Otto P. Geier, Cincinnati, Ohio: Seriously speaking, I cannot help but express my appreciation of this most valuable paper to this audience. I believe it is one of the most valuable papers that we have had presented for some time. Dr. Fleischner has addressed himself to the subject from an entirely new view-point. We are inclined here in our organization to be a self-admiration society and to talk about and emphasize the advantages of Certified Milk to each other. We need to remember that ours is not a sufficiently large audience and that we should extend it. This summary of Dr. Fleischner's has interested me from the fact that it will go out to men who have not paid particular attention to this milk question; and while Dr. Fleischner has used figures in a certain way, I believe it even more emphasizes than he believes the fact that the doctors as a rule know very little about Certified Milk. If you square yourself up before a man and ask him this question which every intelligent man should be concerned about and interested in, you will be compelled to admit that he knows nothing about it, so that I think that the large percentage of the answers given in the affirmative that they know something about Certified Milk is probably misleading. I doubt whether so large a percentage of men as is indicated by the report really know something about Certified Milk; all of which again emphasizes the fact that we are very poor propagandists. Personally I think our experience in Cincinnati would lead to this conclusion, that nothing which the profession of medicine has done for itself in the last ten years has so advanced its standing in the community as the taking up of the question of pure milk in this way. It not only has settled the question of pure milk but has absolutely taken out of the hands of politicians the control of health affairs, and today we are absolutely free from any political domination in this phase of our health work. I believe that result cannot be so well secured through any other means as by beginning pure milk propaganda in any city. The profession has, therefore, popularized itself in the community by taking up this subject and it is crystallizing public sentiment in favor of public health work as much as any other one thing has done.

I believe this leads also to another conclusion, namely, that if this is good for seventy county medical societies today in this country, it is good for fifteen hundred or sixteen hundred county medical societies over which the American Medical Association has some supervision.

It has seemed absurd to me for some years that the American Medical Association, as wealthy an organization as it is, is not spending a considerable sum of money in advancing the program of pure milk. If it will do so it will advance the interest of the medical profession I think in a far more rapid way and more certainly than by any other method that the American Medical Association is now pursuing. I am not certain but what before we adjourn this Conference I will offer a resolution calling upon the American Medical Association to take up this question of pure milk propaganda in a very definite way.

I certainly appreciate what Dr. Fleischner has brought before us.

President McCleave: Is there any one else who wishes to say anything in the discussion of Dr. Fleischner's paper?

Adelaide Brown, M. D., San Francisco, California: I think Dr. Fleischner's point that a number of hospitals are being supplied Certified Milk is rather misleading. I think what is happening is that they are getting the cheapest milk that they can buy. I addressed all the superintendents of nurses of hospitals in the City of San Francisco, I think there were about sixteen women in the audience, and I was informed that the general hospital milk was not of the grade of Certified Milk, in fact, no Certified Milk was used unless the doctors ordered it. I think the hospitals will take Certified Milk for infants, but probably there is where it will end.

Henry L. Coit, M. D., Newark, N. J.: I want to congratulate Dr. Fleischner on this very interesting series of conclusions which he has reached by means of this Questionnaire. I would like to suggest that the various Commissions of the United States institute a like Questionnaire so that we can multiply conclusions and get a more comprehensive idea of the results we are seeking. For one I will promise that I will use them in the community in which I live, and I have no doubt that a great many other Commissions would be willing to do so.

J. P. Sedgwick, M. D., Minneapolis, Minnesota: A point of great interest to me was in regard to the hospitals. We have been talking about it. I believe that our report a year ago at Rochester was that our organization was sending out printed cards to physicians which they were requested to sign and send

in to the hospitals, ordering the hospitals to which these physicians took patients to give Certified Milk to such patients. I say that this has not been wholly successful, but it has been a great help. I know that my patients at all of the hospitals to which children are sent with which I have to do get Certified Milk. Those cards have been sent to all of the physicians in the city and county and we expect it to help in this matter. I should like to hear from Dr. Kerr in regard to the question of the American Medical Association taking up the pure milk problem and as to anything that this Committee has had before it concerning Certified Milk during the past year.

J. W. Kerr, M. D., United States Public Health Service: I really do not know that I can explain the attitude of the American Medical Association or its Committee. The matter has slipped my mind. Dr. Fleischner's paper has again emphasized, however, the importance of the medical profession taking an interest in this and other public health questions.

I feel especially indebted to Dr. Fleischner, because he has done work that the Committee of which I am Chairman did several years ago. For three or four years statistics were presented to this Association of the amount of Certified Milk used in infants' milk depots. In my mind the two movements have always been linked. I associate Dr. Coit with Dr. Koplik, because one inaugurated the Certified Milk movement, and the other established the first infant milk depot. The work that Dr. Fleischner has undertaken has an educational effect on many physicians which we are likely to overlook.

My greatest interest in pure milk began in 1906, in the City of Washington. During a discussion the remark was made that typhoid fever was increasing in the District of Columbia. I went with one of our inspectors to one of the local dairies, and we found conditions fairly good. This dairy by the way was one that I had been taking milk from for my own family. In a few days or weeks we were again discussing the condition of the milk supply of the various dairies throughout the city, in connection with a report of three cases of typhoid fever which had just been removed from one dairy. I inquired which dairy it was and found that it was the one that was furnishing milk for my own family. Since that time I have been more than particular to assure myself of the source and character of the milk used.

I think it might be a good plan to designate some individual or some Committee whose duty it would be not only to get the views of physicians toward Certified Milk and infant milk depots, but the views of consumers themselves and why they are willing to pay one-third to one-quarter more money for Certified Milk. It seems to me that in the thousands of consumers all over the country you have an educational force that ought to be an encouragement to this Association.

President McCleave: The last paper on the program for this afternoon is by Henry L. Coit, M. D., Newark, N. J. on "The Relation of the Medical Milk Commission to Municipal Health Boards."

Relations Between Medical Milk Commissions and Municipal Boards of Health

By Henry L. Coit, M. D., Newark, N. J.

This paper was inspired by the unique experience of the Medical Milk Commission of Essex County, New Jersey, in connection with the problem growing out of the occurrence in a Certified Milk herd of an unusual number of animals with bovine tuberculosis.

The complex situation was caused primarily by the unremitting antagonisms, incredulous attitude and the persistent unwillingness of a local board of health to cooperate with the Medical Milk Commission. Members of this board by insinuation, innuendo and the encouragement of a critical newspaper propaganda continued to make systematic efforts to undermine public confidence in the work of the Commission. Although the Commission antedated this board's activities in pure milk work by many years and although its principles of milk control were those laid down originally by the Commission, during its entire life, this board had uniformly continued to ignore its indebted

ness.

The situation was made more intolerable by the attitude of a single member of the Commission, who, retaining his membership for a time without cooperation, apparently tried to protect his professional reputation by an adroit accommodation to public sentiment. This was accomplished by allowing newspapers to publish his criticisms and by aligning himself with those who would destroy the system.

With these collateral difficulties to surmount we proceeded to attack the real problem before us, namely the investigation of the unknown cause of the occurrence of a large number of tuberculous reactors in a herd from a portion of which Certified Milk was obtained and devoted ourselves to the work of finding a way to prevent a repetition of the unprecedented situation.

Shaken by an earthquake of accusation, beaten by a blinding storm of criticism, and assailed by a driving gale of distrust, we were stranded. Not willing to abandon our ship we pulled off the sands and cautiously set sail with what we had left of our rigging. Someone said "Why do you not come out in the press and publicly defend your system. We replied that it needed