installed these machines during the past year. One of these had to discontinue on account of poor results; another began with and still continues to give remarkably good results. The difference seems to depend entirely upon the men who operate them and who clean and care for the machines after milking. Where owners or managers, who are interested in the machines and like to use them, are the operators, most excellent results can be obtained. In the hands of disinterested hired men very poor results are quite sure to follow.

As the result of our bacteriological study of milking machines during the past year some most notable improvements have been made in these machines. They are now much simpler, more easily cleaned and much more certainly sterilized.

There is considerable rubber tubing with milking machines. We have studied the question of sterilizing these tubes with the result that we now can easily, but certainly accomplish sterilization. Some interesting work is still being done along this line.

Our expert, Dr. Moak, has made 123 regular inspections of the farms during the year. The Chairman, Dr. Bell, has visited every farm to which we certify and all except one during the last year. Several other members of the Commission have also visited during the year. Thus the Commission knows exactly under what conditions the milk is produced to which it certifies.

Throughout the year physicians who are located near each one of our Certified Farms have visited these farms each month to make inquiry regarding the health of employees who have anything to do with the production or handling of the milk, and have made their regular monthly reports to the Commission.

In addition our farms have been inspected and scored by inspectors from the New York City Board of Health, and some of them have also been visited by State Inspectors. Most of our farms received a score of 100% by these inspectors. A few minor criticisms were made at three of the farms. This, we feel, is a remarkably good showing. From our point of view there is scarcely an inspection but some minor point might be criticised.

One hundred and thirty people on the Certified Farms have been immunized by typhoid vaccine. This has been done at the expense of the Commission. No untoward symptoms have

been noticed in any case as the result of this work. The reactions were, however, quite severe in three men past sixty years of age.

Considerably more laboratory work has been done this year than ever before; 1,079 bacteriological examinations have been made. The average count on all these samples showed 3,945 bacteria per c. c. This represents our best year's work. The average count for 1913 was 5,734 per c. c. Our standards call for an average count of 10,000 per c. c.; thus the results for the year are far within the requirements.

The average butter-fat content of the milk was 4.6%.

The sales of Certified Milk again show a fine increase. We sold 2,702,877 quarts during 1914 as against 2,388,982 in 1913.

There has been some agitation about the question of danger of tuberculosis in Certified Milk. We have tested 1,264 head of cattle this year with the tuberculin test and found 6% of reactors. These reactors have all been slaughtered and examined under the strictest Federal standards for beef. The slightness of the lesions in these cows so removed from our herds and slaughtered may be appreciated when we state that not one pound of any one of these carcasses was condemned. In other words, every bit of meat passed inspection. In several of these reacting cows no lesions at all were found. Furthermore, some of these reactors were dry cows and young stock, so that our herds producing Certified Milk are in exceptionally good condition. On this score we know that it is a far better principle to keep tubercle bacilli out of milk than to try and kill them out after they have gotten into the milk. The tubercle bacillus is a fairly tough organism, and slowly, but surely, evidence is accumulating that this organism is often not killed out under some of our most efficient systems of pasteurizing. The old adage is still a good one "An ounce of prevention, is worth a pound of cure.'

The heating or pasteurizing of milk does certainly affect it in the minds of most children specialists. Many men claim that scurvy is thus produced, but that this may be overcome by the feeding of orange juice or other anti-scorbutics.

It now seems a demonstrated scientific fact that certain foods contain substances which when removed or destroyed

alter the nutritional capabilities of the food. These substances have been called "vitamins." Rice has this substance in the outer portion of the grain. In rice which has been polished this substance is removed and people who eat such rice exclusively suffer from beri beri. It is likely that pellagra and scorbutus are analagous conditions. Fine cheddar cheese of characteristic flavor cannot be made from pasteurized milk and research seems to have shown that some substance in milk is destroyed by heating and the lack of this substance (vitamin) affects the bacteria which have so important a part in cheese making.

There are some things in nature which man cannot alter or change and improve them. Milk we believe to be one of these things.

President McCleave: Dr. Campbell, will you report for the Chicago Commission?

Grace H. Campbell, M. D., read the report of the Chicago Medical Society Certified Milk Commission, as follows:

Report of The Chicago Medical Society Milk Commission for 1915 on Medical Inspection of Employees on Certified Dairy Farms

Within the last few years increasing attention is being given to milk and its relation to public health. Milk is used to a greater extent in this, than in any other country. It is one of the most important articles of diet. About 16% of the average American diet consists of milk or milk products. Milk contains all the essentials of a perfect diet. Because of this and its facility of ingestion and being so easily digested it is one of the most important foods for infants and invalids. Milk is of great importance as a substitute for mother's milk in infant feeding, it is well understood that those most dependent on milk as their sole food suffer the greatest injury from use of milk impaired of its nutritive content. Improved living conditions have greatly decreased the mortality in most countries, unfortunately however this does not apply to infants under one year of age.

It is for this reason and many others that the question of a clean, safe milk and its relation to public health is worthy of best efforts.

That milk may play a part in the spread of certain diseases has for many years been appreciated. From present knowledge the most important of these are: tuberculosis, typhoid fever, scarlet fever, diphtheria and tonsillitis. It is believed by many that the tubercle bacilli are in a majority of cases derived from the cow, others believe that they may come from human sources. The contagion of true scarlet fever is believed by some to be transmitted through milk and is considered as coming from man. Diphtheria bacilli when found in milk are regarded as being of human origin. The streptococci exciting tonsilitis are thought to be derived both from cases of septic inflammation of the udder of the cow and from human sources.

Physicians recognizing the dangers in the contamination of milk and the great need that it should always be clean and wholesome have organized Medical Milk Commissions in most of the larger cities of the United States. In the production of Certified Milk there are many requirements to be met by the owner of each farm. One of the most important of these requirements is the medical inspection of all employees. Of the eighty-one requirements of the contract between the producer and the Com

mission nine of these are in regard to the health of employees, but these nine items are only a small part of the amount of work that is being done to further safeguard Certified Milk.

To the late Dr. Julia D. Merrill who was a member of the Chicago Medical Society Milk Commission for six years and was a member at the time of her death one year ago, belongs the credit of having established and enforced medical inspection of all employees upon all farms under certification by the Chicago Medical Society Milk Commission.

Strict medical inspection of employees on Certified Farms was put into force in November, 1912, and since then every employee on each farm who comes in contact with cow, or milk, or utensils has been medically examined at least once a month, except this last winter when the epidemic of foot and mouth disease prevented regular inspections; during this epidemic all Certified Farms were under rigid quarantine. During these months of the quarantine of the farms, postal card reports were made regularly by each producer to the Commission as to the health of all employees and of the existence of contagious diseases, if there were any, in the neighborhood of each.

Several months ago the work of medical supervision of employees on Certified Farms was extended to include a physical examination of each new applicant for employment on certified farms.

In the locality of each Certified Farm a reputable practicing physician has been appointed by the Commission to examine all new applicants. Every new applicant is questioned as to having had any recent illness or having had diphtheria, typhoid fever, or frequent tonsillitis. No person is employed who has not been vacinnated. It is ascertained whether the applicant has been in contact with any persons_suffering with any disease and whether it was contagious. Each must be examined for any disease of the skin of the face, neck, arms, hands and the condition of the fingernails. A careful physical examination is made for signs or symptoms of tuberculosis, either pulmonary or glandular. No one who upon examination is found to have a sore throat or to show signs of conjunctivitis, tuberculosis, syphilis or venereal disease, any suppurative process, or other disease of an infectious or contagious character is considered for employment.