owe a great deal to her, and other women like her, who have supported this work.

Then, too, we have had no opposition, no interference with our work, on the part of the public health authorities. We seem to have been fortunate in having their confidence, so that nobody bothers us from the public health standpoint. We understand that in other parts of the country the influence of the public health authorities of cities or states has been meddlesome rather than helpful in some instances. We have had nothing of that sort to contend with.

We had introduced in the legislature some years ago, and passed without opposition, a bill defining the term "Certified Milk," and stating that it should be unlawful for any one to sell milk as certified except under a label and with the permission of a duly organized Milk Commission appointed by a County Medical Society; so that the term "Certified Milk" in this State is protected by law, and by this law the use of this term is entirely under the control of our Commissions.

While in every legislature we have some milk bill introduced, this last legislature has passed a very advanced milk bill which we hope they will be able to enforce. None of these bills have ever bothered the Commission. They have put in their bills a recognition of the work of the Milk Commission and the validity of the term "Certified Milk." We have had very little trouble in persuading the authors of these bills not to attempt to interfere with our system, so that we feel we are in a very happy condition here, and our work is promising.

We thank you again for doing us the honor to come out and encourage us in our work, and we also feel that it will be interesting to you to have seen the West. Most of you think it is a very long way to come West, but you do not see any reason why we of the West should not go East every year. As a matter

of fact we do not see any reason why we should not go East every year-and we do go. Now some of you men who have come out to the West for the first time, have found that it is not such an awful journey, and I hope you will come frequently.

Dr. Adelaide Brown is the President of the San Francisco Commission, and I will ask her to tell you that she too is glad that you came (Applause). I might say that Dr. Brown is the mother of Certified Milk on this Coast.

Welcome in Behalf of the San Francisco Milk Commission By Adelaide Brown, M. D., President

I am very proud of being grandmother of the Certified Milk and Baby Hygiene Work in San Francisco. I bring you an invitation from Mr. Lively who is at the head of the Live Stock Division of the Panama-Pacific Exposition, where they are holding a milk show during this week. The expert work is done there by various experts, many of them from the State Agricultural Farm at Davis, and the University of California. Mr. Lively telephoned me yesterday that he would be exceedingly glad to have this convention adjourn to his quarters, and he would keep the show open until 6:30 if we would take a car and go out there.

We have in California one remarkable thing, that is, a hospital that furnishes to its trained nurses and patients Inspected Milk which scores, under the United States score-card, 99 per cent. It has been in the past practically impossible to get into the general supply for such institutions Certified or Inspected Milk. The hospital which is doing this is Lane Hospital connected with Stanford University. I am always proud to make that announcement.

Another interesting demonstration in San Francisco is that the dependent babies of the community, are fed with Certified Milk. We have a baby clinic connected with the Associated Charities, of which Mrs. Brownell is President at present. This Charity takes care of 125 babies each year, abandoned babies who are dropped into the foundling basket. The death rate of infants in such institutions is anywhere above 50 per cent.; the death rate under this clinic for infants is 2.8 per cent. Our city death rate for children under 1 year is a little below, 10 per cent. There has never been a death from tuberculosis in these children

in the last four years. I believe this is the strongest tribute to Certified Milk in infant feeding. We have the privilege of autopsy on the children who are sent to Lane Hospital, or to the Children's Hospital, if they are sick so that they need the services of the nurses. All physicians know how many times problems are left unsolved because we cannot hold an autopsy.

The first year we took these babies under our care there were a number of tubercular cases among children who had been promiscuously fed, so that we felt that the deaths in the first

year could be in no way accounted for or considered any proof of the value of Certified Milk.

The Governor has signed a milk bill, which is based largely on the New York Milk Commission's report. It is a bill which enforces pasteurization unless the tuberculin test has been applied annually. This milk bill is of interest to those of us who have advocated Certified Milk here for the last nine years. We have been exceedingly interested in the bill, which does not interfere with the past law with regard to Certified Milk, but grades undefined milk running above 70 per cent. on the Bureau of Animal Industry's score-card at a standard a little higher than Class A milk. There is another point: Milk upon which the largest number of people have to depend is Class B, which under the grading in this bill after pasteurization may contain 50,000 bacteria. This would be the class that the commercial milk will come into. Unfortunately there is no stipulation in the bill that Boards of Health shall score such dairies. Personally I believe the use of the score-card is of great educational value in the handling of the milk supply of a large city. I think when a man sees his percentage down where he feels it should not be, he will very often endeavor to raise it up. It is like children's rating-cards at school. You may say that you do not believe in the graded examination system of percentages for school children which, for instance, states one child has 92 per cent., and another child 92.5 per cent.; nevertheless, there is going to be an effect mentally upon the person who does not get 90 per cent., and there is a certain stimulus there that is valuable. I believe every one that runs a dairy can be interested in bringing up his score-card rating.

Dr. Campbell brought up a question of examining milk employees, which I think is a tremendously vital one. We have had entering our dairies men who should not be permitted to be there. This last year I received a postal from Mr. Timm at Dixon, saying "There is smallpox in the town of Dixon; what do you want me to do?" I said, "Wait a few minutes and I will ring you up"--because I never answer any such question without consulting the Secretary also. We decided that the best thing to do was to quarantine those dairies for two weeks, and vaccinate the employees, then any cases in Dixon were to be isolated at the County Hospital. We might have cut off the supply. However, we felt that two weeks would control the situation, and that was what was done.

One night, at three o'clock in the morning, I was waked up from Walnut Creek by Mr. Hunt, who asked "What shall I do, Dr. Brown, a child on our farm has the measles?"

When you have men owning dairies perfectly alive to their own problems, I think they are going to be more critical than a doctor coming in in a perfunctory way from the outside. I think one of the greatest dangers is perfunctory service. If you go into a dairy once a month and say that the dairy is all right and the employees are all right, you should be as sure that you are accurately stating the facts as you would be in any case where you were giving medical advice. I think we should be very careful to really check up the men's health and make it a tremendously accurate piece of medical diagnosis-even though it may be expensive. I think we should work hard with that end in view. I do not know that we can ever follow it out as thoroughly as the Chicago Medical Commission has blocked it out for us. I think that that was a remarkable report this morning.

We are very glad to have you here, and I hope you will attend the milk show at the Exposition (Applause).

President McCleave: Dr. Stanley Black of Pasadena, is the President of the California State Association of Medical Milk Commissions, of which I spoke; I will ask Dr. Black to tell you that he is glad you came.

Welcome in Behalf of the California State Association

of Medical Milk Commissions

By Stanley P. Black, M. D., President, Pasadena, Cal.

Mr. President, Ladies and Gentlemen:

Dr. McCleave asked me to say just a few words of welcome to you, and I most heartily extend the courtesy of not only San Francisco, but of all California, to the National Association of Medical Milk Commissions.

It seems to me that Dr. Coit builded better than he knew when he started Certified Milk. Milk seems to have been the only thing on which all people can agree with the medical profession. We find that as a result of Certified Milk that the commercial milk has been improved and is steadily being improved. There is more interest being taken in milk than in any other food product; but the interest has extended to other foods, so that we have our National Pure Food Bill directly as the result of our Certified Milk Commission.

In the State of California, which is reputed to have more cranks to the square foot than all the rest of the United States put together, we have never had any criticism nor any disposition evinced to interfere with the Medical Milk Commission. That seems most wonderful to us here! In every legislature we have from ten to fifty bills introduced on the question of milk; but never yet has anybody introduced a bill which interferes with the certification of milk. A bill was introduced at one time which had a "nigger in the wood-pile," but there was practically no consideration of that bill by our State legislature; so that the milk stands as a very unique factor in medicine as well as in the community generally.

I hope that you will all enjoy not only this part of the State, but all parts of the State while you are here, and that we will be able to be instructed by the deliberations had. I again welcome you very cordially to the State of California.

President McCleave: The next item on the program is, "A Review of the Milk Literature of the Past Year." It is a similar review to that which Dr. Ravenel has given us from year to year. I will call on Dr. Ravenel now.