



242 THE COMMON SENSE OF THE MILK QUESTION 

camps. In the United States especially the contro- 
versy between the two schools has been furiously 
waged, often with what the onlookers have felt to be 
much unnecessary vehemence. Often, indeed, there 
has been nothing but mutual misunderstanding to 
account for the bitterness of the war of words waged 
between the two schools. In reality they have not 
been so hopelessly at variance as the bitterness of 
their words would imply. 

I remember addressing a mass-meeting upon the 
subject when there were strong partisans of both 
sides in the audience and upon the platform. The 
object of my address was to promote a better feeling 
between the two factions and to create a more friendly 
relation between them, based upon mutual under- 
standing, with a view to their uniting upon a common 
platform. It was gratifying to have the spokesmen 
of both sides declare their entire satisfaction with 
the position I had taken and their full acceptance 
of the working programme I had hastily sketched. 
Upon several occasions it has been my good fortune 
to bring about similar harmony and confidence be- 
tween groups of workers on both sides, so that I am 
disposed to take a hopeful view of the situation. 
It is my hope that the present volume will do some- 
thing in that direction on a larger scale. Without 
attempting to minimize the differences, it can, I 
believe, be shown that the points of agreement are 



PUBS versus pxtrified milk 243 

quite as numerous and important as are the points 
of difference. 

It is upon these points of agreement I would have 
the two schools unite. It is not necessary for either 
side to enter into any sort of a compromise, to trun- 
cate its principles. That is wholly unnecessary, 
and, in my judgment, undesirable. But it ought 
to be possible for the leaders of both parties, all of 
them earnest and sincere men, to come together and 
say: ''Here are so many points upon which we can 
agree. Let them constitute our immediate, common 
platform, but let nothing be put in the way of those 
who aim at an ideal milk supply which shall need 
no purification." 

II 

In order that there may be a better undeistanding 
between the two schools of reformers, it is necessary 
that the issue between them be clearly defined; 
that the position of each side be correctly set forth. 
Fair and lucid statement of a problem is an impor- 
tant contribution to its solution. 

The position of the radical school, the ''clean 
milk" advocates, who oppose pasteurization, is 
indicated in their name. They are keenly alive to 
all the evils of the present conditions, some of which 
have been described in these pages. They have 
done yeoman service in pointing out the abominably 



244 THE COMMON SENSE OF THE MILK QUESTION 

unhygienic conditions under which our public milk 
supply is produced and distributed ; they have done 
much of the investigation into the causes of con- 
tamination, and shown by actual experiment how 
unnecessary those conditions are; they have forced 
upon public attention the menace of a polluted milk 
supply to the public health and the highly impor- 
tant part milk plajrs in the spreading of disease. 
No reasonable man in the other camp will attempt to 
deny that the clean milk agitation has had all these 
merits.* 

Now, these radicals of milk reform say that it is 
possible to secure a practically germless milk supply 
which is absolutely safe and clean. They say that, 
however Utopian it may sound to conservative ears, 
it is possible, in a little while, given the right spirit 
of civic cooperation, to get a public milk supply 
which will come well within Professor von Behring's 
zone of safety, having a bacterial count of less than 
1000 per cubic centimeter. This, they believe, is by 
no means an impossible ideal, even for the general 
milk supply of any city. In support of their con- 
tention they point to the numerous experiments 
similar to those outlined in the present volume which 
prove that it is possible to produce practically sterile 
mUk. Given such milk, they argue, it would not 
be necessary to resort to pasteurization or any other 
method of purification, and the advocates of pas- 



FUBE versus fubified milk 245 

teurization admit the contention. The radicals^ in 
a word, want pure milk, not purified milk. 

Pure milk; say the radicals, is obtainable with 
the knowledge we now have. The risk of trans- 
mitting the germs of any disease, either of human 
or bovine origin, to the consumers of milk, whether 
they be adults or infants, would be reduced to zero 
practically. And while cow's nulk cannot be con- 
sidered an ideal and absolutely safe food for infants, 
however pure it may be, except when modified and 
distilled through the lacteal glands of the mother, 
milk of the standard of excellence described would 
be as safe as science knows how to secure it, and the 
mortality of infants would be much lessened as a 
result of its general use. 

So much for the point of view of the radicals. 
Now let us turn to the opportimists, to the advo- 
cates of purification. The methods of purification 
usually employed upon a large scale, and recom- 
mended by reformers, are pasteurization and ster- 
ilization. The latter method is almost universally 
used in France and England and some other Euro- 
pean coimtries in connection with the infants' milk 
depots. In this country the former method pre- 
vails, sterilization being rarely or never practised. 
The principle involved in both methods is the same, 
the difference being in the degree of heat to which 
the milk is exposed and the length of the exposure. 



216 THE COMMON SENSE OF THE lOLK QUESTION 

It will be sufficient for our present discussion if we 
consider the point of view of the advocates of pas- 
teurization, which differs only from that of the ad- 
vocates of sterilization in that the latter claim to 
be more "thorough" when they carry the process 
farther. 

Like the clean milk partisans, the advocates of 
pasteurization are thoroughly alive to the evil con- 
ditions which almost universally exist. They, too, 
have done much to direct public attention to the 
unhygienic conditions which surround the milk 
supply from the cow to the table at every stage of 
the long and tedious journey. With the zeal of 
enthusiasts, they have agitated for reform and lost 
no opportunity of calling attention to the perils of 
polluted and infected milk. If they have done less 
original investigation in this field than their clean 
milk rivals, they have abundantly balanced accounts 
by the work they have done as popularizers of the 
truth.' No fair-minded opponent of pasteurization 
in the radical camp will deny that the advocates 
of pasteurization have done most of the pioneer 
work and created most of the existing sentiment 
for reform. They were the radicals of a few years 
ago, and met with the ridicule and opposition which 
radicals must always encounter and endure. 

Nowadajrs, among the reformers, they are con- 
servatives. They frankly admit that pasteurization 






FURE versw purified milk 247 

is a makeshift — a necessary evil. They readily 
admiti as all sane men must; that it would be vastly 
better to have clean and imlnfected milk, rather 
than milk which has been, so to say, cleansed and 
disinfected. They do not for a moment dispute 
the claim that milk so pure as to need no purifjring 
process is the ideal to be aimed at; that milk ought 
to be so pure as not to need any pasteurization. All 
these things they admit without question.' So far 
the two schools are in perfect agreement. 

But they do not share the optimism of the radi- 
cals. Not for many yeara, if ever at all, they say, 
shall we get the milk supply of our cities so pure that 
it will need no purifying. So far as it is possible 
to judge the future, contend the opportunists, there 
are no probabilities of such ideal conditions being 
attained within the lifetime of any now living. They 
point to the fact that we go on quite contentedly 
drinking milk which contains many millions of bac- 
teria per cubic centimeter, even giving it to our 
babies. They take such statements as that made 
by Professor Conn that the milk of our cities con- 
tains more bacteria than their sewage does,^ and 
they urge that now, imtil we can get a pure and 
wholesome supply, entirely safe and free from infec- 
tion, pasteurization is necessary — especially for the 
milk intended for infants. 

The proposition is an exceedingly simple one. 



248 THE COMMON SENSE OF THE MILK QUESTION 

Here is milk which, if properly drawn from a healthy 
COW, mider hygienic conditions, would be clean, 
sterile, and free from disease germs. Not being so 
drawn, however, it is foul and teeming with germ 
life, some of which may be fatal to a child. There 
are the germs of diseases from which the cow suffers, 
and germs of diseases from which human beings 
coming into more or less direct contact with the 
milk suffer. Granted that " cooking " the milk does 
not make it clean, it at least kills the germs. Granted, 
too, that some of the germs are harmless, that some 
of them may even be helpful to the digestive processes, 
it is best to kill them all if that is the only way of 
destrojdng the dangerous germs once they are in the 
milk. The gain which ensues from the destruction 
of the dangerous germs far more than compensates 
for any loss which may result from the destruction 
of healthful germs that are aids to the digestive 
system. And in support of this contention they 
point to the impressive and convincing figures which 
show the reduction made by pasteurizing their milk 
in the mortality of infants. 

It will be seen that there is no criticism of the 
position of the radicals in this, except that it is Uto- 
pian and idealistic. The advocates of pasteuriza- 
tion have no attack to make upon their rivals of 
the clean milk school, their only criticism being that 
they are holding out an ideal that is unattainable 



PURE versus purified milk 249 

within any computable time. And for that they 
do not care provided only that in the meantime milk 
is pasteurized. This statement of their position 
will, I believe, be generally accepted by the leading 
representatives of both schools, and is, indeed, based 
upon the statements made to me by the leading 
exponents of both groups for the purposes of this dis- 
cussion. It is highly important that the fact that 
the only criticism of the clean milk school which 
comes from the advocates of the pasteurization of 
milk is that they are Utopians and visionaries. The 
bulk of the criticism in the controversy comes from 
the radicals. They have placed the advocates of 
pasteurization on the defensive. 

ni 

There is no need to dwell further upon the criti- 
cism of the position of the radicals by their oppor- 
tunist rivals who believe in pasteurization. That 
is all smnmed up in a sentence and can be compre- 
hended by a child. But not so the criticism of the 
opportunists by the radicals. Here we have a body 
of very serious criticism which cannot be so easily 
summarized and comprehended. 

It is not my purpose to attempt to give a complete 
synopsis of this very long and complicated contro- 
versy, much of which has little vital significance. 
I propose only to state the most important points of 



250 THE COMMON SENSE OF THE MILK QUESTION 

the attack upon pasteurization and to consider them 
in relation to the available evidence. 

(1) It is urged that pasteurization does not kiU aU 
the disease germs. It is claimed that the most harmful 
germs survive, those killed being the host harmful, the 
harmless, and the useful. 

Now, it is obvious that, if true, this is a serious, 
though not necessarily fatal, objection. I say that 
it is not necessarily a fatal objection bfcause it 
might be claimed with good reason that if pasteur- 
ization did not kill all the most dangerous germs but 
only a few of them, it would still be advantageous 
if it killed a very large number of disease germs. The 
weight of the criticism, however, cazmot be denied. 
In bacteria land, as in most other places, the wicked 
flourish and the good die too easily. The disease 
germs which men most fear in milk are those of the 
dread tuberculosis, and it is alleged that the pasteur- 
izing process does not kill the tubercle bacilli. It 
is not denied that it kills the germs of scarlet fever, 
typhoid, and diphtheria, but it is contended that one 
of the greatest dangers to be feared is the presence 
of tubercle bacilli in milk, and that the fact of milk 
being an important factor in the spread of tubcircu- 
losis has been one of the most cogent arguments for 
pasteurization. If, therefore, the process does not 
kill the tubercle bacilli, that danger is not removed, 
and the utility of the process is very much less than 
is claimed by its friends. 



• - 
• 



PUBE versus purified milk 251 

Before making any attempt to judge the value of 
this criticism, let us first of all make sure that we 
mean the same thing by the use of the word " pas- 
teurization/' There is no legal definition of pasteur- 
ization. There is no city or state anywhere, so far 
as I know, which has established a legal standard 
of what constitutes pasteurization. The result is 
that every dealer is entitled to adopt a standard of 
his own. There is less difference between raw milk 
and some kinds of pasteurized milk than there is 
between different kinds of pasteurized milk. A 
great deal of the milk which is commercially pro- 
duced and sold as pasteurized milk is simply heated 
to a temperature of about 150^ Fahrenheit for twenty 
or thirty seconds and then rapidly cooled. It is 
admitted that this does not very greatly reduce the 
number of tubercle bacilli, though it may kill prac- 
tically all the germs of scarlet fever, 95 per cent of 
typhoid and diphtheria germs, and as much as 90 
per cent of all the bacteria.* Of the tubercle bacilli 
a very large proportion are not killed.* 

So far, then, much of the criticism is justified when 
directed to a great deal of milk ordinarily sold as 
pasteurized milk. It does not follow, however, that 
if also holds true of scientific pasteurization, such 
as that practised in many foreign cities and at the 
Straus laboratories in this country. This scientific 
method is to keep the milk at a temperature of 167^ 



252 THE COMMON SENSE OF THE MILK QUESTION 

Fahrenheit for at least twenty minvies, sometimes 
for thirty minutes. It has been fomid to be imprac- 
ticable to raise the temperature above 167^ without 
impairing the taste of the milk; and that exposure 
for twenty minutes to that temperature does eflfec- 
tually destroy the tubercle bacilli. The greatest 
living authorities, including Professor Bang/ Theo- 
bald Smith,* Professor Pearson of Pennsylvania,* 
Drs. Park/* Holt," and Freeman," are agreed as 
to this. There are, I believe, records of eixperiments 
which appear to controvert this, but they are of 
very doubtful value." The evidence is overwhelm- 
ingly in favor of the claim that scientific pasteur- 
ization does destroy all disease germs. 

It has never been suggested by any competent 
authority that any considerable number of tubercle 
bacilli survive exposure for twenty minutes to a 
temperature of 167® Fahrenheit. Even if a few 
escape under exceptional conditions, it would still 
be quite fair for the advocates of pasteurization to 
urge its claims upon the basis of its germicidal value. 
With all my sympathies on the side of the radicals, 
I cannot resist the conclusion that a candid study 
of the facts will destroy the value of the criticism 
we are considering, when it is directed agamst scien- 
tific pasteurization. It is most unfortunate that 
efficient pasteurization should be discredited on 
account of a conmiercial imitation to which the 



PURE versTAS pijeified milk 253 

name^ought never to be applied. I have long held 
that there should be a legal definition of what con- 
stitutes pasteurization. Such a definition would 
go far toward protecting the public against what 
is, under all the circumstances, practically a fraud, 
as I said at the Milk Conference held in the New 
York Academy of Medicine in 1906. 

(2) It is alleged that pa^teurizoUion destroys some 
of the nutrient qtuUities of the miOc, renders it difficult 
to digest, destroys the lactic acid bacteria which are of 
great imporUmce, and leads to diseases like scorbutus 
and rachitis in infants. 

I place this group of objections together for the 
reason that they are, ultimately, only different state- 
ments of the same difficulty. I place them second 
only to the objection considered above for the reason 
that, intrinsically, this group of charges undoubtedly 
are second in importance only to the charge that 
the germicidal action of pasteurization is inefficient. 
But it is only fair to add that this mass of criticism 
is less often met with than formerly, so that it is of 
less relative importance than it was at one time. 

There is a bewildering mass of contradictory tes- 
timony on both sides from which either party to the 
controversy could select enough to make out a very 
strong and seemingly conclusive case. It is, however, 
scarcely worth while attempting to sift it, for two 
reasons. In the first place, because no conclusive 



254 THE COMMON SENSE OF THE MILK QUESTION 

result could possibly be reached, and, in the second 
place, because the criticism is being very generally 
abandoned. A brief survey of a few of the salient 
and essential facts will suffice to do justice to the 
reply which the friends of pasteurization have always 
made to this body of criticism. 

It is admitted that the process destroys the lactic 
acid bacteria with the more dangerous kinds of bac- 
terial life. That is admitted by that vigorous antago- 
nist of the "raw food cult," Professor Metchnikoff, 
who likewise admits that the milk thereby loses 
something of value.^^ Just how valuable lactic 
acid in milk is cannot be accurately determined. 
Metchnikoff exalts it so that it becomes practically 
the most important item in diet. It is, according 
to the great French physician and apostle of human 
longevity, a specific against the germs of more deadly 
diseases. The weight of medical opinion seems to 
be that lactic acid bacteria in milk are not injurious, 
that their presence in the intestines in moderate 
quantities is rather desirable than otherwise, since 
they prevent the fermentation of the milk in the 
intestines assuming putrefactive forms injmious to 
health by reason of inducing intestinal disturbances.* 
80 important does Metchnikoff regard it that, after 
destrojdng all bacteria by pasteurization, he puts lao- 

* For a contrary view, axgued with much wei^t> 0ee Brash, 
MUk, pp. 43-50. 



PURE verms purified milk 255 

tic acid bacteria into the milk." It will thus be seen 
that the advocates of pasteurization admit that the 
process destroys bacteria which may be very useful 
to the consumer of milk. It must be remembered, 
however, that the advocates of pasteurization do 
not disguise the fact that pasteurization is a necessary 
evil in their judgment; that milk which needed no 
such treatment would be far better. It is the famil- 
iar case of enduring the lesser evil to be rid of the 
greater. 

In view of the fact that diseases of the digestive 
system are responsible for a terrible proportion of 
infantile deaths, it is fairly obvious that if pasteur- 
ized milk were more difficult to digest than raw 
milk, the mortality from intestinal troubles among 
infants fed upon it would be above the average 
greater than the mortality among infants fed upon 
raw milk. This would undoubtedly be the result — 
unless there were other advantages which mare than 
compensated far this serious disadvantage. And should 
there be such a balance of advantage it would, of 
course, justify pasteurization and destroy much of 
the force of the criticism. The issue must be decided 
by an appeal to fact rather than to theory. 

Now, what are the facts? Is the mortality from 
diseases of the digestive system greater among infants 
fed upon pasteurized milk than among infants fed 
upon raw milk? In this, as in so many other matters, 



256 THE COMMON SENSE OF THE MILK QUESTION 

it is well to apply the common sense test of actual 
experience. That our test may be fair and just we 
must compare the results of feeding upon pasteurized 
milk with the results of feeding upon the ordinary 
raw milk of commerce, and not with the results of 
feeding upon raw milk of exceptional purity. For 
the advocates of pasteurization have never denied that 
pure raw milk woidd be better than milk of doubt- 
ful purity pasteurized. A conclusive answer to our 
questions, it seems to me, is contained in the universal 
experience that where the milk supply is poor, pas- 
teurization leads to a diminution of infantile mor- 
tality. The figures cited in the previous chapter 
afford a sufficient answer to the criticism that pas- 
teurized milk is harder to digest than raw milk. If 
this were true, we should find a larger mortaUty from 
digestive trouble among infants fed upon it, and the 
fact that we get a result the very opposite of this tends 
to show that either the alleged indigestibility is a fic- 
tion, or that pasteurized milk has other advantages 
which outweigh the disadvantages — even when dis- 
eases of the digestive system alone are taken into accovnt. 
In point of fact the criticism never rested upon 
anything more scientific than guesswork. So far as 
I am aware there never existed the conditions which 
could provide a fair basis for a comparison of the 
merits of raw milk with those of pasteurized milk as 
a food for infants. Much of the argument rests upon 



FUBE veraw purified milk 257 

a fallacious basis. Long before the time of Pasteur, 
the mothers of a great part of Europe heated the milk 
given to their babies, generally boiling it. To-day in 
the tenement homes of all our cities milk is most gen- 
erally boiled before being given to babies, almost in- 
variably so in summer. The researches of such men 
as Drs. Park and Holt " show this, and Dr. Darling- 
ton, the Health Commissioner of New York City, has 
had the matter carefully investigated with the result, 
he informs me, that he finds boiling to be the general 
rule. 

I am not unmindful of the fact that this argument 
may be a two-edged sword,' that it may react against 
pasteurization, at least so far as the establishment of 
infants' milk depots is concerned. It may be urged 
with reason and sincerity : " If practically all the milk 
is boiled before it is given to the babies, what need is 
there for pasteurizing it — why not leave that to the 
mothers?" It must not be forgotten, however, that 
the actual pasteurization is only one of the services 
performed by the depots. There is the careful, scientific 
modification of the milk, the supervision of the babies, 
the constant advice to mothers, and, hardly less im- 
portant, the invariable practice of securing the highest 
standard of excellence in the production of the milk 
itself. Then, also, it is important to bear in mind that 
the careful, scientific pasteurization of the milk is 
very different from the haphazard and frequently 



258 THE COMMON SENSE OF THE MILK QUESTION 

careless '' heating '' and '^ boiling " practised by mothers 
in their homes. Much of the scurvy attributed to 
pasteurization should be properly attributed to 
over-boiling, as Jacobi/' among others^ has pointed 
out. 

In connection with this criticism it is significant to 
note that in the great London hospitals milk is almost 
invariably either pasteurized or sterilized before it 
is given to children, and none of the evils complained 
of have been encoimtered.^' It is also worthy of note 
that in France, in connection with the Oautees de 
Lait, there has been a decrease of scorbutic diseases 
among infants rather than an increase.^* I have been 
assured by the most competent medical observers 
that the disease is quite as rare as in this or any other 
country. Dr. Jacobi advocates the boiling of milk, 
but is careful to point out that over-boiling leads 
frequently to scorbutus. I know a physician whose 
sister's child sufifered from a severe scorbutic disease. 
He was called to attend the child and decided that 
the trouble arose from the use of pasteurized milk. 
Henceforth he became an opponent of pasteurization. 
Raw milk was ordered and tried, but the baby did 
not improve in any way. Another physician was 
called in and at once ordered that pasteurized milk be 
given. He was told of the former experience and 
decided that he would make an investigation. I need 
not here describe his investigation in detail as he de- 



FUBE verstLS purified milk 259 

scribed it for me; suffice it to say that he found out 
that the servant who prepared the child's food had 
a notion that ''so long as the milk was well boiled 
it was all right." She '' thought it could not be boiled 
too much." I could give particulars of several other 
cases very similar to this one. 

To sum up : It seems reasonably certain that pas- 
teurization, sterilization, or any other process of heat- 
ing milk to a temperature high enough to have a ger- 
micidal effect impairs it to some extent. On the 
other hand, there is abimdant evidence to show that 
the gain is far greater than the loss. And it is a 
most significant fact that among the radicals, the ad- 
vocates of such methods of inspection as will insure 
clean milk, there is universal agreement that, imtil 
we can obtain milk of the desired standard of purity, 
cleanliness, and freedom from disease germs, it is best 
to pasteurize milk for infants. 

(3) It is objected that to establish depots for the sale 
of pasteurized milk would he a mistake for the following 
reasons, among others: (a) It is an extension of paler- 
nalism. The dty or state ought to leave that to the 
mothers, taking care only to see that the supply is pure 
and good, (b) Where there is so much doubt as to the 
efficiency of the process, it should be optional with parents 
whether they give their babies pasteurized milk or unr 
pasteurized milk; (c) The effect of pasteurization would 
he to make the mOk producers and milk dealers careless, 



260 THE CX)MMON SENSE OF THE MILK QUESTION 

causing them to rely too mvch upon jxisteurization, rather 
than upon deanliness. 

Considering these objections in their order, not 
much need be said with regard to the first. The 
bugaboo of ''paternalism" has been raised whenever 
any advance has been proposed. It was raised against 
the proposal to make education free and compulsory ; 
it was raised against the establishment of municipal 
hospitals and dispensaries, parks, playgrounds, baths, 
recreation piers, and lodging houses for the homeless; 
it was raised against the factory acts; it has been 
raised against every proposal to bring the great cor- 
porations under public control. On the other hand, 
it is difficult to see that pasteurization of milk for 
infants would be more paternalistic in principle than 
the elaborate system of inspection necessary to insure 
pure milk. 

With regard to the second objection, that the use 
of pasteurized milk ought to be optional with the 
parents, since there is some doubt as to the efficiency 
of the process, it need only be observed that only a very 
small minority of the advocates of pasteurization 
would dispute that claim. Most advocates of the 
establishment of infant milk depots for the sale of 
pasteurized milk would be quite willing, I am con- 
vinced, to have raw milk also sold at the depots, 
provided that it reached a certain high standard of exceln 
lence. No objection, I imagine, would be raised to the 



[ 



FUBB versus pubified hilk 261 

sale of raw milk having a low standard of bacterial 
content, approximating the standard set by Professor 
von Behring, and free from disease germs. As to the 
principle involved of giving the parents an option in 
the matter, it is rather suggestive that the advocates 
of laissez faire in this particular do not suggest that 
the rule should be generally applied. There is at least 
quite as much dispute as to the efficiency of vaccina- 
tion, but they do not suggest that parents should be 
allowed an option in the matter of the vaccination of 
their children; there is a not inconsiderable body of 

who oppose pasteurization upon the ground that the 
parents ought to be given an option do not, I have 
observed, admit the right of the Christian Science 
believer to have an option in the matter of calling a 
doctor for his sick child. In all other matters they 
recognize that the child belongs to society rather than 
to the parents. 

So much for the principle involved. As a practical 
question, theories of parental laissez faire and the 
responsibility of society for the child's welfare enter 
into it hardly at all. Except by a few individuals, 
perhaps, it is not proposed that parents should be 
compelled to give their infants pasteurized milk and 
forbidden to give them raw milk. It is proposed 
simply that municipalities should face the fact that 
the ordinary milk supply is a menace to childhood. 



262 THE COMMON 8SN8E OF THE MILK QUESTION 

and that they should establish depots for the sale of 
pasteurized milk scientifically prepared, and educate 
mothers as far as possible to the importance of using it 
for their babies. I have discussed the matter with 
many of the leaders of the radical school, and I have 
not yet met one of them who did not agree to the 
following propositions: (1) the milk supply of no 
American city can be considered a safe food for in- 
fants; (2) tmtil this condition is remedied, it is 
safest and wisest to pasteurize the milk given to in- 
fants. This, I say, has been the unanimous verdict 
of the leaders of the radical school of milk reformers, 
and I see no reason why the cities should not frankly 
teach the mothers that and provide them with the 
means of getting pasteurized milk. 

Concerning the third objection, that pasteurisation 
tends to encourage slovenliness upon the part of the 
milk producer and the milk dealer, I am inclined to 
think that it is the most serious and weighty objec- 
tion of all from a practical viewpoint. There can 
be no doubt of the force of the objection, I think, 
even though it may not rest upon a statistical 
study. It requires but an ordinary knowledge of 
human weakness. Teach people that impure and 
disease-infected milk can be rendered harmless by 
any process of germicide, and, unless special efforts 
are directed to counteract the tendency, there will 
be a drifting away from standards of care and cleanli- 



PURS vertus purified milk 263 

ness on the part of the milk producer and the milk 
dealer, as well as a slackening of energy and a lessen- 
ing of seal on the part of the consimiers. The advo- 
cates of pastew*ization vigorously deny that this 
would be the tendency, but I remain imconvinced 
by their optimism. There is always the factor 
of human weakness to be reckoned with. Boston's 
bacteriological standard lulls the Boston citizen into 
idle complacency, and I wonder if it would be other- 
wise with pasteurization. "Milk Sweet" and "Pre- 
servaline" and the host of other germicidal preser- 
vatives increased the sloth and the weakness of the 
farmer, and I wonder if pasteurization would do less. 
Frankly, I am very sceptical. 

It is this factor which keeps me from being wholly 
one of the opportunists and drives me ever and anon 
to the radical camp — this and the radical ideal. 
But it must be said in justice to the opportimists that 
they do not propose to trust entirely to pasteur- 
ization. Their plan necessitates no lessening of the 
effort to obtain pure milk which will need no pasteur- 
ization. They do not propose that there shall be less 
inspection of dairies and stables than now, but more. 
And it is in this attitude that I see the hope of a uni- 
son of both forces. The radicals agree that until milk 
can be obtained by the average citizen which is 
absolutely safe and fit for use as a food for babies it is 
wise to pasteurize it. The opportunists on their side 



264 THE COMMON SENSE OF THE MILK QUESTION 

agree that pasteurization ought not to be necessary, 
that it ought not to be regarded as a solution of the J 
problem. They, too, believe in trying to get a mUk 
supply which it will not be necessary to pasteurize. 

IV 

Here, then, it seems to me, is a basis upon which 
they can unite for many years to come — years of 
fruitful labor and progress toward a common goal. 
As I see it, the present situation may be likened to 
an outbreak of typhoid in a city, which has been traced 
to the water supply. While the disease is ravaging 
the community, the doctors come together and dis- 
cuss the situation. There is no question as to the 
cause of the epidemic, it can be definitely traced. 
The only question is as to what shall be done. One 
set of doctors say : " Our duty is plain : we must begin 
an agitation and compel the city government to put 
an end to the pollution of the water supply. They 
must stop the sewage from running into the reservoirs." 
They are the radicals of the moment. "But that 
will take five years to accomplish," say the opppr- 
tunists. " Five years, and meanwhile the disease will 
go on; people will needlessly die. We must give 
them more immediate relief. We must get the people 
to boil their water so that the disease germs will be 
killed." In such a situation, the obvious thing to 
do is to adopt both plans — to urge boiling the water 



PURE verstis purified milk 265 

while the fundamental reform is being carried out. 
And; as I see it to-day, that is precisely the situation 
with the milk reform controversy. 

Given the union of the two forces, of the spirit of the 
radical and' the opportunist, and there would be no 
reason to fear the one really important objection to 
pasteurization. There would be no fear that pasteur- 
ization would be regarded as a solution; no fear that 
the movement for better inspection would be re- 
tarded. Time and again I have submitted this view 
of the situation to adherents of both schools, and I 
have never yet failed to get an answer that implied a 
readiness to unite in a common movement upon such 
a basis as I have outlined in these pages. I have 
submitted to leading workers on both sides a pro- 
gramme for united action which they have invariably 
expressed their willingness to accept. Unity of forces 
seems to me, therefore, easily attainable. 

In the hope that something may be done to bring 
together the radicals and the opportimists, I venture 
to place here, as a fitting conclusion to this chapter 
in which the controversy is so hastily summarized, 
a practical programme upon which both sides may 
agree : — 

(1) The establishment of a National Milk Reform 
Association, with branch organizations all over the 
country, and having for its object the promotion of 
legislation for the improvement of the milk supply 



/ 



266 THE COMMON SENSB OF THE MIUC QUESTION 

of cities and towns; the education of the milk pro- 
ducers, the milk dealers, and the milk consumers upon 
the subject; the publication of literature upon the 
subject. 

(2) The principal reforms urged by such an organi- 
zation to be (a) more efficient inspection and the rigid 
enforcement of certain standards of cleanliness and 
purity, the ideal to be aimed at being a safe and germ- 
less supply; (6) the establishment of infants' milk 
depots for the supply of pasteurized milk, with the 
understanding that raw milk of a certain accepted 
standard of purity and cleanliness may be also sold; 

(c) the elimination of tuberculosis from dairy herds; 

(d) the promotion of breast-nursing and the education 
of mothers in the principles of milk hygiene.'* 

There are doubtless many other matters which 
could be very conveniently incorporated into such a 
platform as I have suggested, but my purpose is simply 
to demonstrate that it is possible for all who are work- 
ing for the reform of our public milk supply to join 
hands in a great aU-inclusive, effective movement. 



CHAPTER IX 

OUTLINBS OF A POLICT OF REFOBM 



Those who have read the preceding pages with rea- 
sonable attention will be able to anticipate most of 
the leading features of the policy of reform which I 
desire to outline in bringing this study to a close. 
The problem is many-«ided ; the evils are so numerous 
and varied in character that no single reform will 
suffice. The evils spring from so many somtjes — 
from the animals themselves, their environment, 
their attendants, the utensils into which the milk is 
drawn, the mode of its conveyance from the farms to 
the cities, the places where it is sold, and the unhy- 
gienic conditions which aboimd in the homes where it 
is consumed. At every stage, from the time it is drawn 
from the cow's udder until it enters the infant's stom- 
ach, ignorance, carelessness, and greed — but ignorance 
above all I — add to the natural difficulties and perils 
of using cow's milk as a food for the human infant. 

While the conditions described in the earlier pages 
of this volume obtain generally in all states and in 
most cities, whether large or small, the degree in which 

fi67 



270 THE COMMON SENSE OF THE MILK QUESTION 

a policy adopted. Secondly^ milk is largely a subject 
of interstate commerce. In the city of New York, 
for example, we have a great population drawing its 
milk supply from seven different states, and it is 
foolish to argue that New York has no interest at 
stake when Pennsylvania or Ohio legislates upon 
this question. It is also quite preposterous that 
the citizens of New York, in order to be sure of a 
decent milk supply, should be obliged to maintain 
a costiy system of inspection in half a dozen states, 
as at present. Finally, the organization of such 
work under federal auspices would be, or could be 
made, much more economical than if carried on by 
the various states, 

n 

It seems to me, then, that this great work should 
be undertaken by the nation; that steps should 
be taken to stamp out the disease within a given 
period of time. That this is possible, and not a mere 
dream, no one who is familiar with the work done 
in Denmark, under the leadership of such men as 
Professor Bang, will very seriously doubt. They 
have not reached the ideal, but they have demon- 
strated that, given the necessary funds, bovine tuber- 
culosis can be eradicated. 

Denmark, as is generally known, has long suffered 
to an extraordinary degree from tuberculosis, both 



OUTLINES OF A POLICY OF REFORM 271 

bovine and human. It was found by physicians and 
veterinarians who were alarmed by the excessive 
prevalence of the disease, both among cattle and 
human beings, that there was a very close connection 
between the two. As a result of the agitation by 
the veterinarians which resulted, Copenhagen secured 
from the imperial parliament an act giving it certain 
powers to attack the problem of eliminating the 
disease from the dairy herds, and preventing the 
infection of the people through the use of tuber- 
culous milk and meat. The Copenhagen system, as 
it is called, is to-day universally regarded as the most 
significant experiment ever made in this direction.^ 

Under this system there is frequent and careful 
inspection of all herds. The tuberculin test is used, 
no charge being made to the farmer, either for the 
tuberculin or for the services of the veterinarian. 
The worst animals are slaughtered, including all those 
with badly diseased udders. Others, less seriously 
affected, are separated from the healthy stock, so 
as to prevent the spread of infection. Such segre- 
gated infected animals may be used for breeding 
purposes, or they may be fattened for the market, 
but their milk must not be sold or used for any 
purpose whatsoever. This is frankly regarded as a 
compromise, and the general opinion is that nothing 
short of the slaughter of all infected animals will 
prove finally effective. 



272 THE COMMON SENSE OF THE MILK QUESTION 

All cattle slaughtered in the city, and all carcasses 
brought into the city, intended for the market, 
must be thoroughly inspected for traces of tuber- 
culosis. Where general tuberculosis is discovered 
the whole carcass is condemned and no part of it may 
be used as food. It is first rendered unsalable, after 
which it may be used for soap-making and similar 
purposes. Carcasses in which no trace of the disease 
can be found are marked " First Class " and, of course, 
bring the best prices. Where localized infection 
only is found, the infected parts are first cut away 
and destroyed, after which the remainder is permitted 
to be sold, but it must bear the label "Second Class." 
Great care is taken to protect healthy animals, as 
it is hoped from them to breed a new, healthy stock. 
While the law under which this system is operated 
applies only to Copenhagen, the system is being 
gradually adopted throughout Denmark. 

Of course, Denmark is a little country, and its 
conditions differ from ours in every way. The Danish 
experience is of value to us only as showing that 
bovine tuberculosis can be very greatly reduced and 
that it is not idle to think of its entire eradication. 
To obtain that result it will be necessary to destroy 
an enormous number of valuable dairy cattle, for 
which their owners must be compensated, involving 
an enormous outlay of money, aggregating many 
millions of dollars. It will be necessary, also, to 



OUTLINES OF A POLICY OF BBFORM 273 

disinfect many thousands of cow bams and to destroy 
altogether many thousands more which cannot be 
disinfected. It will also be necessary to rehabilitate 
the breed of dairy cattle by breeding from sound 
stock. It may be necessary even to prohibit imder 
severe penalties breeding from any animals except 
those certified to be perfectly healthy. I frankly 
confess that I do not see how these things can be 
done except by the federal government. 

The problem is a national one, and its ramifications 
are so numerous and varied in character that to cope 
with it in any other way than by federal action seems 
almost impossible. That much can be done by 
means of state legislation and administrative genius 
I have no doubt whatever, but the problem will 
never be entirely solved until it is faced by the union 
of states. Failing such a policy being imdertaken 
by the federal government, then our only hope lies 
in securing an agreement of all the states upon a 
uniform policy of aggressive warfare upon tuber- 
culosis and all other diseases which mankind may 
acquire from his four-footed friends in his food and 
drink. 

m 

In most of the states there has been some provision 
made for the inspection of dairy cattle with a view 
to eliminating tuberculosis from our herds, and the 



274 THS COMMON SSNSS OF THE MILK QUESTION 

tuberculin test is very generally used. It is a noto- 
rious fact, however, that the inspection is pitifully 
and hopelessly inadequate. There are not enough 
inspectors, and as a result too small a percentage of 
the total number of cattle comes under observation 
at any time. Nothing short of a periodical examina- 
tion of every herd will suffice, and we are lamentably 
far from that requirement as yet. 

There would seem, also, to be a great deal of in- 
competency in the use of the tuberculin test. On 
the one hand, we have such obviously inconclusive 
results as those noted in the South by Professor 
Doane/ pointing, it would seem, either to incom- 
petence or dishonesty — probably both. On the 
other hand, there are frequent complaints from 
farmers of serious bungling. Some of the stories 
told, and too well attested to be lightly passed over, 
are almost incredible on account of the stupidity of 
the inspectors. They err sometimes one way and 
sometimes another, but the percentage of error is 
too high. The result is to discredit the tuberculin 
test in the mind of the farmer and the public. Yet, 
when it is properly applied, the tuberculin test is 
marvellously reliable. A number of years ago, 
some very searching investigations into this matter 
were made in Belgium. It was found that post 
mortem examination confirmed the diagnosis made 
upon the tuberculin test in more than 99 per cent 



OX7TLINE8 07 A FOUCT OF BEFORM 275 

of all Buch examinations.' Since then the test has 
been greatly perfected, so that the percentage of 
error ought to be almost nil. Too much stress can- 
not be laid upon the fact that frequently the best- 
looking animals in a herd are the ones most seriously 
aifected. It is important, therefore, that every 
animal should be regularly tested, regardless of 
appearances. 

Nothing less than a periodical test of every dairy 
herd, and of every aninial in every such herd, will 
do. The infected animals should be destroyed, and 
not merely segregated. This is the verdict of practi- 
cally every serious student of the Danish experiment. 
Segr^ation, breeding from diseased animals, or 
fattening them for sale as second-class food for the 
poor are compromises to be avoided. Not only do 
such compromises prolong the process of eradicating 
the disease, but lead to all kinds of corrupt and 
fraudulent practices. So I am assured, and certainly 
such results might be expected. However true this 
latter charge may be of Denmark, it can scarcely be 
doubted that it would be terribly true in this country. 
Every infected animal should be destroyed, and its 
carcass rendered unfit for use as food. 

And this at once raises the question of compensa- 
tion, which the British government has found so 
troublesome. It is plain that if we are ever to 
eliminate bovine tuberculosis, the active support 



276 THE COMMON SENSE OF THE MILK QUESTION 

and cooperation of the dairy farmers must be secured. 
They must realize that the eradication of the disease, 
however difficult and troublesome it may be, will 
ultimately benefit them. Judging from the attitude 
of the farmers in other countries upon this question, 
from the expressions of opinion of some hundreds of 
farmers in this coimtry, and from the attitude of 
the farmers' journals, there is no doubt that the 
farmers would gladly join with the authorities in 
a heroic campaign for the elimination of the disease, 
provided that they are not unfairly burdened. 

It cannot be expected that the farmers, among 
whom the percentage of altruists and saints is not 
appreciably higher than among other classes, will 
be very energetic and enthusiastic in securing the 
slaughter of their cattle if they are to lose 60 or 70 
per cent of the value of all animals so slaughtered. 
That is the condition in the state of New York at 
present. The state pays only 40 per cent of the 
value of any animal killed by order of the state vet- 
erinarian. It is freely admitted that in a majonly 
of cases the farmer is personally not responsible. 
He cannot tell whether his animals are healthy or 
not. Even a clinical examination by competent 
and experienced veterinarians will fail very often 
to detect the presence of the disease. It seems to 
me, therefore, extremely unjust to punish the farmer 
for what is not his fault, to impose upon him' 



OUTLINES OF A POLICY OF REFORM 277 

the bulk of the cost of our common, social pro- 
tection. 

As a result of this policy, many farmers, men upon 
whom we must largely depend if we are to eradicate 
the disease, are in a conspiracy to prevent the de- 
tection of infected cattle. They are human and their 
conduct is human. It is our public policy in the 
matter that is at fault; it is unjust in the extreme. 
Said one old farmer to me: ''We farmers, working 
with the state, could wipe out the plague in ten 
years or so. But instead of the state treating us as 
equal parties in a great effort for the common good, 
it penalizes us. Instead of breeding healthy cattle 
from sound stock and giving the farmer healthy 
animals in the place of those it condemns and 
slaughters, which would be just and wise, the state 
takes 60 per cent or more of the value of our cattle 
away and drives us toward bankruptcy and ruin." 

That old farmer spoke bitterly, but. with a certain 
justice. I do not know whether his suggestion of 
breeding cattle upon state or national farms and 
replacing the condemned animals with healthy ones 
would be practicable or not. If so, it would meet 
one very great objection, the fear of a meat and milk 
famine as a result of the lessening of the number 
of dairy cattle. If diseased animals were replaced 
with healthy ones, there would be no such famine. 
It is not for me to express an opinion as to the practi* 



278 THE COMMON SENSE OF THE MILK QUESTION 

cability of such a plan, but I do say without hesita- 
tion that the present policy of paying the farmer 
less than half of the value of the cattle condemned 
is neither just nor wise. 

There should be imiform rules in all parts of the 
United States providing for proper inspection and 
the efficient use of the tuberculin test; for the slaugh- 
ter of all diseased animals and the encouragement of 
breeding from healthy stock only; for just and 
adequate compensation for animals destroyed, so 
that the farmer would have to bear only his fair 
share of the burden of loss. A large annual appro- 
priation in each state for a period of ten years, aug- 
mented perhaps by federal aid, would go far toward 
suppressing bovine tuberculosis altogether. Except 
the organization of the entire work by the federal 
government, no other plan than one of uniform state 
action seems adequate to the solution of the problem. 

rv 

Tuberculosis is not, however, the only evil which 
must be remedied. It is just as important to see 
that the cow bams, dairies, and creameries are kept 
up to the highest possible standards of cleanliness 
and hygiene, as to see that the cows are free from 
tuberculosis. This is, of course, only another way 
of saying that it is quite as important to prevent 
the disease as to cure it. It is just as necessary to 



0X7TUNES OF A POLICY OF BBFORM 279 

see that every possible safeguard is provided against 
the dissemination of typhoid, scarlet fever, and other 
milk-borne diseases as against tuberculosis. Here, 
in this general inspection, is a task big enough to 
tax the energies of the states. To do it thoroughly 
requires, everjrwhere, a large extension of the system 
of inspection, more money and more men. 

One very great defect in the present methods of 
inspection prevailing throughout the states is the 
lack of uniformity, the same anarchical spirit which 
permeates so much of our national life. There is 
no common standard to which the farmers must 
keep, nor any common method of judging the merits 
of a farmer's conditions. Many different ''score 
cards" have been devised for the purpose of establish- 
ing as nearly as possible ideal standards of require- 
ments which the milk producers and the milk dealers 
should be compelled to fulfil. Of late there has been 
a bewildering increase in the number of these score 
cards, and a careful examination of a large number 
of them is at once interesting and instructive. 

Some of the cards which I have examined seem 
to me to be fairly open to the charge of being "fad- 
dish." More of them are open to the grave objection 
that they are not explicit enough to the farmer, and 
leave room for friction between the farmer and the 
inspector. Too much is left to the personal judgment 
of the inspector. I know well enough that the per- 



280 THE COMMON SENSE OF THE MILK QUESTION 

sonal factor can never be wholly eliminated, but it can 
be reduced to a minimum. It is not enough to tell 
the fanner that his stable is badly constructed or 
that it is not clean. The score card ought to tell 
him just exactly where the faulty construction or 
the lack of cleanliness lies. It is not enough to have 
a card which allows ten points for a stable that is 
entirely satisfactory to the person drawing up the 
card, and then to have another person, with possibly 
another ideal of what a stable should be, go and 
arbitrarily allow the farmer only five points. The 
card should show upon its face exactly what defects 
caused the low award of the inspector. In the event 
of the farmer's feeling that his score is unfairly low, 
he ought to be able to check the award, point by point. 
And the reviewing officer ought to be able to tell by 
reading the card whether the award made by his 
subordinate is fair and just. 

How important this aspect of the problem of 
inspection is the following personal experience may 
serve to illustrate: In company with a physician 
who has long been identified with the milk reform 
movement, a man of unusual knowledge and fine 
judgment, I went through a stable in Orange County, 
New York. We agreed that each should fill in a 
popular score card, with the result that my friend 
marked his "Very Good" and awarded the stable 
95 per cent of the marks allowed, while I marked 



OUTLINES OF A POUCT OF REFORM 281 

my card "Fair," allowing only 50 per cent of the 
marks allowed. Which of the judgments more 
correctly represented the actual conditions is not 
here and now a matter of moment. The important 
point is that two fairly competent and experienced 
observers, absolutely uninfluenced by any personal 
feelings toward the farmer, should come to such 
different conclusions. That there might easily be 
a similar difference in the reports of different inspec- 
tors is quite evident. In such a case either an in- 
justice is done to the farmer or to the public. My 
objection is that there is too much guesswork, too 
much is left to the accidents of personal judgment. 
Some time afterward, my friend and I went through 
another stable, with score cards providing for more 
explicit information. The cards allowed 40 points 
for the stable out of a total of 100 points covering 
all the conditions of the farm. In this case we reached 
practically identical conclusions, one awarding 38 
points and the other awarding 39 points. 

It seems to me, therefore, a matter of considerable 
importance, though little attention has as yet been 
given to it, that there should be a uniform standard of 
inspection based upon the best score card that can 
be devised. The card used by the inspectors of the 
Health Department of New York City, devised by my 
friend Mr. Burton, is in many ways superior to any 
other with which I am familiar, and I note with 



282 THB COfilMON SSNSE OF THE MILK QUESTION 

satisfaction that it was chosen by Dr. Coit for sub- 
mission to the International Congress of the GauUes 
de Lait, which met in Brussels in September, 1907/ 
The omission of any record of bacteriological examina- 
tion is a weakness, however, in an otherwise almost 
ideal card. In this respect the very admirable card 
devised by Dr. Goler and used m Rochester is to be 
commended. An ideal card, suited to all parts of the 
country, could probably be debased by compounding 
the best features of the two.*^ 

There has been somewhat of a t^dency of late, 
among a section of the opportunists, to decry inspec- 
tion and to question its value. That attitude cannot 
be adopted, however, by any one who has a practical 
knowledge of the subject. It may be very slow work, 
it may be impossible to show the results in figures that 
are convincing; but whoever will take the trouble to 
go through the dairy farmmg districts with an open 
mind upon the subject, interested only in ascertaining 
the truth, will be astonished at the immense amount of 
good accomplished by a few efficient inspectors. I 
have gone through the farming districts of New York, 
a stranger, entirely unknown to the farmers with whom 
I have talked, asking all sorts of questions and going 
through all sorts of farms. Invariably I have found 
that the inspectors leave a well-marked trail of im- 
provement behind them — I speak of the inspectors 

* See Appendix II. 



0T7TLINES OF A POLICY OF REFORM 283 

sent out by the Health Department of the City of New 
York, for I rarely heard of the state inspectors. 

Wherever I have gone, I have found the careless 
farmer and the ignorant fanner embittered because 
the inspectors — "Darlington's Devils" they are 
often called — had compelled them to be more care- 
ful in handling the milk or keeping their cows. On 
the other hand, I have found the careful and com- 
petent farmers, especially the younger men, appre- 
ciative of the importance of strict cleanliness, often 
grateful for advice given by the inspectors, and less 
inclined to complain of ''red tape" and ''fads" than 
the others. Above all, I have never heard any sug- 
gestion of graft, though I have pushed inquiries in 
that direction very far^ Of the few places visited 
in Pennsylvania much the same might be said. Wher- 
ever I heard condemnation of Dr. Dixon's policy, or 
of his inspectors, it was from, men who obviously be- 
longed to the reactionary, slovenly school of farmers. 

Personally, I look mainly to increased and more 
efficient inspection for the improvement of our public 
milk supply. Not the old-fashioned inspection which 
aimed mainly at catching culprits, but the more effi- 
cient inspection which seeks the intelligent coopera- 
tion of the farmer, the inspection which lays most 
stress upon education and least upon persecution. 
The most efficient worker for reform is not the sharp- 
nosed inspector who catches the occasional culprit, 



284 THS COBiMON SSNSE OF THE MILK QUESTION 

but the man who can win the confidence of the 
farmer; the man who can successfully appeal to his 
good sense and show him the practical advantages 
which arise from the observance of certain elementary 
rules of hygiene. It must have been some such in- 
spector a dairyman told me about in the neighborhood 
of Media, Perm. " I would rather see the inspector 
come to my place than almost anybody I know. He 
has taught me things worth hundreds of dollars to 
me/' he said. 

v 

How far the cities may depend wholly upon the 
state inspectors to properly safeguard the production 
of the milk they consume is a question which every 
city will have to decide for itself. Certainly not until 
the inspection by the officials of the state is so perfect 
that city inspectors would be a waste of time and 
money, will it be advisable for the cities to give 
up the present general practice of having a staff of 
inspectors divided into two divisions, one for the 
inspection of dairies in the city limits, receiving sta- 
tions, and all places where milk is sold, the other for 
country inspection, of farms, creameries, and so on. 
I am inclined to think that it will always be well — 
at least in the case of the larger cities — to have some 
city inspectors at work in the districts where the milk 
is produced, as a sort of check upon the inspectors 
working under direction of the state. I do not sug- 



OUTLINES OF A POLICY OP RBPORM 285 

gest that the cities should trust too implicitly the 
state inspectors. 

At the same time^ it is evident that the burden of 
inspection falls too heavily upon our cities at the 
present time. I take the case of New York City 
as an illustration^ because I am more familiar with the 
details of its system of inspection; and because the 
situation in other large cities is dififerent only in de- 
gree. A very brief summary of conditions will suflSce 
to show how enormous the problem is in a great city.' 

The daily milk supply of New York City averages 
about 1,600,000 quarts. This great ocean of milk is 
drawn from more than 35,000 farms, shipped through 
some 700 creameries. These farms and creameries 
are located in Vermont, Massachusetts, Connecticut, 
Pennsylvania, New York, New Jersey, and Ohio. 
It will be seen at once that the health authorities 
of the city have no legal powers in other states. As a 
matter of fact their authority is confined to the geo- 
graphical limits of the city. But the Sanitary Code 
of the city of New York provides that "No milk 
shall be received, held, kept, offered for sale, or 
delivered in the city of New York without a permit 
from the Board of Health." 

Herein lies the power of the Board of Health in 
sending its inspectors outside of the city limits, even 
into other states. It can refuse a permit for the 
milk to enter the city until satisfied that it is produced 



286 THE COMMON SENSE OF THE MILK QUESTION 

under proper conditions, or it can rescind a permit 
once given. To safeguard the interests of the city 
there are some thirty-five inspectors of food detailed 
to milk inspection. Eighteen of these are engaged 
in the city, looking after the conditions in the railroad 
terminals where the milk arrives at night, seizing and 
destroying all that is above the legal temperature. 
They must also inspect all depots, trucks, retail 
wagons, stores where milk is sold, the condition of 
cans and bottles being returned to the country — 
in short, all the conditions of the milk supply after 
it reaches the city are subject to their inspec- 
tion. 

If a householder complains of the quality of the 
milk supply, either by letter, by telephone, or in per- 
son, the complaint is promptly investigated. Sam- 
ples are secured and such action as may be necessary 
is taken. Some of the inspectors are detailed to the 
work of taking samples for bacteriological examinar- 
tion and analysis. When there is an excessive bac- 
terial count reported, the report is made the basis of 
an investigation of the conditions at the place where 
the sample was taken, or the dealer from whom the 
milk was obtained. Then the matter is turned over 
to the country inspectors, who pursue the investiga- 
tion at the creamery from which the milk came and 
thence back to the farms from which the creamery is 
supplied. And whenever a case of typhoid occurs in 



OUTLINES OP A POUCT OP REPORM 287 

the city^ it is tabulated and the source of the milk 
supply ascertained. If several cases occiu* among the 
patrons of any retailer, this is regarded as a sufficient 
reason to suspect the milk supply, and a careful inves- 
tigation of the retailer's methods and of his source of 
supply is made through the country force, going right 
back to the farms. 

From this account it will be seen that the require- 
ments of city inspection in any city — for these things 
are just as necessary in a city of seventy-five thousand 
inhabitants as in New York — are many and complex. 
That they might be considerably simplified is unques- 
tionable. The retailing of ''loose" milk, for example, 
might well be restricted, and certainly ought never 
to be permitted by pedlers. Further, the sale of 
milk ought to be prohibited in stores where other 
than dairy products are sold, except, of course, milk 
sold in restaurants and the like to be consumed on 
the premises. The sale of milk in grocery stores is 
an almost unmitigated evil. It is conceivable, then, 
that the number of milk retailers could be greatly 
reduced. There is no good reason why New York 
should have from twelve to thirteen thousand places 
where milk is sold. True, there would be some 
objection to any attempt in the direction of lessening 
the niunber, on the ground that it crushed out small 
dealers and tended to the centralization of the trade. 
But that is the law of progress, in distribution as well 



288 THE COBOION SENSE OF THE MILK QUESTION 

as in production. The small fanner and the small 
retailer must go! 

The amoimt of work performed by these city inspec- 
tors in New York is enormous. Figures give a very 
inadequate idea of the work, though the fact that they 
make annually something like one hundred and six- 
teen thousand inspections is impressive. Still, it is 
recognized that work is inadequately done, and the 
constant cry is for more inspection — for more money 
and more men. Sometimes the cry is raised that men 
should be taken away from the country work and used 
in the city, but those who raise the cry have never 
taken the trouble to understand the situation. Noth- 
ing could be more foolish than to. lessen the rigidity 
of the inspection at the farms and creameries. So 
long as our milk supply continues to be produced as at 
present there will always be the necessity of a very 
costly system of inspection. 

To realize the great importance of the country in- 
spection one has only need to consider the case with 
which the outside work of the New York Health 
Department practically began. It occurred toward 
the end of 1904. One of the inspectors went into 
a creamery and found the manager in the act of adul- 
terating the milk. In the centre of the creamery 
there was a well which acted as a cesspool for the 
drainage from a badly broken and filth-saturated 
floor. Off from the main room of the creamery, in 



OUTLINES OF A POUCY OF REFORM 289 

a smaller room, the inspectors found a small keg of 
formaldehyde and a cask of " Lactine/' a coloring used 
in the adulteration of cream and milk. It developed 
that when the manager had notified the proprietors 
of the creamery that he was without an ice supply, 
they had answered him by sending the keg of for- 
maldehyde with instructions how to use it, which 
he had done regularly. Skim-milk was regularly 
colored up with "Lactine" and shipped to the city 
as pure milk, while the bottles were all washed in 
water taken from that contaminated well which 
was practically a cesspool. The inspectors found a 
large shipment of milk from this creamery upon the 
platform ready for the New York train, whither 
they followed it, and, finding it adulterated, seized 
and destroyed more than sixty cans of the stuff. Of 
course, the permit of that company was revoked. 

Now, it is doubtless true that this was an excep- 
tionally bad case. It taught New York the value of 
country inspection as no amount of arguing could 
have done. It was a lesson that went home. I do 
not think that I am violating any confidence when I 
say that all kinds of influence were used to stop the 
Health Commissioner from pursuing the radical course 
thus begim, but to no purpose. Fifteen inspectors 
dividing their time between 35,000 farms and 700 
creameries scattered through seven states is, natu- 
rally, an altogether inadequate staff. Making rather 



290 THE COMMON 8BK8B OF THE MILK QUESTION 

less than 25,000 inspections a year, they must leave 
some places uninspected and they have little oppor- 
tunity for reinspections. When one thinks of it, 
there is something radically wrong in a system which 
compels the city of New York to send its inspectors to 
Vermont and Ohio to make sure that the milk is pro- 
duced under decent conditions. Testing the herds 
for tuberculosis is a state function and sanitary inspec- 
tion ought to be. As the states become more and 
more conscious of their duty in the matter, and develop 
their systems of inspection, the cities will be relieved 
of a great deal of needless expense. How the neglect 
of the states burdens the great cities we see in the case 
of the part of its milk supply which New York draws 
from Pennsylvania. As the state improves its meth- 
ods of inspection it becomes less important for New 
York inspectors to devote their time to that state. 
A similar improvement in the other states would make 
it possible for New York to use most of the force at 
present employed in the country division upon the 
work of city inspection. In other words, New York 
City has to pay for the negligence of New York State 
and other states. 

To sum up the whole matter : If the testing of herds 
so as to secure a milk supply drawn from perfectly 
healthy cattle is the first article in the creed of the 
milk reformer, the second is efficient inspection to in- 
sure perfect sanitary conditions at every point, from 



XXVI. (a) A Modes 



I Railroad Milk Station — Nm 



1 



OtITLINEB OF A POLICY OF REFORM 291 

the COW to the consumer. Filthy and impure milk 
cannot be made safe by any process of pasteurization 
or sterilization, and the logical thing is to aim at clean, 
wholesome milk. Without deprecating pasteurization 
in any way, it can be safely said that the protection 
of the general milk supply and its improvement can 
best be secured by proper state and federal legislation 
looking to the eradication of tuberculosis and other 
diseases from dairy cattle; the exclusion of all per- 
sons suffering from infectious or contagious diseases 
from any direct connection with the production or 
distribution of milk ; the adoption of a uniform score 
card as a standard for inspectors; the thorough 
inspection of all the conditions under which milk is 
produced, shipped, and sold. And this creed can be 
reduced to two words, ''health" and ''cleanliness." 

VI 

I do not believe that any city should pasteurize, 
or compel to be pasteurized, all its milk supply, except 
under exceptional conditions, as a temporary measure. 
I can very well imagine a condition arising which 
would make it absolutely essential that all milk com- 
ing into a city should be pasteurized, but that condi- 
tion does not normally exist in this country, where, 
in spite of everything, our milk supply is equal to 
that of any other country in the world. In this I 
have been compelled to differ from many of my 



292 THE COMMON SENSE OF THE MILK QUESTION 

friends in the movement for milk reform who demand 
compulsory pastemization of the entire milk supply 
of our cities. That seems to me to be a retrogressive 
step and not a progressive one. 

The municipalization of the entire milk supply of 
any large city is out of the question for many years 
to come. But I do believe in the establishment of 
municipal farms for producing, under the very best 
conditions and most scientific direction obtainable, 
the milk necessary for such municipal institutions as 
hospitals and asylums, and for such other institutions 
of a like nature which may not be actually under 
municipal management and control, but which are 
essentially public institutions. As I have tried to 
show,* siich a system of municipal production would 
not only make it possible for these institutions to se- 
cure a pure and wholesome milk supply, but would 
also set a standard for private enterprise to follow. 
That the proposal is a perfectly practical one the 
experience of English cities shows. 

I believe as firmly as any of the advocates of 
pasteurization that, until we can get a better milk 
supply than any city now has, wise parents will pas- 
teurize the milk fed to their infants. Even if I lived 
in Rochester, I think I should continue to pasteurize 
the milk given to my baby, unless I could get a supply 
of extraordinasy pm-ity and cleanliness. Therefore 

♦Chapter VIi: ' 



. OUTLINES OF A POLICY OP REFORM 293 

I believe in the establishment of infants' milk depots 
as one of the most important means of lessening infant 
mortality. I imagine that there are very few cities 
having a population of more than twenty-five thousand 
in which there is not a need for such depots. 

I am clearly of the opinion, moreover, that these 
should be in all cases established and maintained 
by municipal authorities rather than by private phi- 
lanthropy, for reasons already stated in another 
chapter. Under present conditions, and probably for 
many years to come, pasteurization of the milk sup- 
plied at these infants' milk depots will be necessary 
in most cases. There are doubtless many cities which 
will need to adopt pasteurization only temporarily, 
if at all. Where there is a comparatively small city, 
having a high standard of citizenship and better 
housing conditions than those which exist in the 
larger cities, and where the milk supply is produced 
within a short distance from the city limits, making 
its control relatively easy, there ought to be no 
difficulty about getting a milk supply of a high aver- 
age standard of excellence, and a special supply for 
the infants' milk depots so pure as to need no pas- 
teurization. 

I choose for illustration a typical Southern city, 
the city of Savannah, Ga. How far the conditions 
which Professor Doane described as existing there 
three or four years ago * still exist I am unable to 



294 THB COMMON SENSE OF THE MILK QUESTION 

judge. From one correspondent of good judgment 
I learn that there has been '^ considerable improve* 
ment/' while another assures me that '' things remain 
in about the same bad way." This is immaterial, 
however, for my purpose. I desire simply to use the 
city as an illustration. Here we have a population 
of between fifty and sixty thousand, with many cows 
kept in the city limits by private families, the rest 
of the milk supply coming from herds kept within a 
few miles of the city. With no milk inspection, Pro- 
fessor Doane found that it was quite common for 
dairymen to water, skim, color, " preserve," and other- 
wise adulterate their milk. So poor was the milk 
supply that physicians almost invariably preferred 
condensed milk for infant feeding, and very few in- 
fants were fed upon cow's milk. These are, of course, 
the conditions of a small city at their worst. In such 
a city, it seems to me, the first need is a campaign of 
education and the organization of its public-spirited 
citizens for reform. The establishment of infants' 
milk depots would seem to be one of its most pressing 
needs, and I should say that, for some time, it would 
be necessary to pasteurize the milk supplied by such 
depots. But, with the sources of supply so near 
and so easily controllable, pasteurization ought not 
to be regarded as a permanent condition, but as a 
temporary expedient. It should be possible to obtain 
in a very little while a supply of milk for the depots 



OUTLINES OF A POUCT OF REFORM 295 

80 pure that pasteurization would be unnecessary 
and foolish. 

Upon these general lines, it seems to me, our cities 
must proceed. Infants' milk depots are generally 
necessary, and in most of the large cities, as well as 
in many of the small ones, conditions are such that 
pasteurization of the milk supplied for infant feeding 
seems to be inevitable for a very long time to come. 
While this should be regarded as an evil to be over- 
come, and efforts to obtain a pure supply should be 
made, in my opinion it is necessary to recognize the 
condition — and to pasteurize. In our great cities, 
without exception, there ia need for a chain of such 
depots at which parents can obtain satisfactory 
food for their infants. I protest against the taint of 
charity in connection with such depots, for they are 
as necessary to the fairly well-to-do citizen as to the 
poorest. In the homes of the wealthy, where ex- 
pense is not considered, where trained nurses and other 
competent help are available, there is a chance to 
obtain milk of a high grade and to modify and pas- 
temize it skilfully and under aseptic conditions. But 
this is practically impossible for all except the wealthy 
few, for the great mass of ordinarily prosperous 
families not less than for the poorest. Such depots 
should, in my judgment, be imder medical super- 
vision, nurses and physicians being employed in con- 
nection with them to advise mothers concerning the 
care of their babies. 



296 THE COMMON 8EN8S OF THE MILK QUESTION 

Connected with the infants' milk depots in the laiger 
cities I should like to see something like the French 
Cansidtations de Nourrissons, described in Chapter 
VIL It may not be necessary to follow the French 
method exactly, but the principle of having incor- 
porated into the system of providing proper food for 
infants some plan for the encouragement of breast- 
nursing seems to me a good one. It is my firm con- 
viction, based upon long and careful study of the 
problem, that a great deal may be done to lessen 
infantile mortality by means of education. The 
mothers need educating, and it has been shown that 
breast-nursing, the natural way of feeding a child, 
can be promoted by education. At the risk of some 
rather tedious repetition, I would remind the reader 
that this question of breast-nursing goes to the 
roots of the evil. It is no accident that the infant 
death-rate in such a crowded ward of a great city 
as the Cheetham Division of Manchester, England, 
should be the lowest in the city. The Jewish mothers 
there, as a rule, suckle their infants. It is not an ac- 
cident, either, that similar conditions are found in 
the crowded districts of the East Side of New York 
City, where the infant mortality is lower than for the 
whole city, or that the infant death-rate in Ireland 
is low. Breast-nursing is the explanation.^ What- 
ever can be done, therefore, to promote breast-nursing 
should be done. 



OUTLINES OF A POLICY OF REFORM 297 

VII 

It is rather fashioimble to speak pessimistically of 
the great problem of maternal education. Every- 
body recognizes the need for such education of the 
mothers, but there is very little faith shown in any 
comprehensive programme aiming to provide the 
education. As an abstract proposition, every one 
agrees with the statement that mothers need educa- 
tion, but it is relatively difficult to get up any interest 
or enthusiasm when practical measures are proposed. 
Nevertheless, in outlining these suggestions for a pro- 
gramme of reform, I desire to lay special emphasis 
upon this aspect of our problem. Given the purest 
possible milk supply, and the most efficient system 
in the world, if the mothers do not know how to take 
care of the milk, a great deal of the social effort and 
care will be utterly wasted and lost. 

It is not merely among the much patronized ''poor" 
of our cities, who have come somehow to be regarded 
as rather less than human, that there is maternal 
ignorance. The evil is by no means confined to that 
class for whose benefit social settlements and similar 
institutions are established. In the course of an 
address to the members of a fashionable church not 
long ago, I remarked that in many of the essentials 
of motherhood they could learn from the poorest, 
and that it might not be a bad idea for some of the 



298 THE COMMON SENSE OF THE MILK QUESTION 

East Side mothers to establish a social settlement for 
the wealthy mothers of Central Park West. Maternal 
ignorance is fairly well distributed among the classes, 
but the wealthy few can, and do as a rule^ engage 
trained and competent nurses. If we leave this class 
out of question, their children being provided for, it 
will be found that education is the great need for the 
mothers of the rest of the community. 

Everywhere there is ignorance of the most ele- 
mentary principles of infant care and feeding. Among 
the poorest of our immigrants, accentuated by poverty 
and squalor, ignorance shows itself more, but there' 19 
an appalling amount of ignorance among mothers 
higher in the social scale. Many of the underfed 
children in our schools come from homes where there 
is no poverty, except poverty of intelligence on the 
part of the mothers, and some of the worst instances 
of maternal ignorance I have ever heard of have been 
among the fairly well-to-do. 

Can anything be done to educate the mothers? 
To that question I unhesitatingly give an afiirmative 
reply. I think we begin too late when we begin with 
the mother, that we ought to have begun with the girl 
long before she became a mother; but it is possible 
to do a great deal in the way of educating mothers, 
a work in which public authorities and voluntary 
agencies can imite. In Australia, for example, as 
soon as a baby is bom the health authorities are 



OUTLINBS OF A POLICY OF RBFOBM 299 

notified by telephone, and, as soon as possible, a lady 
''nurse inspector" visits the home and sees that 
everjrthing is all right. Where the mother seems to 
need her assistance, the nurse inspector gives it ; and 
if it develops that the mother needs instruction, as 
most do, friendly visits of the nurse inspector, which 
are robbed of aU official appearance, are continued 
as long as necessary. The system works well and it is 
the universal testimony of those I have consulted 
concerning it that this education of mothers is most 
successful.* 

In New York City, I have taken great pains to 
observe the work of the special corps of niu'ses em- 
ployed by the Health Department during the summer 
months, and what has most impressed me has been 
the educational side of their work. Few citizens, I 
imagine, have any very clear idea of the work that 
is done by these nurses in educating mothers. I have 
seen a nurse teaching an Italian mother how to pre- 
pare her baby's bed, for example, so that the child 
could sleep restfully, and later seen the mother show- 
ing several other Italian mothers how to do it. I 
have seen mothers following every movement of the 
nurse, as she cut off the clothes little babies had been 
"sewed up for the winter" in and then properly 
dressed them, with an intense interest which could 
not be mistaken. The mothers want to learn and 
are, therefore, teachable. One who has followed 



300 THE COMSrON 8EN8B OF THE MILK QUESTION 

the work of the corps of nurses and friendly visitors 
employed by the New York Association for Improv- 
ing the Condition of the Poor cannot fail to believe 
in the practicability of educating mothers. 

In this connection, the much-discussed ''Hudders- 
field experiment'' is of interest principally because it 
points to the union of municipal and voluntary forces 
in a most successful undertaking. The city is divided 
into nine districts. For each of these districts there 
is a voluntary ladies' committee, made up of "lady 
helpers" and a "lady superintendent." It is the 
business of these voluntary agencies to cooperate 
with the officials of the Board of Health in the follow- 
ing manner : There are two lady doctors appointed 
by the City Council, working under the immediate 
direction of the Medical Officer. All births in the city 
must be reported to the Medical Officer within twenty- 
four hours, and it is the business of the lady doctors 
to visit the newly bom infants and their mothers at 
the earliest possible moment. They make it as much 
as possible a friendly and informal call, giving advice 
only where it seems to be necessary. They leave 
with the mothers a few printed rules for the care 
of the little ones and, if it seems necessary, repeat the 
visits. Each Saturday the lady doctors place in 
the hands of each lady superintendent a list of the 
cases in her district where friendly visits are likely to 
be helpful and appreciated. These cases are then 



OUTLINES OF A POLICY OF BEFOBM 3Q1 

divided among the assistants, each lady helper 
undertaking to make periodic visits for a certain 
period) usually a year, and to keep the case under 
observation. The greatest possible care is taken to 
avoid encroachment upon the domain of the family 
physician, and to keep the visits upon a friendly 
basis rather than an official one. 

I regret that I am unable to speak of the Hudders- 
field experiment from personal observation. At 
first, upon reading an account of it in the Annual 
Report of the Medical Officer of the city, I was in- 
clined to question its practicability. It seemed to 
me that there would inevitably be friction between the 
visiting ph}rsicians employed by the Board of Health 
and the family doctors, and also that the volunteer 
visitors would be likely to offend many mothers by 
their tactlessness. I submitted these matters to a 
medical man of standmg in Huddersfield and he 
assured me that, in his experience, neither of the 
difficulties had arisen, and that the plan was working 
splendidly and accomplishing great good. Since it has 
been in operation only two years, it is too early to 
attempt a statistical measure of its value, but the 
Huddersfield authorities seem to believe in it and to 
expect great results from it.* 

One thing is evident from these fragmentary ex- 
I)eriences and experiments, namely, that the great 
majority of mothers are fully aware of their need of 



302 THE COMMON SENSE OF THE MILK QUESTION 

education and willing to receive it. That, I take it, 
is the most promising condition that could be desired. 
In every city in the land I should like to see some 
effort made to develop a comprehensive, practical 
plan for the education of mothers in the essentials of 
motherhood. Until we can accomplish this, babies 
will continue to die needlessly, victims of ignorance 
and social helplessness. 

But why should we begin education after mother- 
hood has been reached? Is it idle to hope that we 
shall yet develop our educational system so that our 
girls will not enter wifehood and motherhood — as 
most of them must — so utterly unprepared and un- 
fitted for their life work ? Is it too much to expect 
that some means will be devised to give them a 
practical education in these matters? No girl, 
it seems to me, ought to leave school until she has 
learned how to cook simple and wholesome food in 
a practical and economical manner ; how to sew and 
mend; how to wash and dress, feed And manage, 
infants and young children. She should know, from 
actual practice, how to do these things, and how 
to clean a house properly. She should have a stand- 
ard of cleanliness — for, alas I the house which many 
regard as being very clean is really very dirty. She 
should know something of the values of foods, and, 
especially, the dangers which may be incurred 
through contamination. She should know some- 



OUTLINBS OF A POLICY OF RBFOBM 303 

thing of sexual physiology, as, indeed, should our 
boys. 

To put the whole matter in a few words, our girls 
should know enough before they enter upon wife- 
hood to avoid the awful mistakes for which such a 
terrible price in baby lives is now paid. Among the 
greatest defects of our civilization to-day is our failure 
to fit for parental responsibilities the boys and girls 
who go through our schools. 

vm 

In this chapter I have tried to indicate, very briefly 
and simply, the most important features which a 
practical programme of reform should embrace. I 
do not expect that it will be adopted in its entirety 
by any city; nor do I expect that it will escape crit- 
icism. But, in the main, it represents, I believe, the 
consensus of practical and expert opinion upon a most 
important problem. I believe, too, that upon the 
lines indicated a programme can be framed to suit 
the needs of each individual city upon which all 
sincere friends of milk reform can unite. Such unity 
of forces is above all things else desirable, and if this 
study, inadequate as I know it to be, helps to create 
that unity, I shall feel abundantly repaid. 

Healthy herds — efficient inspection — insistence 
upon cleanliness and careful handling of the milk — 



304 THE COMMON SENSE OF THE MILK QUESTION 

municipal farms for providing public institutions — 
infants' milk depots for the sale of properly modified 
and pasteurized milk for babies — education of the 
mothers and of the girls before they reach wifehood 
and motherhood, — such are the principal features 
which must be included in our campaign for the reform 
of our public milk supply and saving the babies. 

I have been asked many times whether the ordinary 
farmer will be able to meet the conditions which it 
will be necessary to impose upon the production of 
milk, and I frankly reply that I cannot believe he will. 
The small farmer, in my judgment, will be unable 
to do all that will be demanded. Like the small 
retail stores, the small dairy farms will, in all probabil- 
ity, be forced out of existence. Not this year or next, 
perhaps, but sooner or later. It is inevitable. With 
our present unorganized production and distribution 
of milk, it will be impossible to carry reform very far 
without raising the price of milk to a very injurious 
and deplorable standard. And to greatly increase 
the price of milk means that the babies will perish 
for want of milk — if, indeed, there is not a revolt 
which will sweep aside the reformers and their schemes 
of reform. 

But I differ from many careful students of the 
problem in believing that, given proper organization, 
a satisfactory milk can be produced even more 
cheaply than the poor and contaminated stuff now 



OUTLINES OP A POLICY OP REFORM 305 

sold in our cities. I believe with Sir Richard Douglas 
Powell that "scientifically conducted dairy farms on 
a large scale, with urban depots for the reception and 
distribution of piu'e milk in clean bottles," could be 
made to pay without any excessive prices." I 
should like to see the experiment tried by a sort of 
"model milk trust," organized upon much the same 
lines as the various model tenements associations. 
Given the necessary capital, it would be perfectly 
possible, I believe, to have large, scientifically con- 
ducted farms within a reasonable distance of the 
cities, and a system of retail establishments of the very 
highest type scattered through the cities, supplying 
milk of a much higher standard of purity and excel- 
lence than is now supplied anywhere in the world — 
except in a few cases where small quantities are sup- 
plied to a few rich people at fancy prices. I believe 
that it could be done, even in competition with the 
ordinary milk of commerce, at a fair profit. When 
one considers the wastefulness of present methods, 
this does not seem an unreasonable hope, for the 
economies which could easily be effected would more 
than compensate for the additional expense incurred 
in protecting the supply. 

In the campaign for a better milk supply, especially 
for the protection of our babies from unnecessary 
disease and premature death, we need the earnest 
cooperation of all the constructive forces in society. 



306 THE COMMON SENSE OF THE MILK QUESTION 

CSvic loyalty, paternal and maternal love, and en- 
lightened minds are needed to solve the great prob- 
lem which, unsolved, demands so many innocent little 
lives as tribute for our failure to solve it. Shall we 
have a clean milk supply? Shall we have a safe 
supply for our little ones? 
It 18 for America to answer! 



APPENDIX I 

Milk as a Carrier of Infsctious Diseases 

Milk may acquire infective properties after it leaves 
the udder of the animal. Numerous instances have been 
observed in which outbreaks of typhoid fever, scarlet 
fever, and diphtheria, by their sudden and explosive 
character, affecting families living in streets and locali- 
ties supplied by the same milkman, naturally pointed to 
the milk supply as a common cause. Dr. Michael Tay- 
lor, however, was the first physician (in 1857) to point 
out definitely that cow's milk might serve as a medium 
of spreading typhoid fever from a dairy where the dis- 
ease prevailed. In 1867 he also showed that scarlet 
fever might be distributed in the same way. In 1877 
Jacob traced a diphtheria epidemic at Sutton, England, 
to the milk supply ; and in 1872 Macnamera traced an 
outbreak of cholera at Calcutta, India, to an infected 
dairy. These facts could not fail to sharpen the powers 
of observation in others, and in consequence similar 
outbreaks were more frequently reported, so that Dr. 
Kober was enabled to present to the International Medi- 
cal Congress, held in Paris in 1900, the history of 195 
outbreaks of typhoid fever, 99 of scarlet fever, and 36 
of diphtheria, all traceable to the milk supply. 

It has been demonstrated that disease germs may not 
only survive, but in many instances actually proliferate, 
in the milk, and it is not a difficult matter to point out 
the many ways by which these germs gain access, espe- 
cially when some of the employees are also engaged in 

ao7 



308 APPENDIX I 

nursing the dicky or are suffering themselves from some 
mild infection while continuing their duties, or are con- 
valescent from disease, and thus infect the milk in han- 
dling it. 

It is quite conceivable how animals, in wading in filth 
and sewage-polluted water, may infect the udder, and 
through it the milk, with the germs of typhoid fever. 
We can also appreciate how infected water may convey 
the germs when used for washing the utensils or in de- 
liberate adulterations. Infection may also take place 
through the agency of scrubbing brushes, dishcloths, 
flies, and exposure to infected air. 

MILK-BOBKB TYPHOID FEVEB BPIDEMIG8 

Of the 195 epidemics of typhoid fever tabulated by 
Dr. Kober, there is evidence in 148 of the disease hav- 
ing prevailed at the farm or dairy. In 67 instances 
the infection probably reached the milk by percolation 
of the germs into the well water with which the utensils 
were washed; in 16 of these the intentional dilution 
with water is a matter of evidence. In 3 instances the 
BaciUv^ coli communis and the t3rphoid germs were 
demonstrated in the suspected water. In 7 instances 
infection is attributed to the cows wading in sews^ge- 
polluted water and pastures; in 24 instances the dairy 
employees also acted as nurses ; in 10 instances the pa- 
tients while suffering from a mild attack, or during the 
onset of the disease, continued their work; and those 
who are familiar with the personal habits of the average 
dairy hands will have no difficulty in surmising the man- 
ner of direct digital infection. In t>ne instance the milk 
tins were washed with the same dishcloth used among 
the fever patients. In 2 instances dairy employees 



APPENDIX I 309 

were connected with the night-soil serrice, and in 
another instance the milk had been kept in a closet in 
the sick room. 

In the recent exhanstive investigation conducted by 
the Public Health and Marine-Hospital Service the com- 
mission definitely traced 85 of the 866 cases of typhoid 
fever in the District to the use of infected milk. 

MHiK-BOBKB SCARLET FEVEB EPIDEMICS 

Of the 99 epidemics of scarlet fever the disease pre- 
vailed in 68 instances at the dairy or milk farm. In 6 
instances persons connected with the dairy either lodged 
in or had visited infected houses. In 2 instances the 
infection was conveyed by means of infected bottles or 
milk cans left in scarlet fever houses. In 17 instances 
the infection was conveyed by persons connected with 
the milk business while suffering or recovering from the 
disease, and in at least 10 instances by persons who 
acted as nurses while handling the milk. In 3 instances 
the milk had been stored in or close to the sick roouL 
In 1 instance the cans had been wiped with an infected 
cloth. (In 19 instances the infection was attributed to 
disease of the milk cows, such as puerperal fever and 
inflammation of the udder and teats; but these out- 
breaks were probably not genuine scarlet fever, but a 
so-called streptococcus or staphylococcus infection, the 
symptoms of which closely resemble those of scarlet 
fever.) 

MILK-BOBNB DIPHTHBBIA EPIDEMICS 

Of the 36 outbreaks of diphtheria, there is evidence 
that the disease prevailed at the dairy or farm in 13 
instances. In 3 instances the employees continued to 



310 APPENDIX I 

handle the milk while suffering themselyes from the 
disease. In 12 instances the disease is attributed di- 
rectly to the cows having inflammatory conditions of the 
teats and udders. (These instances, howeyer, may be 
regarded as typical examples of streptococcus and 
staphylococcus infection, giving rise to a form of fol- 
licular tonsilitis or pseudo-diphtheria, often difficult to 
distinguish clinically from true diphtheria or scarlet 
fever.) 

In addition to the foregoing diseases there are re- 
corded a limited number of outbreaks of cholera which 
have been traced to milk infection through various chan- 
nels already referred to, chiefly in handling with in- 
fected fingers, by contaminated water, and the agency of 
flies. There is also reason to assume that the organism 
of cholera infantum and the infectious agent of smallpox 
may find in milk a suitable medium for growth and 
transmission. 

It is interesting to note that of the 330 epidemics 
analyzed by Dr. Eober, 243 have been recorded by 
English authors, 52 by American, 14 by Qerman, 1 1 by 
Scandinavian, and 5 each by French and Australian 
writers. This is probably due to the fact that the Eng- 
lish and Americans usually consume raw milk, while on 
the Continent the milk is rarely used without being 
boiled. 

— From Sanitary Milk Produotion. Report of a Conference 
appointed by the CommiasioneTB of the District of Columbia, 
witli accompanying papers. — Circular 114« Bureau of Animal 
Industry, August 20, 1907. 

At the time of going to press with this volume, the 
*' Report on Milk in its Relation to Public Health,^' by 
Surgeon General Walter Wyman, of the United States 



APPENDIX I 311 

Public Health Seryioe, has not been published. To-day, 
March 5th, 1908, as the last proofs are being read, the 
2^ew York Times contains the following statement, plainly 
indicating that the position taken in this volume is, in 
the main, supported by this federal investigation : — 

500 EPIDEMICS FROM MILK 

SxTBOEON General Wtman Reports Results or 
! Federal Investigation 



Washington, B.C., March 4. — Snigeon General Walter 
Wyman of the Public Health Service to-day submitted to Secre- 
tary of the Treasury Cortelyou a *' Report on Milk in its 
Relation to Public Health." The report is the result of an 
investigation ordered by President Roosevelt and conducted by 
Federal experts. 

In his introduction to the twenty-two treatises of the experts, 
Dr. Wyman says : *' The steady decrease in general mortality 
does not apply to the infants. It is recognized that gastro- 
intestinal disease is the largest single factor determining infant 
mortality. This enormous loss of potential wealth is of grave 
concern to the state and worthy of most careful consideration. 
It has been the object of this work to include all available data 
showing the influence of milk as a carrier of infection and the 
measures necessary in consequence.'' 

The Surgeon General writes : — 

"Dr. Mohler points out that probably the most important 
disease of cows from the standpoint of pubUc health is tubei^ 
culosis, and that it is the most prevalent. He insists that all 
milk should come from either tuberculosis tested cattle or be 
subjected to pasteurization. 

** References will be observed to the achievements of Mr. 
Nathan Straus in promoting the use of clean pasteurized milk 
for infants and the establishment of infants' milk depots both 
in the United States and abroad, and it is proper here to give 
recognition to his philanthropic and successful efforts." 



312 APPENDIX I 

The report contains an amazing array of evidence of the 
responsibility of infected milk for epidemics of typhoid fever, 
scarlet fever, and diphtheria. Past Assistant Surgeon General 
John W. Trask has tabulated the data of 500 epidemics that 
were definitely traced to the milk supplies, including 317 
typhoid epidemics, 126 scarlet fever, 51 diphtheria, and 7 of 
pseudo-diphtheria, or epidemic sore throat. 



APPENDIX II 
Score Cards — I. Boghester 

Rochester Barean of Health. Division of Milk Ias|»ectioo 

Inspector Date 190 



Date 

Vame Town P. 0. Address 

Marketed Sise of StaUe Containing Fresli Cows. ..Dzy Cows. .. 



n. a 

b 

e 
d 

IIL a 

b 

c 

« 
IT. a 



V. a 



c 
d 



1 rSeparate Place for Galvlnff 1 

S " Buildinff for Sick CowB 4 

8 J Health and Comfort of Cows (Dedoct not to 

exceed 46) 20 

Tnberealoals Teat (each cow not Tested 

takes off 80 diyided by n umber of cows) . . 20, 

Location on Hill or Slope 5' 

Window Space for Eacn Cow. 4 square fiset 
counts 10; 8 square fMt T.6; 2 square 
feet 5 ; 1 square foot 2.6 10 

EfBdent System of Ventilation 

Cubic feet of Air for each Cow, 460 oonnts 10 
for each 26 feet less, take off 1 

J Food 10 » 

lof •••• 



9 

.10 

.•loj 



f Water— dean 



Total. 



—Cleanliness of Cows 

J Shavinprs for Bedding 6 

1 Clean Stalls and Passage Ways 16 

—Barnyard and Pasture Clean 

1 Presence of Cobwebs 
Presence of Dust 
Presence of Odors 

Total 



}■■ 

m m t 

... 



(Good cleaning of Utensils 10) 

) Sterilizing Utensils 80 f " 

1 Plentiftil Supply of water 10 ) 

( Location ana Ttoteotion ot source 15 ) * " 

—Inside of Utensils kept free lh>m Dust after 

Sterilizing , 

—Small Top Pail , 

Total , 



# ■ • • • 

20) 



— Healtii of Employees 

( Wearing Clean Washable Suit 

< Washing and Drying Hands before and 

( during Milking 

(Washing Udder 16) 

1 Discarding Fore Milk 10 f"" 

Total 

1— Prompt and Efficienti 
Cooling in an hour to 

2— Holding Milk at Low 
Tern. In Transporta- 
tion at 



40O counts 40:460-86; 
eOO-80; 65^-26 ;fl0o. 
20: 660-I6: 700-10 
and aboTC tO^-O. . . 



l\ 



Banltory Condition of Milk Boom 16 ) 

Proteotton by Lock or Seal from Opening Cans 6 ) " " 

Total 



PSBFaOT 



46 



Total or all. 



85 



20 
"100 

"io 

20 
20 

80 

"100 

40 

25 

20 

15 
100 

45 
80 

25 

loo 



40 
40 



16 
6 

100 



SOOBS 



{480 and each 
460 division 
400 is 
Below 400 



flK) 

80 

60 

Below 60.. 

813 



600 

An<i f Below 26,000.. Excellent 
ronnti " 60.000.. Good 
Count< .. 75;ooo.. Medium 



314 



APFENDIX II 



SoosE Cabds — 11. New York 



FIUHo. 



F«r«Mt8eoMlOO% 
Boore Allowvd..... % 



DEPARTMENT OF HEALTH 

OITT OF HSW TOBK 



Dairy Intpeetloii 



DtrltloB of IB^poetloBt 



100 



1 Inspection No Time A. P. M. Date 

2 Tenant P. O. Address 

8 Tovi^ship Coanty State 

4 Owner Party Interyiewed 

6 Milk delivered at Since 

Formerly delivered at • 

6 Creamery on B. B. Branch Miles to N. T..... 

7 Creamery operated by Address 

8 Distance of farm from creamery Occupied farm since 

No. of Cows Breed No. Milking 

Quarts milk produced ^ . 

10 All persons in the households of those engaged in producing or 
handling milk are free from all infectious disease 

11 Date and nature of last case on farm 

12 A sample of the water supply on this farm taken for analysis 
190 ... . and f oun d tobe 

18 Size of cow bam, length feet Width feet. Height 

of ceiling 



8TABLB 

Cow Stable ts located on etoyttod ground with no 

stagnant water, hog pen, or pri^ within 100 foot 

Tloon are construotea of oonerete or tome non- 
absorbent material 

Floors are properly graded and water-tight* 

Drops are oonstmcted of concrete, stone or some 

non-absorbent material 

Drops are water-tight 

Feeding Tronght, platforms or cribs are well lighted 

slean 



U 
15 

16 

17 

18 
19 

90 

81 



andot 



is. 



.tight 



Ceiling is constrncted of and 

and dust proof 

Celling is ft«e from hanging straw, dirt or cobwebs 




Allow 



APPENDIX II 



315 



n Vuaiiber of Windows totel iqiitfe Ibet whioh 

is ...•uffldent 

28 Window panes are washed and kept clean 

M VeBtUfttioa eonsUtsof 

which Is suffldent 8, flUr 1, Insaffldent 

SO AirteACOls cable ibet per cow whioh is 

saffident (600 and over —8) (600 to 600— 9) (400 to 600 — 1) 
(nnderiOO— 0) 

S6 Intorior of stoble painted or whitowaahed on which 

Is MtlsfiMstorY S, flttar 1, never 

87 Walls and LodgM are free from dirt, dust, maaue 

or cob webs 

88 Floors and Prsmisss are flree ih>in dirt, mbblsh or 

decayed animal or Tegetable matter 

89 Cow Bods are dean 

80 LIto Stock, other than cows, are exdnded from 

rooms in which milch cows are kept 

81 There Is direct opening from bam into sUo or grain 

pit 

88 Boddinf nsed is dean, dry and absorbent 

88 Separats Bnildinc is proTlded for cows when 

sick 

84 Beparato quarters are proTlded for cows when 

calving 

86 Xannn is removed daily to at least 900 ibet ftt>m 

the bam ( ft.) 

86 Manure pile is so located that the cows cannot get 

at it 

87 Uqnid Matter U absorbed and removed dally and 

allowed to overflow and saturate ground under 

or around cow bam 

88 Rumlng Water supply for washing stables la located 

within building 

89 Dairy RvlOi of ttie Department of Health are posted 

COW TABD 



40 Cow Yard is properly graded and drained 

41 Cow Yard is dean, &y and fi«e from manure 

COWS 

48 Cows have been examined by Veterinarian 

Date. 190 — Report waa 

48 Cows have been tested by tuberculin, and all tuber- 
culous oows removed 

44 Cows are all in good flesh and condition at time of 

Inspection 

46 Cows are all free from dinging manure and dirt 

(No. dirty ) 

46 Long Hairs are kept short on bdly, flanks, udder 

andtdl 

47 Udder and Teats of cows are thoroughly deaned 

before milking 

48 All Peed Is of good quslltv and all grain and coarse 

fodders are iree from durt and mould 

49 DistiUery waste or any substenoe in a stote of fbrmentotion 

or pntrelbction Is fed 

60 Water Supply for cows is unpoUated and plentifril 



PssrsoT 



Allow 



8 



8 
6 



r 



316 



APPENDIX n 



MILKBRS Ain> MILKINO 

51 AttendAlltt are Id good physical oondltioa 

68 Bpeoial MUklng Salts are used 

08 Clotliliig of mukere la clean 

64 Hands of milkers are washed clean before milking.. 

65 ig<iiH«£ is done with dry hands 

56 Fore Ifilk or iBrst few streams from each teat is 

discarded 

57 Milk Is strained at and in clean atmosphere 

58 Milk strainer is dean 

59 Milk is cooled to below (XP F. within two hoars 

after milking and kept below 50^ F. ontil deUvered to the 
creamery 

80 Milk from cows within 15 davs before or 5 dftys after par> 

torition is discardea 

UTBNSILS 

81 MUk Plili have all seams soldered flash 

88 Milk pails are of the small-moathed design, top 

opening not exceeding 8 Inches in diameter. Diameter . . . 

88 Milk palls are nnsed with cold water immediately 

after nslng and washed clean with hot water and washing 
solution 

84 Drring racks are provided to expose mOk palls to 

uesan 

MILK HOUSB 

85 Milk House is located on elevated groand with no 

hog pen, manare pile or privy within 100 ibet 

88 Milk nouse has direct commanication with 

building 

87 Milk house has sufficient light and ventilation 

88 Floor is properly traded and water-tight. 

80 Milk house is tret from dirt, rubbish and all material 

not used in tiie handling and storage of mUk 

70 MUk house has running or soil supply of pure clean 

water 

71 Ice is used for cooling milk and is cut firom 

WATER 

78 Water Snpply for utensils is from a located 

feet deep and apparently is 

pure, wholesome and uncontaminated 

78 Is protected against flood or surlkoe drainage 

74 There is privy or cesspool within 860 feetC* 

feet) of source of water supply 

75 There is stable, barnyard, or pile of manare or other 

sooroe of oontaminatlon within 800 feet ( feet) 

of sooroe of water supply 



1 
1 
1 
1 
S 

s 

1 
1 



8 

1 

1 
8 

8 
1 



1 
1 
1 



1 

1 



6 

a 

8 

1 



100 



Aujow 



•••••••I 



>•■••••• 



Inspector of Foods. 



APPENDIX II 



317 



SooRB Gabds — III. U. S. Department of Agbiculture 
UHITBD STATES DEPARTMENT OF AORICULTURS 

BUREAU OP AimiAL lEBUSTRT. DAIRT DIYI8I0E 



8AHITART lESPBCTIOE OF DAIRIES 

Owner or lessee of farm : 

Town: State: 

Total No. of cows : No. milking: . . 

Quarts of milk produced daily : 

Is product sold at wholesale or retail ? 

If shipped to dealer give name and address : 



Permit No Date of 


inspection : 


190 




Boobs 


REMABVa 




Perfect 


Allowed 


COWS 

flmulltiAfi fSrt ■.•••...«. 


fr-40 

6 
5 
5 

f ^ 
8-86 

[ 6 

5 
6 

0-ao 

5 
10-16 

10 

6 
6-80 






H«Alth (8^ 






f^iflanHnffc^ , 






^ITAiAr flnnnl V •..••••.....•..•..•• 






STABLES 






fTlAA.1lMflMIA *^* ^.^^A.o.. ...... 






Xjght 






VfintilAtinn ^4^ 






f^nhl^ anarrfi imup aow IK\ .•••....«. 






HmriAviU itt iTiAnnrA fQi ...•....••• 






Stabltt Tsrdfl) 






MILK HOUSE 






BrtnlninAiit (Si ....»..«....•..•«•. 






mj^nlliMiiii 






OftvM fttul jftlAAffillnAAA nf ntAiiMf1« . . 






Water Supply (Tamp ^ F.). 

MILKERS AED MILKIEO 

HftAltli of ftttandAntA 










Cl4wnHn4mtt of mllklnr 






HAEBLmO THE MILK 

Prompt and effldeDt ooottng 

CTempentare of milk : <> F.). 

storing at a low temperatore 

ProtMtlon during transportation . . 


















Total Soomi 


100 







Sanitary conditions are — Excellent :. . . Qood : . . . Fair :. . . Poor u . . 
Suggestions by inspector : 



Signed: Jnspecior. 



318 APPENDIX n 



DISSCTIOlf 8 FOR SCORINO 

00W8 

Conditioil and BMlthlvlBMf. — Dadvet S polata If in poor flatly tad 8 points 

If not taberoulin-tosted • 10 

CleuiliiMM. — Cloaa, 5; good,4; Mr, I: bad, 5 

Water Supply. — If oImii aad nnpollatad, 6 ; fldr, 8; ottMrwiM,0 

8TABLBB 

COBStnietioiL —For oemont floor (a)* in good oondition allow t points : Ikir, 1 ; 

poor, 0; wood floor (6) or other material In good oondition, 1; ntr, ^; 

poor, ; good tie (e), 1 ; good manger (tf), 1 : box stall (a), 1 6 

Cloanlineat. -> If tboroaghly dean, Inelndlng floor (a), windows (&), and oell- 

In^B (c),5; good, 4; medium, 8; ftir, 9; poor, 1 ; bad,0 6 

Light. — Four square Ibet of glass pw eow, 6 ; 1 point off Ibr each 10 per oent 

U'»s than 4 square feet per oow 5 

YentiUtlon. — Oood ventilating system. 4 ; flOr, 8; poor, 8; bad, 4 

Cubic Space per Cow. — If 600 onbio feet or over per eow, 8 ; leaa than 000 

ami ovttr 4(K). 8; less than 400 and over 800, 1 ; lose than 800, 8 

Removal of Xanuxe. — Hauled to field daily, 8; removed at least 80 fset fWmi 

stable, 1; otherwise, 8 

Stable Tard. — In good oondition («),%; well drained ((), ^ ; otherwise, 0. . 1 

mLK HOUSB 

Conatructlon. —Tight, sound floor, and not connected with any other bnfldlag 
(a), well lighted (ft), well ventilated (c),%; id) it connected with another 
bnlldln]? under good conditions, 1 : otherwiBe, ; (a) tf no milk house, 8 

Bquipment. — Hot water for cleaning utensils (a), 1 ; cooler (5), 1 ; proper 
palls (e) and strainers (d) used for no other purposes, 1 8 

Cleanlineea. — Interior clean, 6; good condition, 4; medium, 8; Ihlr, 8; 
poor, 1 : bad, 5 

Care and CleaallBeee of Utenaila. — Clean (a), 8 ; kept In milk house or suit- 
able outside rack (6), 8; otherwiae, 6 

Water Supply. — If pure and clean running water, 5 ; pure and clean atfll 
water, 8; otherwise, 6 

IQLKQIQ 

Attendanta. — Healthy 6 

Cleanlineea of MiUdng. — Clean milking suits, milking with dean dry handa, 
and attention to deamtness of udder and teats while milking. 10 ; no special 
suits, but otherwise dean (a), 7 ; deduct 4 polnta fbr uncleanly teata (p) and 
udder (e) and 8 potnta fbr undeanly hands (d) 10 

HAMDUNO THB lOIX 

Prompt and Bttdent CooUxig. — If prompt (a), 6; eflldent (b);itW*W,w 
under, 5 ; over 00^ and not over KP, 4 ; over 09^ and not over 60^, 8 ; over 
60<>, 0; if ndther prompt nor eflldent 10 

Storing at Low Temperatore. — If fiO^ F. or under, 5; over 00^ and not over 
6fl°, 4 : over NSP and not over 60®, 8 ; over 60®, 6 

Protection during Tranaportation to Market. — If thoroughly protected 
(iced), 5; good protection, 4 ; partly protected, 8; otherwise, 6 

8C0RB ^^ 

If total score is 90 or above and eadi division 85% perflMt or over, the dairy Is 

Bzoellent (entitled to registry). 
If total score is 80 or above and eadi division 7S% perfoct or over, the dairy la Good. 
If total score Is 70 or above and each dlvlaion 65% perfect or over, the dalnr is Fair. 
If total scors is bdow 70 and any divldon ia bdow 66% perfect, the daixy is Poor. 

♦The l<mii e, i, e, etp., riioold be entort^ en teore eerd te Shew eeadillen of dalnr, and 

■0 euAared iboeld tlwf ladiealsa deioieecy. 



NOTES AND AUTHORITIES 
L The Rise in the Value of Babies 

1. The Family, an Ethnographical and Historical 

Outline, by Elsie Qews Parsons, Ph.D., 1906. 
Das Kind in Branch und Sitte der Volker, by 

Professor Ploss, ch. vii. 
Principles of Sociology, by Herbert Spencer, vol. i. 

2. The Children of the Nation, by Sir John E. Gorst, 

1907, p. 16. 

3. See speech of Dr. Northrup, Report of Milk Con- 

ference, New York, 1906, p. 38. 

4. Infantile Mortality and Infants' Milk Depots, by 

G. F. McQeary. 
Infant Mortality, by G. Newman, M.D., D.P.H., 

r.xv.o.E. 

Gorst, op. cit. 

Reports of the Royal Commission on Phjrsical 
Training (Scotland) and the Interdepartmental 
Committee on Physical Deterioration; Memo- 
randum by Sir William Taylor, Director-Gen- 
eral (British) Army Medical Service, in Par- 
liamentary Paper, Cd. 1501. See also The 
Bitter Cry of the Children, by John Spargo. 

5. McQeary, op. dt., p. 2. 

6. Idem, p. 11. 

810 



320 NOTES AND AUTHORITIES 

7. Annual Report of the Medical Officer of Health, 

city of Montreal, 1902. 

8. Gorst, op. cU.j p. 16. 

Poverty, by Robert Hunter, pp. 309-313. 

9. Hunter, op. cit., pp. 304-^13. 

Discussions in Economics and Statistics, by Fran- 
cis A. Walker, vol. ii, pp. 417-426. 

10. McCleary, op. dt., p. 12. 

See also the Report of the Royal Commission on 
the Decline of the Birth-rate and on the Mor- 
tality of Infants in New South Wales, 1904, 

11. Mankind in the Making, by H. G. Wells, pp, 80- 

90. 

12. Census of 1900, vol. iii, pp. li and lii. 

13. The Wealth of Nations, by Adam Smith, vol. i, 

ch. viii. 

14. Quoted by Thirlwall, History of Greece. 

15. Roman Imperialism, Lectures and Essays, by 

J. R. Seeley. 

16. The History of Rome, by Th. Monunsen, Book 

V, ch. xi. 

17. Adam Smith, op. dt., vol. i, ch. viii. 

18. Parsons, op. dt., Lecture iii. 

Other works used more or less freely include: 
Vital Statistics, by William Farr; The Ele- 
ments of Vital Statistics, by A. Newsholme; 
The Infant, The Parent, and The State, by 
H. Uewllyn Heath, D.P.H. 



NOTES AND AUTHORITIES 321 

Also the following journals : Jovmal of the Royal 
Statistical Society, 1890; The Pedagogical 
Seminary, 1903 to date; and the files of the 
Popular Science Monthly. 

n. When the Mothers Fail 

1. For a fuller discussion of this subject, see The 

Bitter Cry of the Children, ch. i. 

2. Parsons, op. cU., pp. 44-59. 

3. The Jewish Encyclopsedia, article Milk (vol. viii), 

by Rabbi J. H. Greenstone. 

4. Gorst, op. cit.f p. 21. 

Report of the Interdepartmental Committee — 
Evidence. 

5. Jewish Encyclopsedia, article, cited. 

6. Parsons, op. dt., pp. 26-27, 45-46. 
Gorst, op. dt., pp. 21-22. 

See also McQeary, op. cU., for the opinions of Dr. 
Marfan and others. 

7. Parsons, op. cit., p. 27. 

Gorst, op. dt., pp. 20-24, 40-46. 
See also Spargo, op. dt, pp. 37-44. 

8. Report Interdepartmental Committee, pp. 50-51. 

9. Die Zunehmende Unf&higkeit der Frauen hire 

Kinder zu Stillen, by G. von Bunge, Munich, 
1903. 
See also the same writer's pamphlet, Alkohol- 
vergiftung und Degeneration, Leipzig, 1904, 



322 NOTES AND AUTHORITIES 

10. American Medicine, July, 1906, p. 233. 

11. Diseases of Infancy and Childhood, by L. EJmmet 

Holt. 

12. Parsons, op. cit., p. 27. 

13. See The Slav Invasion, by Wame; On the TrsSL 

of the Immigrant, by Steiner; the Studies of 
Slavic Immigration (in Charities and the Comr 
mom) by Emily Greene Balch, etc. 

14. Vide the opinion of Sir William Jenner, quoted in 

Transactions of the National Association for 
the Promotion of Social Science, 1882, p. 387. 

See also Spargo, op. cit,, p. 16. 

It should be noted that bottle-fed babies are less 
''rickety" than breast nurslings of the poorer 
classes. See Archives of Pediabrics, June, 1906, 
p. 452. 

15. The Feeding of Animals, W. H. Jordan, New York, 

1903. 

16. Facts About Milk, by R. A. Pearson, M.S., p. 11 

(United States Department of Agriculture, 
Farmers' Bulletin No. 42). 

17. Pediatrics : the Hygiene and Medical Treatm^it 

of Children, by Thomas Morgan Rotch, Third 
Edition, 1901. 

18. See article by Dr. St. George T. Grinnan, in Ar- 

chives of Pediatrics, April, 1905, p. 272. 

19. The Variations in the Fat Percentage of Mother's 

Milk, by Louise Tayler-Jones, M.S., M.D., in 
Archives of Pediatrics, July, 1906. 



NOTES AND AUTHOBITIBS 323 

A Clinical Report on the Chemical Examination 
of Two Hundred Cases of Human Breast Milk, 
by V. and J. S. Adriance. 

See also Rotch, op. cU. 

20. The Composition and Methods of Analysis of 

Human Milk, by Professor Albert R. Leeds, 
Ph.D. 

21. G. von Bunge, op. cU. 

22. Heredity and Human Progress, by W. Duncan 

McKun, M.D., Ph.D., pp. 147-158. 
The Criminal, by Havelock Ellis, p. 109. 

23. The Theory and Practice of Infant Feeding, by 

Henry Dwight Chapin, M.D., p. 196. 

24. BriHsh Medical Journal, May 21, 1904. 

25. Report Interdepartmental Committee, pp. 50-^1. 

26. Chapin, op. cit., p. 214. 

27. Idem. 

28. Chapin, Breast Feeding and the Infant's Develop- 

ment, in Archives of Pediatrics, August, 
1904. 

29. It was at one time seriously proposed to substi- 

tute some artificial food for human infants in 
place of breast milk, on the ground that it 
would be better for the infants I See report of 
a lecture by Professor Leeds before the New 
York Academy of Sciences, the Sanitarium, 
May 24, 1883, p. 325. 

30. Ambulatory and Hospital Management of the 



324 NOTES AND AUTHORITISS 

Gastro-intestinal Derangements of Infancy, 
Archives of Pediatrics, M&y, 1900, 

31. Dr. St. George Grinnan, op. dt. 

32. Idem, 

33. Gorst, op. dt., p. 24. 

34. How to save the Babies of the Tenements, by 

Virgmia M. Walker, Charities [and the Oomr 

mons], August 5, 1905. 
Spargo, op. dt., p. 245. 
See also Dr. Newman's valuable work, Infant 

Mortality, 1907. 

35. British Medical Journal, June 4, 1904, p. 1339. 

36. Gorst, op. dt., p. 22. 

See also Infant Mortality and Factory Labour, 
by Dr. George Reid, in Dangerous Trades, 
edited by Professor Thomas Oliver, p. 89. 

37. Idem. 

Spargo, op. dt., p. 231. 

38. Chapin, op. dt., p. 179. 

39. Idem. 

40. Idem. 

41. See article by Saunderson-Wells in the British 

Medical Journal, July 8, 1905. 

42. Idem. 

43. McQeary, op. dt., p. 38. 

The following works have been more or less 
freely used: The Nutrition of the Infant, by 
Ralph M. Vincent, M.D.; The Diseases of 



NOTES AND AUTHOBITIBS 325 

ChUdren, by Henry Ashby, M.D., Lond., and 
G. A, Wright, B.A., Oxon.; Foods and the 
Principles of Dietetics, by Robert Hutchinson, 
M.D.; Milk, by E. F. Brush, M.D.; and Milk 
and Its Products, by H. H. Wing. 
Also the following journals, other than those 
noted above: InlerruUional Clinics; Medical 
Record; American Medicine; and The Lancet. 

III. Why Cow's Milk? 

1. Ancient Society, by Lewis H. Morgan, ch. ii. 

2. See Deuteronomy xxxii, 14. The Iliad, iv, 433. 

3. Pearson, op. dt. 

4. Idem. 

5. Human and Bovine Tuberculosis, by E. F. Brushy 

M.D. 

6. Chapin, op. cU., p. 280* 

7. Idem, pp. 25-27. 

8. Idem. 

9. New International Encyclopaedia, vol. xiv, article 

Reindeer. 

10. Idem. 

11. Idem. 

Also Annual Reports United States Department 
of the Interior, 1890 and on. 

12. See McQeary, op. cU., p. 31. 

13. Jewish Encyclopedia, vol. v, article Sheep, by 

I. C. Casonowicz, Ph.D. 



326 NOTES AND AUTHORITIES 

14. New International Encyclopsedia, article eit. 

15. See, for example, the Encyclopsdia Britannica, 

art. Goat; and the London Quarterly Review. 

16. Idem. 

17. As noted in the foot-note to which this reference 

belongs, there are cases on record of the inocu- 
lation of the goat with tubercle bacilli, bovine 
and human. It is very evident, however, 
from the few cases on record of the disease 
developing naturally, and the extreme difficulty 
with which the animal can be experimentally 
inoculated, that its immunity is practically 
complete. 

18. Some Fat Problems and Goats' Milk, J. Finley 

Bell, Archives of Pediatrics, March, 1906. 

19. Idem. 

20.' British Medical Journal, quoted in Current 
Literature, 1907. 

21. Idem. 

22. See testimony of Dr. Winters and Dr. Matthias 

NicoU, Jr., at the New York Academy of 
Medicine, January 11, 1906, reported in the 
Archives of Pediatrics, March, 1906, pp. 226- 
226. 

23. Casanowicz, op. cit. (Jewish EncydopfiKiia). 

24. The Talmud (Temurah 15 b). 

25. The Talmud (Shebbat 109 b)- 

26. Pearson, op. dt. 



NOTES AND AX7TH0RITIBS 327 

27. New International Encyclopedia, art. Milk, vol. 

xiv, by L. Emmet Holt, M.D, 

28. Idem. 

29. Idem. 

30. Idem. 

31. C!hapin, op. cU., p. 8. 

32. Idem, pp. 22-23. 

33. Idem., ch. iii. 

34. Idem., p. 51. 

35. McQeary, op. cU., pp. 3^-^. 

36. Etude clinique sur quelques maladies infectieuses, 

par Professor Roger, Revue de Medicin, April, 
1900. 
McQeary, op. cU., pp. 35-^6. 

37. Idem. 

38. Very useful formulas will be found in Dr. Chapin's 

Theory and Practice of Infant Feeding and Dr. 
Holt's The Care and Feeding of Children. 

39. McQeary, op. eU., p. 49. 

40. Chapin, op. cU., p. 221. 

41. Idem. 

42. See Feeds and Feeding, by W. A. Henry (Madi- 

son, Wis., 1902). 
The Feeding of Animals, by W. H. Jordan (New 

York, 1903). 
The Feeding of Farm Animals, by E. W. Allen 

(Washington, 1897). 

43. Archives of Pediatrica, November, 1906, p. 830. 



328 NOTES AND AX7THOBITIE8 

The following works have also been frequently 
consulted with great advantage: Food and 
Principles of Dietetics, by R. Hutchinson, 
1903; Bibliographia Lactaria, by Dr. H. de 
Rothschild (contains over eight thousand 
titles) ; Milk and Its Products, by H. H. Wing, 
1897; Milk: Its Nature and Composition, by 
C. M. Aikman, 1899; The ProWem of the 
Milk Supply, by F. Lawson Dodd ; Bacteriology 
of Milk, by Swithinbank and Newman, 1903; 
many of the publications of the United States 
Department of Agriculture, and of the agricul- 
tural experiment stations in New York, Wis- 
consin, Illinois, Maine, California, etc. 

Also the following journals : Hoard^s Dairyman; 
The American Farmer; British Medical Jowr- 
nal; Journal of Hygiene; Public HeaUh. 

IV. Filth as Infants' Food 

1. Pearson, op. dt., p. 10. 

The Problem of the Milk Supply, by F. Lawson 
Dodd, p. 13. 

2. Information received in a personal letter from 

Dr. Park. 

3. See Archives of Pediatrics ^ December, 1906, p. 943. 

4. See the descriptive scores of exhibits at the 

National Dairy Show, 1906, published in Bul- 
letin 87 of the Bureau of Animal Industry. 



NOTES AND AUTHORITIES 329 

The Milk and Cream Exhibit at the National 
Dairy Show, 1906, by Qarence B. Lane, B.S. 

5. Dairy Products at the Paris Exposition of 1900, 

by H. E. Alvord, United States Department of 
Agriculture Year Book, 1900. 
Dairy Development in the United States, by 
H. E. Alvord, Sixteenth Annual Report Bureau 
of Animal Industry. 

6. Idevfi. 

7. Pearson, op. cit. 
Chapin, op. cit., pp. 93-99. 

The Bacteriological Examination of Milk, by Pro- 
fessor H. W. Conn, in Chapin's book above 
cited, p. 154. 

8. Idem. 

9. Tuberculosis as a Disease of the Masses and How 

to Combat It, by S. A. Knopf, M.D., p. 11. 

10. Idem. 

11. Idem. 

12. Consumption and Civilization, by John B. Huber, 

M.D., p. 47. 

13. Report of the Royal Commission (England) on 

the Effect of Food derived from Tuberculous 
Animals on Human Health, Part ii. 

14. Idem. 

15. Care of Milk on the Farm, by R. A. Pearson, 

United States Department of Agriculture, 
Farmers' Bulletin No. 63, p. 12. 



330 N0TS8 AND AUTHORITIBS 

16. Chapin, op. cit., pp. 88-99, 148-169. 

17. Idem. 

18. Market Milk: A Plan for Its Improvement, by 

R. A. Pearson, M.S., Seventeenth Annual Re- 
port Bureau of Animal Industry. 

19. The Hygiene of Milk, by Leslie Mackenzie, M.D., 

Edinburgh Medical Journal, 1898. 
McCleary, op. cU., pp. 50-^1. 
Dodd, op. cit., pp. 1^14. 

20. The Milk Supply of Large Towns, published by 

the British Medical Journal, 1903, pp. 11-12. 
Docid, op. dt., pp. 14-15. 

21. Parliamentary Paper, Cd. 833, Appendix IV — 

Report on a Visit to Ireland, by Dr. Bulstrode 
and Professor Tunnicliffe. 

22. Municipal Milk and Public Health, by F. Lawson 

Dodd, Fabian Tract No. 122. 

23. Chapin, op. cit., pp. 88-89. 

24. Conn, op. dt., pp. 148-169. 

25. Idem. 

26. The Suppression of Tuberculosis, by Professor E. 

von Behring, p. 67. 

27. The Economic Production and Distribution of 

Qean Milk, by Joseph Robey, M.D., 1906. 

28. Vide London press reports of the Congress. 

29. Pearson, Facts About Milk (Farmers' Bulletin 

No. 42). 

30. Jewish Encyclopaedia, art. Milk. 



NOTES AND AUTHOBITIES 331 

V. Milk-borne Diseases 

1. Efficient Democracy, by W. H. Allen, ch. viii. 

2. Idem. 

3. Knopf, op. eit., p. 13. 

4. The Statistical Laws of Tuberculosis, by Freder* 

ick L. Hoffman, Maryland Medical Journal, 
February, 1904. 

5. Tuberculosis and Children, by A. Jacobi, M.D., 

in A Handbook on the Prevention of Tubercu- 
losis, Appendix VIII. 

6. E. von Behring, op. cit. 

7. Report of Royal Committee on The Effects of 

Food derived from Tuberculous Animals, 
Part i, p. 20. 

8. Report of the Royal Commission on Administra- 

tive Procedures for controlling the Danger to 
Man through the Use as Food of the Meat and 
Milk of Tuberculous Animals, Part i, p. 2. 

9. Report of the Royal Commission on the Relations 

of Human and Animal Tuberculosis, Interim 
Report (1904) ; Final Report, 1906, Part i. 

10. Jacobi, op. cit. 

11. Idem. 

12. Quoted by Ravenel, Maryland Medical Jovmalf 

February, 1904. 

13. Report of Tuberculosis Commission of Maryland, 

p. xxxii et seq. 



332 NOTES AND AUTHORITIBS 

14. Report of Royal Commission on the Relations of 

Human and Animal Tuberculosis. 

15. Maryland Conmiittee Report, pp. xxxii, lx« 
Huber, op. cit,, p. 63. 

16. Maryland Report, p. xxxii. 

17. Idem., p. xxxiii. 

18. Idem., pp. xxxii, xli. 

19. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals, Part iii. 

20. Maryland Commission Report, pp. xxxviii, 

Iviii. 

21. Knopf, op. dt., pp. 24-26. 

22. Huber, op. cU., p. 63. 

23. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals. 

24. Maryland Commission Report, pp. xxxiii-xli. 

25. Idem. 

26. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals, Part iii. 

27. Quoted by Ravenel, Maryland Report, p. xxxiv. 

28. See Sanitary MUk Production — Circular 114, 

Bureau of Animal Industry, United States 
Department of Agriculture. 

29. The Milk Supply of Twenty-Nine Southern Cities 

by C. F. Doane, M.S., Bureau of Animal In- 
dustry, Bulletin No. 70. 

30. Maryland Report, p. 6. 

31. Idem. 



NOTES AND AUTHORITIES 333 

32. See Reports of the British Royal Commissions 

cited. 

33. Idem. 

34. Idem. 

35. Idem. 

36. Idem. 

37. Report of Royal Commission on the Effect of 

Food derived from Tuberculous Animals. 

38. February 10, 1907. 

39. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals. 

40. Idem. 

41. Idem. 

42. British Medical Journal. 

43. Report of the Milk Conference, New York, No- 

vember, 1906. 

44. Dodd, op. cU. 

45. Idem. 

46. Vide press reports. 

47. Idem. 

48. Dodd, op. cU. 

Note: The reader is specially referred to the 
Report of a Conference Appointed by the 
Commissioners of the District of Columbia 
published as Circular 114 by the Bureau of 
Animal Industry for an interesting and vauable 
account of the spread of infectious diseases by 
milk. 



334 NOTES AND AUTHORITIES 

VI. A Brief Sumbiart of the Problem 

1. How to Reduce Infant Mortality^ by Nathan 

Straus. Letter to the New York Board of 
Health, March 22, 1897. 

2. See Gorst, op. cU., pp. 108, 247; Spai^go, op. cit., 

pp. 8, 9, 291-296. 
Also, Report of the (British) Interdepartmental 
Committee on Physical Deterioration. 

3. Idetn. 

4. rA« Lancet, February 2, 1901. 

5. Newman, op. cU., ch. i. 

6. Idem. 

7. Idem. 

8 and 9. Spargo, op. cU., pp. 43, 44, 51 
Gorst, op. cit.f p. 42. 
Newman, op. cU., p. 227. 

10. Rotch, op. cU. 

11. See Newman, op. cU.^ p. 145 et 9eq. 

12. Chapin, op. cit., p. 286. 

13. Doane, op. cU. 

14. Pearson, Facts About Milk. 

15. Idem. 

Also, The Use and Abuse of Food Preservatives, 
by W. D. Bigelow, in United States Depart- 
ment of Agriculture Year Book, 1900. 

16. Idem. 

17. Idem. 

18. Idem. 

19. Idem. 



NOTES AND AUTHORITIBS 335 

Vn. Remedial Theories and Experiments 

1. Municipal Monopolies, edited by E. W. Bemis: 

I, Water Works, by M. N. Baker, Ph.B. 

2. Idem. 

See also The Problem of the Milk Supply, by 
Dodd ; and Germ Diseases, by Kenelm Wins- 
low, B.A.S., M.D., in vol. i, The Home Medi- 
cal Library. 

3. Typhoid : an Unnecessary Evil, by Samuel Hop- 

kins Adams, in McCltare^ 8 Magazine. 

4. Dodd, The Problem of the Milk Supply and Mu- 

nicipal Milk and Public Health. 

5. See the issues of January, February, March, 

1907. 

6. Fabian Leaflet No. 90. 

7. The Milk Supply of Boston, New York, and Phila- 

delphia, Bulletin 81, Bureau of Animal Indus- 
try. 

8. Dodd, op* cd. 

9. Idem. 

10. Idem. 

11. McQeary, op. oit., p. 8S. 

12. Idem. 

13. This sketch is based largely upon McCleary's 

book, supplemented by Budin's Le Nourrisson 
and Manuel Pratique d'Allaitment. 

14. For this sketch, also, I have drawn freely from 



336 NOTES AND AUTHORITIES 

Dr. McQeary's work^ as well as from the works 
of Dufour and others. 

15. British Medical Journal, August 18^ 1900. 
Annual Report of the Health of St. HdenSi 1900. 

16. Vide reports from Liverpool, Battersea, St. Helens, 

and Finsbury medical authorities. 

17. McQeary, op. ciL, p. 85. 

18. Fu26 annual reports. 

19. Idem. 

20. McCleary, op. cit., pp. 130-131. 

21. Idem. 

22. La Goutte de Lait a F^amp, by Dr. Leon Du- 

four (1900), and Comment on Cr^ une Goutte 
de Lait F6camp (1902), by the same writer. 

23. Information received from Mr. Straus. 

24. McCleary, op. cU. 

25. A large part of this section is reproduced from my 

article in the Craftsman, on The Political 
Economy of Saving Babies' Lives. 

26. Figures supplied by Dr. Goler. 

27. How to produce Milk for Lifant Feeding, by E. 

R Brush, M.D. 

28. Idem. 

29. Robey, op. cit. 

30. Gorst, op. cit., pp. 10-14. 

31. Consultations de Nourrissons et Grouttes de Lait, 

article by Dr. Peyroux in La Semaine M6dicdle, 
Paris, December 24, 1902. 



NOTES AND AUTHORITIES 337 

32. L'Avenir des Gouttes de Lait, in the Archives de 

Midicine des Enfants, April, 1903. 

33. Peyroux, op. cU. 

34. British Medical Journal, February 20, 1904. 

35. Report of the Medical Officer of Health for Liver- 

pool. 

36. Report of the Medical OflScer of Health for Bat- 

tersea. 

37. Newman, op, cU., pp. 301-304. 

38. Idem. 

39. Annual Report on the Health of Liverpool, 1903. 

40. Vide Mr. Straus's paper read at the Congrte Li- 

temational des Gouttes de Lait, 1905. 

41. Report upon the Results with Different Kinds of 

Pure and Impure Milk in Infant Feeding, etc., 
by W. H. Park, M.D., and L. Emmet Holt, M.D. 

42. Idem. 

43. See, for instance, Peyroux, op. cit. 

44. The Efficient Life, by Luther S. Gulick. 

45. Journal of the Statistical Society of London, vol. 

xxix, 1866. Quoted by Newman, op. cit., 
pp. 228-233. 

46. Idem. 

47. Idem. 

VIII. Pure versus Purified Milk 

1. Among the best statements of the position of the 
radical school are the works of F. Lawson Dodd, 



338 NOTSS AND AUTHORITIBS 

Chapin, and the pamphlets by Dr. Qoler^ fre- 
quently quoted in these pages. 

2. I do not wish this statement to be taken too 

literally. It would be hard to say, without a 
good deal of calculation, whether the advocates 
of pasteurization or the radical opponents have 
done a greater amount of research. But I do 
not think the most radical will deny the pas- 
teurizers the credit of being the pioneers of 
popular agitation on the subject of milk reform. 

3. See, for instance, Mr. Straus's paper. Pure Milk 

or Poison 7 read at the Milk Conference, New 
York, November 20, 1906. 

4. See page 111. 

Also New York Times, January 11, 1908. 

5. Vide letter of Dr. Park, to Milk C!onferenoe, New 

York, November 20, 1906. 

6. Idem. 

7. Some Experiments on the Temperature Necessary 

for killing Tubercle Bacilli in Milk, by Gustav 
Bang, Transactions of the British Congress on 
Tuberculosis, London, 1901, vol. iii. 

. 8. The Thermal Death Point of Tubercle Bacilli in 
Milk and Some Other Fluids, by Theobald 
Smith, Journal of Experimental Medicine, 
March, 1899, pp. 217-233. 
9. See Straus, Pure Milk or Poison ? 

10. Idem. 



NOTES AND AUTHORITIES 339 

IL Idem. 

12. Idem. 

Upon this subject see also: (1) New York Ag- 
ricultural Experiment Station BuUetin No. 
172 for the experiments of Harding and 
Rogers ; and the 17th and 21st annual reports 
of the Wisconsin Agricultural Experiment 
Station (1900-1904) for the experiments of 
Russell and Hastings. 

13. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals^ Part ii, 
pp. 64r-66. 

14. The Prolongation of Life, by Elie Metchnikoff. 

15. Idem. 

See also the 16th annual report of Storrs Agri- 
cultural Experiment Station, Connecticut, 
1904, pp. 27--88, for the views of Conn and 
Esten. 

16. Park and Holt, op. ciL 

17. Jacobi, op. cU. 

18. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals, Part ii, 
p. 59. 

19. Valeur nutritive du lait de vache st^rilis^ a 180^ 

pour Tallaitment artificiel, par G. Variot, 
Compts Rendus Acad^mie des Sciences, t. 
139, No. 23, pp. 1002-1003. Paris, 1904. 

20. See the report of the Conference appointed by the 



340 NOTES AND AUTHORITIES 

Commissioners of the District of Columbia, 
Circular 114 of the Bureau of Animal Industry. 

IX. Outlines op a Policy of Reform 

1. Report of Royal Commission on Effect of Food 

derived from Tuberculous Animals, Parts ii 
and iii. 

2. Doane, op. cU. 

3. Report of Royal Commission on Administrative 

Procedures for controlling Danger to Man 

through the Use as Food of the Meat and MUk 
^ of Tuberculous Animals, Part ii, p. 266. 
(4. Du Development pris Aux Etats Unis par le 

Mouvement Pour la Consommation du Lai 

Pur, Dr. Henry L. Coit. ) 

5. I am indebted to Dr. Darlington, and to Mr. 

Burton of the country division of the depart- 
ment of food inspection, for kindly placing at 
my disposal many facilities for the observation 
and investigation of this work of the Depart- 
ment of Health. 

6. Doane, op. cit. 

7. Newman, op. cit., p. 226. 

8. Spargo, op. cit., pp. 244-247. 

9. Newman, op. cit., pp. 264-265. 
Gorst, op. cit., p. 23. 

10. Journal Sanitary InstitiUe, August, 1904, p. 350. 



INDEX 



Adulteration of milk, 168-172, 

180. 
Alaska, reindeer's milk used in, 

54. 
AUentown, epidemic of t3rphoid 

in, traced to milk supply, 

146. 
Alvord, Major, 89. 
America : 

Attitude toward milk modifi- 
cation in, 76-78. 
Bacteriological standards of 

some cities in, 113-115. 
Certified milk movement in, 

113, 206, 207, 219. 
Decline of native stock in, 6, 

9, 10. 
Infant death-rate in, 154-158. 
Infants' milk depots in, 192, 

194, 195, 205-217, 228, 

235. 
Infants' milk depots needed in, 

185, 186. 
Not ready for municipalization 

of entire milk supply, 177, 

178, 181, 292. 
Pasteurization in, 76, 202-203, 

205, 209-217, 231-235, 245 

et Beq. 
Pasteiuization controversy in, 

241-266. 
Possibility of saving infants' 

lives in, 157-158, 240. 
Science of milk question ad- 
vanced in, 77. 
Tubereulosis in, 122-123. 
Tuberculous cattle in, 134-136, 

137. 



Amsterdam, condition of milk 

supply, 116. 
Analysis of milk of various ani- 
mals, 49, 53. 
Anal3rsis of human breast milk, 

28-29, 49, 53, 54-56, 59. 
Animals, milk of various, used as 

food, 46, 49, 53. 
Anti-bodies, 72-73. 
Antiquity of the use of animals' 

milk as food, 46. 
Archives of Pediatrica, 80. 
Argentina, infants' milk depots 

in, 192. 
Arloing, goats inoc\ilated by, 

58 n. 
Artificial feeding becoming gen- 
eral, 16, 17, 35, 37, 38. 
Ashton-under-Lyne, infants' milk 

depot in, 197. 
Ashton-imder-Lyne, 

older childr^i 

sold, 201. 
Asiatic cholera, 154. 
Ass, digestive system of, 66. 
Ass, milk of, 49, 51, 53. 
Australia : 

Decline of birth-rate in, 3, 6, 

7,8. 
Infanticide in Central, 2. 
Visiting nurses for infants in, 

298. 

AlTSTRIA : 

Death-rate of infants in, 158. 
Decline of birth-rate in, 8. 
Mothers of, unable to nurse 

offspring, 21. 
Peasant women of, neglecting 

their own babies to become 

"wet-nui8es,"238. 



milk for 
and adults 



841 



342 



INDEX 



B 



BacQhu tttbercidotiB, discovery of, 

91. 
BaeiUut iuberculoeiSf bovine and 

human varieties of, 126-129. 
BaeiUut iuhereulonB found in 

cow's milk, 92. 
Bactbria: 

Behring, Professor E. von, on 

dangers to infants from, 124. 
Cause decomposition of milk, 

89, 93, 171. 
Cause gastro-intestinal trou- 
bles, 112, 164, 165, 166. 
Description of, 90. 
Found in intestines of infants, 

134, 164. 
How examined, 163-164. 
How they get into milk, 93-98, 

99-100. 
Lactic acid, 253-259. 
Ifilk in udder free from, 87. 
Millions of, in the air, 97. 
More in milk than in sewage, 

107, 111, 247. 
Not indigenous to milk, 89. 
Number of, in certified milk, 

113. 
Number of, in Rochester milk, 

113. 
Number of, permitted under 

bacteriological standards, 

113-115. 
Pasteurisation and, 250-253. 
Pathogenic varieties of, 93. 
Poisonous, resisted by anti- 
bodies, 72-73. 
Rate of increase of, 98, 104-106. 
Small proportion of, dangerous, 

110-112, 117. 
Some kinds of, harmless, 93. 
Temperature in which they 

thrive, 98, 108. 
Useful kinds of, 93. 
Vast numbers of, in milk, 106, 

107, 109, 111, 116. 
Ballard, Dr., 39. 



Bang, Professor Ghutay, 92, 136, 

252, 270. 
Battebsba : 
Establishment of infants' milk 

depot, 197. 
Modified milk formula used in, 

198. 
Mothers induced to weig^ 

babies, 200. 
Statistics of infant mortality in, 

226. 
Sterilised milk soki, 203-204, 
205. 
Beauvau, OouUe de LaU, 194. 
Beef, nutritional value of, 63-64. 
Behring, Professor E. von, 112, 

113, 124, 136 n. 
Belgium, decline of birth-rate in, 8. 
Belgium, LaUerie MaUmeUu in^ 

192. 
Bell, Dr. J. Finley, 60-61. 
Belleville Dispensary, Paris, 191. 
Bhir and Bhir, Messrs., 40. 
Birmingham, England, 39, 184. 
Birth-rate, Dbclinb op : 
Among Americans, 9, 10. 
Among Australians, 3, 6, 7, 8. 
Among leisured classes, 6, 10, 

11-13. 
Among people of British stoek 

in Canada, 5, 6. 
Causes of, 12-13. 
In eighteen different countries 

(Uble), 8. 
In FVance, 4, 7, 8. 
In Greece, 10-11. 
In Rome, 11-12. 
{See aUo Race suicide.) 
Bollinger, Dr., 130. 
Booker, Dr., 164. 
Boston, BCasB., has bacteriological 

standard, 113-115. 
Bottles, milk in, foul, 149. 
Bradford : 
Infants' milk depots in, 197, 

201. 
Partial munieipalisation of milk 
supply, 201-202. 



movx 



343 



Bread, nutritioDAl value of, 68- 
64. 

Bbsast-kxtbsino : 
Accompanied by low death- 
rate of infaats, 83, 38, 89, 

159, 296. 

Among Hebrews, 16, 81, 82, 
296; immigrants, 24; Irish, 
296. 

Among mothers attending the 
CannUtations de Nowrriuonaf 
187-190, 296. 

British Interdepartmental Com- 
mittee on, 20. 

British National Health So- 
ciety, the, 116. 

Dtdine of: ascribed to alco- 
holism, 30; to atrophy, 17, 
21 ; dress and, 22-24 ; food, 
24--d0 ; greatest among well- 
to-do and leisured classes, 18, 
22, 31 ; Dr. Holt on, 21-22, 
31 ; Dr. Morgan on, 23 ; in- 
dustrial conditions and, 17- 
19; necessitates system of 
artificial feeding, 35 et 9eq.; 
not necessarily sign of de- 
generacy, 30, 35 ; rare among 
savages and primitive peo- 
ples, 16, 31; result of 
physiological changes, 17, 
19 ei aeq.; voluntary causes, 
17, 18. 

General in Norway and Sweden, 
33,38. 

Infants' milk depots and, 191, 
235-237. 

Law to punish neglect of, 237. 

Schemes to promote, 39-41, 

160, 187-190. 
Substitute (wet-nurse), limita- 
tions of, 44. 

The Consultations ds Nourris- 
sons and, 187-190, 296, 
British well-to-do classes infertile, 
6. 

Msdiodl Journal, 61, 100, 
140. 



British Royal Commissions and 
Parliamentary Committees, 
20, 124, 125, 128, 129, 138, 
140, 143. 

Brockton, Mass., has bacterio- 
logical standard, 115. 

Brush, Dr. £. F., 124 n., 218, 
254 n. 

Budin, Professor, 40, 188, 190. 

Buffalo, N.Y., condition of milk 
supply of, 141-142. 

Buffalo's milk, 49. 

Bulgaria, infants' milk depots In^ 
192. 

Bunge, Professor von, 20, 80. 

Bureau of Animal Industry, 
United States Department of 
Agriculture, 99, 127, 147 n. 

Burnley, England, infants' milk 
depot in, 197. 

Burton, Mr. £. W., 149 n., 281. 

Butter made from tuberculous 
milk dangerous, 140. 



Cambridge, Mass., has bacterio- 
logical standard, 115. 

Camel, milk of, 49, 51, 53, 54. 

Camel, unsuited to American 
needs, 55. 

Canada, decline of birth-rate in, 
5,6. 

Canada, infants' milk depots In, 
192. 

Carbohydrates, 52, 54. 

Casein, 50. 

Cat, milk of, 49. 

Cato, 10. 

Cattie, tuberculosis among, 134- 
139. 

Certified nulk, 113, 219. 

Chapin, Dr., 36, 65, 76, 113. 
quoted, 36, 42, 66, 71. 

ChariU HospUal, Paris, 188. 

Chaterinkoff, Dr., 38. 

Cbaveau, Dr., 129. 



344 



INDEX 



Cheese, bacteria used in making, 

93, 111. 
Cheese, tubercle bacilli active in, 

140. 
Chicago, epidemic in, 147-148, 

152. 
Chicago, infants' milk depot in, 

194. 
Chicimecs, infanticide among, 2. 
Children, see Infants. 
Cholera infantum, 164. 
Christian Science, 261. 
Clinique d'AccotichemerU Tamier, 

188, 189. 
Coit, Dr., 113, 219, 282. 
Cologne, mothers paid by city for 

nursing babies, 40, 238. 
Compensation for tubercular cat- 
tie destroyed, 135. 
Concentration in distribution of 

milk, 181-182. 
Conn, Professor, 247. 
Connecticut, native birth-rate de- 
clining, 9. 
Connecticut supplies New York 

aty with milk, 285. 
Consultations de Nourriaaons, 187- 

191. 
Copenhagen, see Denmark. 
Cornell University, 137 n. 
Cows: 

Analysis of milk of, 49, 50, 53. 
Causes of tuberculosis among, 

137-139. 
Comparison of milk of, with 

milk of other animals, 49, 

53^54, 58. 
Dangers to infants from milk of, 

65-69, 124, 125, 133. 
Diarrhoeal diseases caused by 

impure milk of, 38, 39, 108 

n., 112, 120. 
Digestive sjratem of, 66-69. 
Diseases spread by means of 

milk of, 58, 85, 92, 93, 108 n., 

110, 112, 120 et seq. 
Milk of, compared with human 

milk, 49, 53, 54, 59. 



Cows: 
Milk, food values of, 63-65. 
Milk, inferior to goat's milk, 

58-61. 
Number of, in United States, 63. 



Darlington, Dr. Thomas, 131, 

257, 283. 
Death-bates : 

In Austria, 158; England, 39; 
France, 8, 157-158; New 
Zealand, 158; Norway and 
Sweden, 33, 38; Russia, 158; 
the United States, 154-158. 
Influenced bv breast-nursing, 

33, 38, 39, 159, 296. 
Of native whites exceeds birth- 
rate in New England, 9-10. 
Reduced by infants' znilk de- 
pots, 223-234. 
Reduced when mothers can 
care for their babies, 159- 
160. 
De Jong, 58 n. 
Denmark : 
Infants' milk depots in, 192. 
Statistics of tuberculous cattle 

m, 134-139. 
Systematic efforts to eradicate 

tuberculosis, 270-273, 275. 
Tuberculosis, bovine and hu- 
man, in, 270-271. 
Diagram showing components of 

cow's milk, 50. 
Digestive systems of man and 
various animals compared, 
66-69. 
Diphtheria, 72, 109, 110, 144, 147. 
Dirt in cow's milk, 84 et seq. 
Dixon, Dr., 283. 
Doane, Professor, on adulteration 

of milk, 169, 294. 
Doane, Professor, on tuberculin 

test, 135, 274. 
Dodd, Dr. F. Lawson, 101. 
quoted, 150, 176. 



INDEX 



345 



Dog, milk of, 40. 
Dolphin, milk of, 49. 
Dufour, Dr. Leon, 76, 192. 
Dundee, infants' milk depot in, 

197. 
Dunkinfield, infante' milk depot 

in, 197. 

E 

Edinburgh, tuberculous cattle in, 

92. 
Effects of industrialism upon 
maternal functions, 17, 19 n. 
Elbeuf , France, 40. 
Elephant, milk of, 49. 
Engel, Dr., 21. 
England : 

Decline of birth-rate in, 3, 6, 

8. 
Excessive mortality of arti- 
ficially fed infants, 39. 
Experiments in partial munici- 
palization of the milk supply, 
183-184, 201-202. 
Infants' milk depots in, 192. 
Municipal infants 'milk depots, 

193, 196, 197-202. 
Report of Local Qovemment 
Board of, 101. 
'EpmsiacB : 

Allentown, Penn., 146. 

Chicago, 147-148. 

Diarrhoeal diseases, 108 n., 

149, 164. 
Diphtheria, 144-145. 
Infant paralysis, 153. 
St. John's Wood, England, epi- 
demic of diphtheria in, 144- 
145. 
Scarlet fever, 72, 120, 147, 148. 
Sore throat, 140. 
Typhoid, 145-146. 
Woking, England, epidemic in, 
caused by milk, 140. 
Erysipelas, 72. 

Eskimos, infanticide among, 2. 
Eskimos, use of reindeer's milk 
by, 64. 



Evanston, HI., epidemic in, 147. 
Ewe, milk of the, 49, 51, 53. 



Fabian Society, the, 177-178. 
F6camp, OotUU de LaU, 193, 202, 

227. 
Fijians, infanticide among, 2. 
Finland, refusal to nurse infants 

at breast punished, 237. 
Finland, women of, compelled to 

neglect babies, 238. 
Finsbury, infants' milk depot re- 
duces mortality, 227. 
FoBticide, 13. 
Foster, Sir M., 128. 
France: 
Breast-nursing encouraged in 

government factories, 44. 
ConstUtatwns de Nourri8son9 

in, 187-191. 
Decline of birth-rate in, 8. 
Decrease of scorbutic diseases 

in, 268. 
GouUes de LaU in, 191-194. 
Influence of Gouttee de LaU on 

infant death-rate, 225-226. 
Modified milk not commonly 

used, 76. 
Use of goats' milk in, 61. 
French Canadians, superior fer- 
tility of, 5-6. 
French cities, breast-nursmg sub- 
sidized by, 40-^1. 
Fry, Dr. F. M., 80. 



Germant: 

Decline of birth-rate in, 8. 

Infants' milk depots in, 192. 

Tubercular cattle in, 136, 137. 
Glasgow, infants' milk depot in, 

197. 
Goats: 

Advantages of milk of, for in- 
fant feeding, 66-62. 

As mUch animals, 56-57. 



346 



INDEX 



Goatb: 
Curative p r op e rti es of milk of, 
believed in by Hebrews, 61- 
62. 
Immunity of, from tubercu- 
losis, 68. 
Milk of, compared with cows' 

milk, 69. 
Milk of, compared with woman ^ 

milk, 69. 
Milk of, used by Italians, 61. 
Milk of, used in France and 
Switserland, 61. 
Qoler, Dr. Q. W., 186, 206, 207, 

209, 213, 282. 
Qorst, Sir John £., quoted, 3, 221. 
Qosse, Swiss physioian, 133. 
QourrBs db LAir : 

French system used as pattern 

by other countries, 192-193. 
Influence of, on infant death- 
rate, 226. 
Medical supervision and, 191. 
Methods of the, 193-194. 
Modified milk in a few, 194. 
Origin of, 191-192. 
Small number of children served 

by, 226. 
Spread to other lands, 192. 
SteriUaed, unmodified milk gen- 
erally used in, 193-194. 
(See aUo Infants' Milk Depots.) 
Greece, depopulation of, 10. 
Greene, Dr., quoted, 141-142. 
Grenoble, QouUe de LaU, 226. 



Harris, Dr. F. Drew, 197. 
Hartley, Robert M., 120-122. 
Havre, sterilization practised in 

infants' milk depot, 194. 
Hbbbew : 

Mothers and breast-nursing, 16, 

31. 
Scriptures and milk, 46. 
Talmud and milk hygiene, 118- 
119. 



Herrgott, Professor, 187, 188, lOa 
Hippocrates, 30, 91. 
Hoffman, Frederick L., 122. 
Holland, infant milk depots in, 

192. 
Holmes, Oliver W., quoted, 138. 
Holt, Dr. L. Enmiet, 21, 22, 81, 

75, 233, 267. 
quoted, 22. 
Homer's Iliad, 46. 
Hope, Dr., 39. 
Horace, quoted, 66. 
Horse, digestive system of, 66- 

69. 
Huddersfield ssrstem, the, 80(^ 

301. 
Human Bbbast Milk : 
Analysis of, 28, 49, 63. 
Compared with other milks, 49, 

63,64. 
Influenced by diet, 24-29. 
Variations of fat percentages in, 

28. 
Humphrey Clinker, 86. 
Hungary, decline of birth-rate in, 

8. 

I 
Ibsen, 160. 
Illinois, milk sent to Paris from, 

88. 
Imperial Sanitary Office of Ger- 
many, 130. 
Infants: 

Breast-nurmng best for, 72, 73, 

237. 
Breastonursing lowers mortality 

of, 33, 38-39, 169. 
Class inequality in death-rates 

of, 166-167. 
Mortality among artificially fed* 

38-39,66. 
Mortality of, lessened by in- 
fants' mUk depots, 223-236. 
Needless sacrifice of, 167-169. 
Proprietary foods dangerous 

for, 41-^44, 82, 161-162. 
Rich and poor bom on equal 
physical terms, 166. 



INDEX 



347 



IffVAMTS: 

SUtifltios of mortaaty of, 88, 

39, 154-166, 166. 
Infants' Mblk Dbpotb : 

Axnerieaa, mostly of French 

type, 103, 104. 
American inferior to IVenoh in 

management, 104-100. 
Beyond mere theoretical stage, 

186. 
CofuuUatioru de Nourrisaoru 

only incidentally milk de- 
pots, 187-101. 
Countries in which established, 

192. 
Duty of municipalities to pro- 
vide, 185, 220, 203. 
Fonnulas used in American, 

British, and French, 202-206. 
OoutUa de Lait, the IVench type, 

101-102. 
Influence of, in lessening mor- 

taUty, 186-186, 223-236. 
Municipal, American, 206-217. 
Municipal, British, 107-202. 
Needed in most cities, 186 n. 
Objections to, 236. 
Pasteurised and modified nulk 

used in America, 202^203. 
Rochester system, the, 186, 

206-217. 
Sterilised and unmodified milk 

commonly used in French, 

202. 
Sterilised and modified ("hu- 
manised") milk in British, 

108. 
Straus system, 186, 103, 104, 

106, 220-236. 
Infanticide, 2. 
Inspection of didries important, 

282-201. 
Ireland, decline of birth-rate in, 8. 
Isocrates, 01. 

Italy, decline of birth-rate in, 8. 
Italy, infants' milk depots in, 

102. 
Ithaca, water supply of, 176-176. 



Jacobi, Dr. A., 124, 126, 268. 
Johns, 126. 

Jordan, Professor, 26, 26, 27. 
Jupiter^ intemperance, 30. 



Knopf, Dr. S. A., 180. 
Kober, Dr. George M., 138. 
Koch, Profbssob R. : 
Announces discovery of tuber- 
cle baciUus, 01, 126-127. 
Declares bovine and human 
tuberculosis essentially dif- 
ferent diseases and not trana- 
miasible, 126-127, 120. 
Early experiments pointing to 

another conclusion, 120. 
He admits validity of case of 

transmission, 132. 
His conclusions not supported 
by investigation, 130-138. 
Koplik, Dr. H. M., 38. 



Lactation, influence of food upon, 

24-20. 
Lactation, problems of, should be 

studied, 20, 20, 36. 
(See also Breast-nursing.) 
Laplanders and reindeer's milk, 

64-66. 
Lecithm, 70-71. 
Lederle, Dr., 160 n. 
Leipsig, tuberculous cattle in, 137. 
Leith, infants' milk depot in, 197. 
Lister, 87. 
Liverpool, infants' milk depot, 

107. 
Llama, milk of, 40. 
London, milk supply in, 116. 



McQeary, Dr., 187, 200. 

quoted, 46. 
Macfadyean, Professor, 02, 180. 



348 



INDEX 



liaoKencie, Dr. Leslie, quoted, 

09-100. 
BCaine, decline of native birth- 
rate in, 9. 
lialthus, 10, 124. 
Martin, Dr., 139. 

quoted, 140. 
Maryland, tubercular cattle in, 

136. 
Marf^nd Medical Journal, 58 n. 
Maasachuaetta suppliee milk to 

New York, 285. 
Maternity hospitals, 187, 188, 

190. 
Maygrier, Dr., 189. 
Media, Pennsylvania, 284. 
Mdnert, Dr., 39. 

Melanesiaus, infanticide among, 2. 
Metchnikoff, Professor E., 254. 
Milk: 

Adulteration of, 168-172, 182. 
Analysis of various kinds of, 

28, 29, 49-53, 54, 56, 59. 
Anti-bodies in, 72-73. 
Ash in, 50-52. 
Ass's, 49, 51, 53. 
Bacteria in, see Bacteria. 
Behring, Professor E. von, on tu- 
berculous infection tlm)ugh, 
124. 
Behring, Professor E. von, on 
standard of bacterial con- 
tent, 112. 
Biblical references to, 16. 
Buffalo's, 49. 
Camel, 49, 53. 
Casern in, 50, 52.! 
Cat's, 49. 
Certified, 113. 
Compared with bread and 

meat, 63. 
Cow's, see Cows. 
Dangerous "preservatives" 

used in, 168-173.. 
Depots, see GoiUtes de Lait and 

Infants' Milk Depots. 
Diagram showing components 
of cow's milk, 50. 



Milk: 

Digestibility of, 64. 

Diseases conveyed throu|^, 

ITOHseq. 
Dog's, 49. 
Elephant's, ^9. 
English Royal Commianonfl on 

dangers f^om, 124-125. 
Ewe's, 49, 53. 
Food constituents of various 

kinds of, 53. 
Formulas for modified, 202- 

205. 
Goat's, 16, 49, 51, 53, 65, 56- 

62. 
Human, 26-29, 37, 47, 49, 51, 

53-n65, 59, 60. 
Inspection, 282-291. 
Llama's, 49. 
Lecithin in, 70-71. 
Mare's, 49, 53. 
Modification of, for infants, 75- 

78. 
Municipalization of, 177-185. 
Pasteurisation of, 241-266. 
Porpoise, 49. 

Rabbinical regulations con- 
cerning, 16, 118-119. 
Reindeer's, 51, 53-55. 
Science of, in United States, 77. 
Sent to Paris from United 

States, 88-89. 
Sow's, 49. 
"Trusts," 181. 
Tubercle bacilli found in, 92. 
Tuberculosis spread by, 123- 
134. 
Milking machines, 179-180. 
Mommsen, Professor, quoted, 11. 
Montreal, decline of birth-rate in, 

5-6. 
Moore, Dr. V., 137 n. 
Morgan, Dr. J. M., !23. 
Morocco, infants' milk^ depots in, 

192. 
Mothers, education of, 297-^303. 
Mothers, ignorance of, 14, 297- 
298. 



INDEX 



349 



Mimich, foul supply of milk in, 
116. 

Municipalization of the milk sup- 
ply, 177-186. 

N 

Nancy, France, 187-188, 190. 

Natioxud Dairy Show, 88. 

Negro women, decline of nursing 
abUity, 23. 

Newark, N.J., 219. 

New Hampshire, decline of native 
birth-rate in, 9. 

New Jersey supplies milk to New 
York, 285. 

New Jersey, tuberculous cattle in, 
135. 

New Jersey Tuberculosis Com- 
mission, 134. 

Newman, Dr. Alfred, 227. 

New York, tuberciilar cattle in, 
137 n. 

New York CSty, milk supply of, 
116, 286. 

New York City, 'system of in- 
spection employed, 283, 286- 
290. 

New Zealand, decline of Inrth- 
rate in, 9. 

New Zealand, infantile death-rate 
in, 158. 

Nocard, Professor, 68. 

Norfolk, Va., 136, 136. 

Norway, breast-nursing responsi- 
ble for low death-rate, 33, 38. 

Norway, decline of birth-rate in, 
8. 

Norway, infants' nulk depots in, 
192. 

Nottingham, England, Municipal 
milk, 183-184. 



Ohio and adulteration of milk, 

169. 
Ohio supplies milk to New York, 

286. 



Olivier, Dr., 126. 
Ontario, decline of birth-rate in, 
6. 

P 

Paris Exposition of 1900, 88. 
Park, Dr., 233, 267. 
Pasteiu*, 267. 

PASTEtnUZATION : 

Abandoned in Rochester, N.Y., 

205, 214. 
Argimatents for and against, 

241-266. 
At Pol-sur-Mer infants' milk 

depot, 194. 
Commercial, 261-262. 
Defined by Straus, 261. 
Destro3m disease germs, 260- 

263. 
Employed in America, 194. 
Statistics showing reduction of 
infantile mortality by, 210- 
213, 226, 229-234. 
Sterilization and, 202. 
Patent foods, 41-44, 161-162. 
Pearson, Professor, 136. 
Peyroux, Dr., 226. 
Philadelphia, infants' milk depot 

in, 194. 
Pol-sur-Mer, milk pasteurized in, 

194. 
Polybius, 10, 11, 12. 
Portugal, decline of birth-rate in, 

8. 
Portugal, infants' milk depots in, 

192. 
"Preservatives" in milk, 168- 
173, 180. 

Q 

Quebec, decline of birth-rate in 

Province of, 6. 
Queensland, decline of birth-rate 

in, 8. 

R 

Rabbinical regulations conoem- 

ing milk, 16, 118-119. 
Race suicide, 4, 12, 13. 



350 



INDEX 



Baoe suieide, among bActeri*, 

104. 
Rachitis, 26. 

Ravenel, Dr. M. P., 190, 186. 
Beading, England, municipal milk 

expenmont, 184. 
Reindeer, milk of, 51, 53-64. 
Rhode Island, decline of native 

birth-rate in, 0. 
Roby, Dr., 219. 
Rochester, N.Y., municipal milk 

depots, 206-217. 
Roger, ProfesBor, 72. 
Rome, decline of population in, 

11-12. 
Roosevelt, Theodore, 4, 8, 10, 

12. 
Rotch, Dr. T. Iforgan, 27, 75, 76, 

162. 
Rowntree, Seebohm, 108 n. 
Russia, death-rate of infants in, 

158. 
Riisms, infants' milk depots in, 

102. 



8 



St. Helens, England, infants'milk 

depot in, 107. 
Salmon, Dr., quoted, 58 n. 
Saxony, tuberculous cattle in, 

136. 
Scarlet fever, 72, 100, 110, 120, 

147, 148. 
Scorbutus, 42, 258. 
Score cards, 270-282. 
Scotland, decline of birth-rate in, 

8. 
Sedey, Professor, quoted, 11- 

12. 
Seltser, Dr., 88. 
Shroeder, Dr., 167 n. 
Smith, Adam, 10. 
Smith, Dr. Theobald, 127, 128, 

129. 
Smollett, quoted, 85-86. 
Sophocles, quoted, 12, 156. 
Sore throat, epidemic of, 140. 



South Australia, dediae of birth- 
rate in, 8. 
Sow, milk of, 40. 
Spun, infants' milk depots In, 

192. 
SUtistical tables, 5, 7, 8, 28, 20, 

49, 53, 136, 165. 
SteriUsation, 189, 190, 104, 196, 

201, 202, 204, 269. 
SiSAUB Milk Depots: 
Qoeely follow French depots, 

194. 
Formulas used in, 202-203. 
Reduction of deaUi-i»te 

through, 220-234. 
ffick children served by, 100. 
Straus, Nathan, 186, 194^ 105, 
221, 220, 230, 231. 
quoted, 164. 
Sweden : 

Breast-nundng in, 83, 38. 
Decline of birth-rate in, 8. 
Infante' milk depots in, 102. 
Low mortality in, 33, 38. 
Switaeriand, use of goat's milk in, 
61. 



Tasmania, decline of birth-rate m^ 

8. 
Tayler-Jones, Dr. Louise, 28. 
Troje, Dr., 132. 
Tubercle bacilli, ses BadUus 

tuberculosis. 
Tuberculm, 131, 135, 186, 273- 

276. 

TUBEBCULOSIS : 

A house disease, 137. 
Cattie and, 134-130. 
CSonveyed through milk, 123, 

124, 126, 126. 
Extent of ravages of, 122-123. 
Fowls and, 131. 
Qoats and, 58-50. 
Human and bovine, 126-134. 
In Denmark, 186 n., 270-273, 

275. 
In United States, 122-138. 



INDEX 



351 



Typhoid, 72, 92, 109, 110, 146- 
146, 147 n., 162, 166-167. 



U 



Udder, tuberculoma of, dangiBt- 

OU8, 126, 133, 139-143. 
XJmted States, aee America. 



Variot, Dr., 76, 191. 

Vomont, decline of native birth- 
rate, 9. 

Victoria, decline of birth-rate in, 
8. 

Vmemin, 127. 



W 

Watkb * 

Municipalization of, 174-176. 
TuberculofliB germs not found 

in, 176. 
Tyi>h<ttd germs in, 109, 146, 
146, 176. 
West Australia, decline of birth- 
rate in, 8. 
Wet-nurse, 44. 

Woodhead, Dr. O. Sims, 92, 130, 
140. 

Y 

Yonkers, N.Y., 194, 196. 
York, England, infanU' milk 
depot in, 198. 



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