THE MILK SITUATION IN THE DISTRICT OF COLUMBIA. 35 



filth and refuse in the same manner. Many medical authorities take 

 the position that the question of dirt and the bacterial contamination 

 of milk is of infinitely greater importance from the standpoint of 

 health than a high chemical standard governing the composition of 

 milk, for the reason that very poor milk (that is to say, that which is 

 low in proteids, fat, and milk sugar) is still very valuable as a food 

 and contains a great deal of nutriment, providing it is sufficiently 

 clean to be consumed with safety, while, on the other hand, it is well 

 understood that dirty milk and milk bacterially contaminated is not 

 only responsible for the high death rate prevailing among young 

 children from cholera infantum, but that polluted milk is also re- 

 sponsible to a large degree for the spread of such infections as diph- 

 theria, scarlet fever, typhoid fever, and tuberculosis, and for acute 

 cases of milk poisoning, which are by no means uncommon. 



The investigations of the market milk of Washington, 1 made in 

 1907. demonstrated that the milk was for the most part old, stale, 

 and dirty, its bacterial content averaging in 1907 over 22,000,000 

 per cubic centimeter and in 1908 over 11,000,000. It was further 

 established that at least 11.3 per cent of the cases of typhoid fever 

 occurring during the summer of 1906 in Washington were certainly 

 attributable to contaminated milk, while in 1907 9.18 per cent and 

 in 1908 approximately 10 per cent of the typhoid cases were abso- 

 lutely traced to infected milk. In fact, it may be stated without 

 hesitancy that the average commercial milk of large cities is not a 

 safe food. 



In an interesting article on " The future of milk supplies of large 

 cities from a sanitary standpoint," by Dr. Ernst J. Lederle, health 

 officer of the city of New York, 2 published under date of March 19, 

 1910, the writer refers to the fact that the milk dealer of to-day occu- 

 pies a unique position in the commercial world, trafficking in a prod- 

 uct which is one of our most important foodstuffs, bringing blessings 

 to millions of people when properly produced and carefully handled 

 and distributed, but which, when coming from unhealthy and insani- 

 tary sources and when carelessly handled, is capable of spreading 

 disease and misery. It is clearly the duty of the milk dealer, he 

 states, to supply the quality of milk which is approved by those dis- 

 interested physicians and sanitarians who have made a special study 

 of the requirements of infants and invalids, and who are familiar 

 with public-health problems in their broadest application. In the 

 light of present knowledge on the subject, he says, it would appear 

 that the dealer should not be satisfied to offer the public any milk 

 unless it be clean and safe either a clean, high-grade market milk, 

 a scientifically pasteurized, or a clean, raw milk of low bacterial count 

 from healthy animals. Under existing conditions no large dealer, 

 he continues, can afford to supply milk in large cities unless it be 

 either of the certified type, guaranteed or inspected, or scientifically 

 pasteurized. New conditions, he continues, are forcing great changes 

 in the character of conducting a large milk business. 



The dealer, to be successful and progressive, requires the services 

 of veterinarians to inspect the cattle from which his supply is re- 

 ceived and to assist in the elimination of diseased animals, and of the 



1 Rosenau, Lumsden and Kastle, Bulletins Nos. 35 and 44, Hygienic Laboratory, U. S. 

 Public Health and Marine Hospital Service. 



2 Journal of American Medical Association, Vol. LIV, No. 12. 



