adopted in most cases.

Those of the Medical Milk Commission of

the Philadelphia Pediatric Society are as follows:

Specific gravity from 1,029 to 1,034; reaction, neutral or faintly acid; proteid from 3 to 4 per cent; sugar from 4 to 5 per cent; fats from 3 to 4 per cent; also an additional fat standard of 5 per cent, the permissible limits of variation being from 4 to 51 per cent.

A knowledge of the fat content is of much importance, and its determination at regular intervals is required by all commissions. The examination for adulterants and preservatives is of much less importance, as it is altogether unlikely that these substances would be used by dairymen willing to undertake the production of certified milk.

In order to attain these standards great care is necessary in the production and transportation of the milk, and the dairyman is required to observe certain rigid requirements. These are codified and in some instances incorporated in a rigid contract, which is signed by the dairyman and members of the commission.

REGULATIONS OF THE MILK COMMISSION OF THE MEDICAL SOCIETY OF THE COUNTY OF NEW YORK.

The following requirements of the Milk Commission of the Medical Society of the County of New York show great care in preparation, and contain all of the essential rules required by other commissions:

1. The barnyard. The barnyard should be free from manure and well drained, so that it may not harbor stagnant water. The manure which collects each day should not be piled close to the barn, but should be taken several hundred feet away. If these rules are observed, not only will the barnyard be free from objectionable smell, which is an injury to the milk, but the number of flies in summer will be considerably diminished.

These flies are an element of danger, for they are fond of both filth and milk, and are liable to get into the milk after having soiled their bodies and legs in recently visited filth, thus carrying it into the milk.

Flies also irritate cows, and by making them nervous reduce the amount of their milk.

2. The stable. In the stable the principles of cleanliness must be strictly observed. The room in which the cows are milked should have no storage loft above it; where this is not feasible, the floor of the loft should be tight, to prevent the sifting of dust into the stable beneath. The stables should be well ventilated, lighted, and drained, and should have tight floors, preferably of cement, never of dirt. They should be white washed inside at least twice a year, unless the walls are painted or of smooth cement finish, which can be washed frequently.

The air should always be fresh and without bad odor. A sufficient number of lanterns should be provided to enable the necessary work to be properly done during the dark hours. The manure should be removed twice daily, except when the cows are outside in the fields the entire time between the morning and afternoon milkings. The manure gutter must be kept in a sanitary condition. All sweeping must be finished before the grooming of the cows begins, so that the air may be free from dust at the time of milking.

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There should be an adequate supply of water, warm and cold, and the necessary wash basins, soap, and towels.

3. Water supply. The whole premises used for dairy purposes as well as the barn must have a supply of water absolutely free from any danger of pollution with animal matter and sufficiently abundant for all purposes and easy of access.

4. The cows. No cows will be allowed in the herd furnishing certified milk except those which have successfully passed a tuberculin test. All must be tested at least once a year by a veterinarian approved by the milk commission. Any animal suspected of being in bad health must be promptly removed from the herd and her milk rejected. Do not allow the cows to be excited by hard driving, abuse, loud talking, or any unnecessary disturbance.

Feed. Do not allow any strongly-flavored food, like garlic, to be eaten by the

COWS.

When ensilage is fed, it must be given in only one feeding daily, and that after the morning milking, and the ftill ration shall consist of not more than 20 pounds daily for the average-sized cow. When fed in the fall small amounts must be given and the increase to the full ration must be gradual.

Cornstalks must not be fed until after the corn has blossomed, and the first feedings must be in small amounts and the increase must be gradual. If fed otherwise, ensilage and cornstalks are liable to cause the milk to affect children seriously.

Cleaning.-Groom the entire body of the cow daily. Before each milking wash the udder with a cloth used only for the udders and wipe it with a clean dry towel. Never leave the udder wet and be sure that the water and towel used are clean. The tail should be kept clean by frequent washing. If the hair on the flanks, tail, and udder is clipped close, and the brush on the tail is cut short, it will be much easier to keep the cow clean. The cows must be kept standing after the cleaning until the milking is finished. This may be done by a chain or a rope under the neck. 5. The milkers.-The milker must be personally clean. He should neither have nor come in contact with any contagious disease while employed in handling the milk. In case of any illness, in the person or family of any employee in the dairy, such employee must absent himself from the dairy until a physician certifies that it is safe for him to return.

In order that the milk commission may be informed as to the health of the employees at the certified farms, the commission has had postal cards printed, to be supplied to the farms, and to be filled out and returned each week, by the owner, manager, or physician of the farm, certifying that none are handling the milk who are in contact with any contagious disease.

Before milking the hands should be washed in warm water with soap and nail brush and well dried with a clean towel. On no account should the hands be wet during milking.

The milkers should have light-colored, washable suits, including caps, and not less than 2 clean suits weekly. The garments should be kept in a clean place, protected from dust, when not in use.

Iron milking stools are recommended and they should be kept clean.

Milkers should do their work quietly and at the same hour morning and evening. Jerking the teat increases materially the bacterial contamination of the milk and should be forbidden.

6. Helpers other than milkers.—All persons engaged in the stable and dairy should be reliable and intelligent. Children under 12 should not be allowed in the stable or dairy during milking, since in their ignorance they may do harm, and from their liability to contagious diseases they are more apt than older persons to transmit them through the milk.

7. Small animals.-Cats and dogs must be excluded from the stables during the time of milking,

8. The milk.-All milk from cows sixty days before and ten days after calving must be rejected.

The first few streams from each teat should be discarded, in order to free the milk ducts from the milk that has remained in them for some time and in which the bacteria are sure to have multiplied greatly. If any part of the milk is bloody or stringy or unnatural in appearance, the whole quantity yielded by that animal must be rejected. If any accident occurs in which a pail becomes dirty, or the milk in a pail becomes dirty, do not try to remove the dirt by straining, but put aside the pail, and do not use the milk for bottling, and use a clean pail.

Remove the milk of each cow from the stable immediately after it is obtained to a clean room and strain through a sterilized strainer of cheesecloth and absorbent cotton. The rapid cooling is a matter of great importance. The milk should be cooled to 45° F. within an hour and not allowed to rise above that as long as it is in the hands of producer or dealer. In order to assist in the rapid cooling, the bottles should be cold before the milk is put into them.

Aeration of milk beyond that obtained in milking is unnecessary.

9. Utensils.—All utensils should be as simple in construction as possible and so made that they may be thoroughly sterilized before each using.

Coolers, if used, should be sterilized in a closed sterilizer, unless a very high temperature can be obtained by the steam sent through them.

Bottling machines should be made entirely of metal with no rubber about them, and should be sterilized in the closed sterilizer before each milking, or bottling. If cans are used, all should have smoothly soldered joints, with no places to collect the dirt.

Pails should have openings not exceeding 8 inches in diameter, and may be either straight pails, or the usual shape with the top protected by a hood.

Bottles should be of the kind known as common sense," and capped with a sterilized paraffined paper disk, and the caps authorized by the commission.

All dairy utensils, including the bottles, must be thoroughly cleansed and sterilized. This can be done by first thoroughly rinsing in warm water, then washing with a brush and soap or other alkaline cleansing material and hot water and thoroughly rinsing. After this cleansing they should be sterilized by boiling, or in a closed sterilizer with steam, and then kept inverted in a place free from dust.

10. The dairy.-The room or rooms where the utensils are washed and sterilized and milk bottled should be at a distance from the house, so as to lessen the danger of transmitting through the milk any disease which may occur in the house.

The bottling room, where the milk is exposed, should be so situated that the doors may be entirely closed during the boiling and not opened to admit the milk nor to take out the filled bottles.

The empty cases should not be allowed to enter the bottling room nor should the washing of any utensils be allowed in the room.

The workers in the dairy should wear white washable suits, including cap, when handling the milk.

Bottles must be capped as soon as possible, after filling, with the sterilized disks.

These regulations in effect provide that none but healthy cows shall be used in the production of "certified" milk, that extraneous contamination of their product shall be reduced to a minimum, that it shall be cooled to 45° F. to prevent bacterial growth, and that it shall reach the consumer before noticeable biological or chemical changes have occurred therein. For their observance the greatest care and intelligence is required, and it is necessary that the dairy be of modern sanitary construction.

This does not imply, however, that elaborate and expensive apparatus is absolutely essential. The surgeon may of necessity be forced to convert the kitchen into a surgical amphitheater, but his skill and attention to detail will insure an aseptic wound. The same in fact is also true of the dairyman, whose conscientious and welldirected efforts will yield, even with limited facilities, a product which may be impossible of attainment in the elaborately equipped dairy of the "agriculturist."

Much also depends upon the zeal of the professional body under whose patronage the dairy operates a fact clearly evident to one visiting these model establishments.

The sanitary excellence of "certified" milk and the standards it represents may therefore be expected to improve in proportion to the increasing appreciation of the medical profession and the educational attainment of those engaged in dairying and dairy hygiene.

THE RESULT ACCOMPLISHED.

Since the beginning of the movement fourteen years ago, a limited supply of pure milk has been rendered available for clinical purposes in a number of cities of the country.

The plan which was originated by a member of the medical profession has been the means of arousing that body itself to the importance of pure milk for the use of infants, invalids, and the public generally.

The methods adopted have had an influence in creating a demand for improved conditions in the production of market milk, and in addition exerted a beneficial effect upon the character of the general supply in those localities where "certified" milk is produced. They have also emphasized anew the dangers of bovine tuberculosis and the necessity of preventing the use of milk from tuberculous cows.

The standards of purity have already served as a basis for the formulation of measures which it is proposed to enact into law, a milk conference in the District of Columbia having recommended that "certified" milk be recognized by law and that it be certified by the health officer of the District.

Finally, the continued interest of the medical profession in the sanitary supervision of milk from the farm to the consumer will result in the adoption of new standards of purity far in advance of those in use at the present time.

INFANTS' MILK DEPOTS.

The milk dispensary, or Goutte de Lait, was called into existence in consequence of a recognition that bad milk and bad hygiene are responsible for excessive infant mortality among families of the poor.

Its primary object is to encourage maternal feeding, and when this is impossible, to supply a pure milk to meet the special need of the infant. An additional important function consists in the diffusion of knowledge among mothers regarding the hygienic care of their children in the home, especially with reference to the conditions necessary for success in artificial feeding.

The first institution of this character appears to have been founded in St. Gertrude's district, Hamburg, in 1889. The second of which there is record was that established by Doctor Variot in connection with the Belleville Dispensary, Paris, in 1892.

Since 1892, similar establishments have been opened in many localities in this and other countries. The first depot in the United States was established in New York in 1893 by Mr. Nathan Straus, whose interest and philanthropy have been potent factors in extending the movement in that and other cities of the country.

Although the methods employed in the conduct of infants' milk depots have varied somewhat both in this country and abroad, their objects have been the same. It is recognized that all milk dispensed should be produced and transported under conditions insuring a product of the highest purity, that it should be prepared and modified in the depot under medical supervision, and that strict bacteriological precautions should be taken in every step of the process.

In addition to the care exercised in the depot, the milk is packed in a manner to guard against contamination in the home. Each bottle contains but one feeding, and is so designed that it will not stand on end, and therefore can not be left standing open.

The milk is modified in accordance with standard formulæ in use at the various depots, and in addition, special modifications are made upon the prescriptions of physicians.

The following are the formulæ now in use at the infants' milk depots. in New York:

a Von Ohlen, Milk Depots in Germany, "Public Health," 1905.