MILK FUND ASSOCIATION, LOUISVILI^ 307 



Second Preparation and distribution. All milk, whole as well as 

 modified, was prepared in the Association laboratory according to 

 physicians' prescriptions and sent at a regular hour daily to the 

 trained nurse in charge of each station for individual distribution. 

 This laboratory is in charge of a laboratory nurse and two assistants. 

 Both the nurses and the management of the laboratory were under the 

 control of the supervising nurse and the chairman of the Medical 

 Committee. Whole milk was supplied to mothers in half pints or 

 multiples thereof, where indications justified it. 



Weekly bacterial counts were made of the whole milk and vari- 

 ous modifications taken from the stock prepared for daily consump- 

 tion. These counts were especially gratifying, the maximum being 

 under 22,000, and the great majority running under 8,000. 



The milk sugar was also frequently examined in order to prevent 

 contamination from this source. Constant vigilance was observed 

 as to the icing, both to and from the distributing centers and where 

 necessary, Hess refrigerators were supplied in the homes. And lastly, 

 constant effort was made to minimize the handling of our products. 



Third Medical and nurse supervision. Competent physicians were 

 in weekly attendance at each station and made more frequent house 

 visits where the severity of the case demanded. The station nurses 

 were subject to the order of these physicians, and carried out such 

 directions as were given, daily or oftener, and for as long a period 

 as was necessary. 



These nurses were under the immediate control of the supervising 

 nurse and kept a daily hour at their respective stations for purposes 

 of distribution and enrollment. They also had a weekly hour of 

 class instruction in regard to matters pertaining to their work which 

 was conducted by the supervisor. The rest of their time was spent 

 in house to house visiting, home instruction, and relief nursing at 

 the direction of the staff or neighborhood physicians. 



Also a volunteer board of women visitors was maintained who did 

 follow-up and relief work. 



Fourth Social. A systematic effort was made by the nurses and 

 workers to teach and maintain proper methods of caring for and pre- 

 paring food, cleanliness of house and person, destruction of flies, 

 ventilation, and simple rules of general prophylaxis. 



Fifth Statistical. 



Total number of children registered May to October 558 



The number under one year of age 236 



The number over one year, up to five years 322 



The number of physicians represented 120 



Visits by Association nurses 4,952 



Number of bottles of modified milk 117,257 



Number of bottles of whole milk 23,343 



The total number of deaths for the season was seventeen, two of 

 which were surgical and three occurred in less than thirty-six hours 

 after being first seen. This makes the death rate 3.04 per cent, for 

 the whole 558 children registered. The death rate for children under 

 one year of age is less than half that averaged by the city at large 

 during the last five years. 



