A most valuable demonstration of the use of certified milk has 

 been made this year in San Francisco when the foundling infants 

 were removed from the Asylum and the "boarding-out" system tried. 

 Under this change alone a death rate of 40% plus was reduced to 

 12% in the first six months, the feeding of the child being left to 

 the judgment of the woman with whom it was boarded. A careful 

 investigation then showed that the children were not gaining as 

 normal children should and in most cases were being fed condensed 

 milk. Certified milk was then secured for these infants, and under 

 the services of a nurse the foster-mothers were taught artificial 

 feeding, with the result within the next six months of a death rate 

 of less than 2%, and an absolute gain in the normal in practically 

 all of the cases. The remarkable effect of clean milk in infant feed- 

 ing can only be appreciated by the physician who is constantly in 

 contact with the problem of artificial feeding. The bottle baby has 

 become with this pure food product a more normal citizen. The 

 work of the Medical Milk Commissions seems to me to express 

 as thoroughly as does the anti-tuberculosis work of the medical 

 profession the new and preventive methods in medical practice. 

 Keeping the child well is far more worth while than caring for its 

 digestive disturbances when poor grades of milk are furnished it. 



THE MILK PRODUCTION PROBLEM. 



By Prof. Herbert A. Hopper. 



Much that will be said in this paper is already well known to those 

 who are following the trend of modern tendencies in the produc- 

 tion and handling of milk for direct consumption. From the finan- 

 cial and especially the public health point of view, it is a national 

 problem and is absorbing the attention of thinking men and women 

 everywhere. While most forms of food have in recent years come 

 more or less completely under the supervision of the pure-food 

 authorities, no one form has given them so much anxiety as has the 

 milk supply. Certainly their efforts in controlling the sanitary 

 features of other food supplies have met with more success than 

 those directed toward the dairy and its product. The reasons for 

 this are not hard to find. The problem is a complex one. Unlike 

 some other forms of production, dairying does not yield readily 

 to centralization. Its separate units are hard to fit into a sys- 

 tematic organization. The local and special demands of each 

 farm makes its successful operation largely a problem by itself, 

 and to this extent so far has prevented any considerable number 

 of farms being operated in accordance with any plan or scheme of 

 centralization. The points of view, training, methods and aims 

 of the operators have lacked so much in uniformity that the 

 quality of the product has been made more difficult to control. 

 Methods of inspection and control as used in other lines have often 

 met with uncertain results when applied to the milk supply. 

 Further, the attitude of producers in general, and the training and 

 personality of the inspector as well are to be considered. At best, 

 it has been a long-range effort, associated with many serious diffi- 

 culties, though much progress, has been made. The subject of 

 milk production is too large to compass in one paper. It is my 



