A card index of every employee on each farm is kept, the points recorded include twenty-seven questions and answers and the findings of the primary physical examination. A separate card index is kept of the medical inspections which are made each month, there are ten items included in this examination: the date is recorded, the temperature and pulse are carefully taken, a close inspection of the eyes, the skin of the face, neck, arms, hands is made; and especially the throat is examined. Excepting tobacco throats, cultures are taken from every throat that shows any hyperemia or that looks the least suspicious. This rule of taking cultures is strictly adhered to.

When employees live upon the premises their dormitories are sanitary as to location and construction. A separate bed kept supplied with clean bed clothes is provided for each. Proper bathing facilities are also provided. In addition to the ordinary habits of personal cleanliness milkers are provided with clean white suits and caps daily to be worn while milking. The careful washing of the hands before milking each cow is another requirement. On some of the farms individual towels are provided to be used once only; where these are not provided sanitary towels are supplied in abundance.

Each producer is required by his contract with the Commission to report immediately to the Commission any illness whatsoever of employees or other residents on the farm.

The Commission has arranged with a bacteriologist of recognized ability to examine all cultures taken from employees for purposes of diagnosis. Culture tubes are provided on each farm and the superintendents on each farm are instructed how to take cultures, and in the event of any illness of a suspicious nature such employees shall be quarantined, the attending physician shall be called and a culture sent at once to the bacteriologist approved by the Commission.

Since November, 1912, eight hundred and eight primary medical examinations have been made of the employees on Certified Farms. Three hundred and ten, or thirty-eight per cent., of this number are of foreign birth; of this number, besides American born, twenty-one nationalities are represented, viz:

Beside the seven-hundred and seventy-five primary examinations that have been made, there have been two-thousand and seventy-four medical inspections made since the work of medical supervision has been in force. There have been three-hundred and fifteen throat cultures taken, the results of the examination of these are as follows:

Of the thirteen cultures that showed streptococci, and the two pseudo diphtheria, and the four suspicious, a second medical examination was made at once and cultures taken again which in each case were found negative, but as a precaution all employees at that farm were instructed to use a mild antiseptic gargle just before each milking.

Considering that this was new work and that it incurred added expense to the producers, each and every one has responded to this work, and have co-operated heartily in every possible way, and have done, and are doing everything in their power to safeguard Certified Milk and to give a milk that is beyond suspicion.

At no time since the first Medical Milk Commission was established has there been a case of either a contagious or communicable disease traced to the use of Certified Milk. No case of tuberculosis has ever been traced to a Certified Milk farm. No epidemic of scarlet fever, measles, diphtheria, or streptococcic sore throat has ever been traced to a Certified Milk farm.

The question of securing competent and efficient employees, the education and mentality of each is a very serious problem to be met by the producer, for the average length of time that an employee remains on one farm is not over two months, altho on some of the farms there still remain a few employees who were there from the beginning of the production of Certified Milk on that farm. ·.

During the time that medical examinations have been made regularly the number of employees found necessary to remove from contact with the care or handling of the Certified Milk have been very few. There have been no cases of the commoner infectious fevers found among the employees on any Certified Farm.

The educational value of regular medical examinations has also had a very beneficial effect on each and every employee with decided improvement in their personal cleanliness, knowing they were to be examined each month and oftener if necessary.

All of the producers have signified their approval of this work and believe that the primary physical examinations and the regular medical examinations made each month have done much to uplift the moral status of each employee.

In the few instances where new employees have refused medical examination, these employees have either been discharged at once or immediately removed from that part of the farm which would bring them in contact in any way with the care or the handling of the Certified Milk.

In October, 1913, a driver on one of the Certified Farms who was not in any way connected with the Certified Milk, who had been employed on this farm for three years and had not been away from the farm for several months, except to haul freight to and from the railroad station which was about two and a half miles from the farm, was taken sick and a positive diagnosis by the best known scientific methods was made of typhoid fever, however, he had been removed to a hospital several days before this report of a positive diagnosis was made. For the four weeks following daily medical examinations were made of all the employees on this farm, repeated analyses of the water and every other source from which contamination might have come were all negative. There were no contact cases, no suspicious cases of typhoid fever removed from the farm and there has been no recurrence since on this or on any other Certified Farm.

Just a year ago in another locality near where four Certified Farms are located, an epidemic of diphtheria developed to such an alarming extent that the public schools in this town were closed for weeks and all public meetings were abandoned; the nearest farm to this town is two miles. An enormous amount of work was done at this time. Employees on the Certified Farms in this locality were forbidden to leave the premises, no visitors were allowed, medical examinations were made each day of all employees, cultures were taken daily of each employee, results of which were all negative in every case. Every one that came in contact with cows or utensils or milk were required to gargle with a mild antiseptic just before milking, this precaution and every other possible antiseptic precaution was taken to protect Certified Milk.

At the outset of the epidemic of the foot and mouth disease and knowing this disease was communicable from the lower animals to human the Chicago Medical Society Milk Commission instituted certain restrictions as to the conduct of Certified Milk production during this epidemic. Each farm was notified that any employee who left the farm was not allowed to return, except the man who delivered to the railroad station,

and he, upon his return daily, was to immediately take an antiseptic bath and make an entire change of clothing, the wagon. wheels were to be run through a solution of carbolic acid, the horses' hoofs and shoes carefully cleaned and washed with an antiseptic solution. All dogs, cats, and pigeons were to be killed or confined, any stray animals coming onto the farm were to be killed at once. No visitors or peddlers were to be allowed on the premises.

The bottles and crates when received at the farm were to be immediately immersed in a solution of the chloride of lime and the wagon sprayed with the same solution.

If an outbreak of foot and mouth disease occurred within a radius of five miles of any Certified Milk farm all the milk from that farm was to be pasteurized at a temperature of 155 degrees F. for thirty minutes, and until the quarantine was removed from the infected farm.

Medical safety means the conservation of health, it is preventive medicine not curative, it is much more theatrical to cure a disease than to prevent its occurrence, to stamp out an epidemic is to some a far more notable achievement than to prevent its occurrence. If a baby should be scalded to death in boiling milk the incident would have all the elements of human interest but when disease carries away thousands nothing happens. The efforts of prevention are obscure and negative, but the results of cure are evident and positive.

Direct evidence in the safeguarding of the Certified Milk supply in Chicago to the consumers is wanting, but this must not be interpreted as a reason for withdrawing regular medical examinations of employees on Certified Farms, but rather encourage us to even more rigidly enforce every rule that will help us to further safeguard Certified Milk.

The regular examinations of all employees on the farms producing Certified Milk has an immediate effect by keeping frequently and prominently before each employee the possibility of infection being conveyed by milk through infectious material.

Certified Milk should have health examinations and inspections because in paying the extra price for an extra product, the consumers are entitled to and have a right to demand, that protection which medical supervision of employees gives.

In the propaganda of Certified Milk emphasis of the safety of its production and knowing the public have been educated to