method of getting across the Bay tomorrow. You will find directions printed on the lower portion of the third page of the Program (Reading same). If you will follow these directions carefully we will meet you at the station on the other side with automobiles. In case any of you should be prevented from coming to the meeting tomorrow afternoon, I want to call your attention to the trip to Mt. Tamalpias, Muir Woods and the Sleepy Hollow Certified Dairy. The details of the trip Saturday are not entirely correct as printed on the Program. What hour do we leave, Dr. Fleischner? E. C. Fleischner, San Francisco: I think in all probability 8:45 A. M. President McCleave: So that the directions on the bottom of page three are correct with the exception that the hour should be 8:45 instead of 9:15 for you to take the Sausalito Ferry at the foot of Market Street, Saturday morning. Now we will listen to Dr. Fleischner, who is Secretary of the San Francisco Commission, on "The Attitude of the Medical Profession toward Certified Milk." Dr. Fleischner then read his paper, as follows: The Attitude of the Medical Profession Towards Certified Milk E. C. Fleischner, M. D., San Francisco In view of the infrequent but sufficiently numerous complaints that have occasionally emanated from Medical men relative to Certified Milk and which have been enormously exaggerated by the laity, it seemed advisable to address a series of questions to the medical profession to determine if possible the attitude of the practitioner of medicine towards Certified Milk. Furthermore, it seemed probable that certain results might be gained as to the value of Certified Milk in the community and that certain just criticisms might be brought to the attention of the Milk Commission by which the supply could be improved. Before summarizing the results obtained, an apology is offered because in order to reach any satisfactory results it has become necessary to offer as a basis for conclusions statistical data. Statistics of any sort are usually far from interesting, but if any satisfactory conclusions can be drawn from the questionnaire that has been prepared, then perhaps the results will compensate for the time which has been consumed. As a means of giving data the following questions were sent to all members of the Medical Associations in Alameda, Los Angeles, San Francisco, Merced, Humboldt and Riverside Counties; a total of about 1,500. 1. Are you familiar with the requirements of Certified Milk? 2. Have you ever visited a Certified Dairy? 3. Do you supervise the milk supply of your patients? A. In good health? B. During illness? 4. Do you recommend Certified Milk to your patients when they are not ill? A. During infancy from birth to 2 years? B. During childhood from 2 to 6 years? C. To older children? D. To adults? 5. Do you order Certified Milk for your patients during illness? 6. Do you favor continuing the production of Certified Milk? 7. Are you familiar with the methods of commercial pasteurization? 8. Do your patients ever consult you as to their milk supply? 9. Have you had for the past 5 years any cases of Tuberculosis developing in infants being fed only on Commercial Milk? If so how many and what lesions? 10. Have you had for the past 5 years any cases of Tuberculosis developing in infants being fed only on Certified Milk? If so how many and what lesions? 11. Have you had any cases of Tuberculosis of older children or adults in your practice in the past 5 years in which you can trace the sources to the Milk supply? If so how many? 12. Were any of these cases using Certified Milk? 13. Has Certified Milk given you entire satisfaction? 14. Kindly state your complaints, if you have any as to 15. Have Have you had in your practice during the past 5 years any acute infections that you consider due to the Milk supply, such as Diphtheria, Scarlet Fever, Typhoid Fever, or Septic Sore Throat? 16. Were any of these cases receiving Certified Milk? 17. Are you using Certified or Commercial Milk in your own home? 18. What is the source of milk supply of any hospital with which you are connected and to which you send your patients? 19. Is the milk supply of the hospital carefully investigated by the management? It is interesting to note that replies were received from over 500 men, a proportion which is more than satisfactory, showing as it does the interest that the men have taken in the subject that was presented to them. Taking up the questions in detail the results are as follows: 1. Are you familiar with the requirements of Certified Milk? Yes 90%. Fairly so 5%. No 5%. 2. Have you ever visited a Certified Dairy. Yes 25%. No 75%. 3. Do you supervise the A. In good health? B. During illness? milk supply of your patients? 4. Do you recommend Certified Milk to your patients when they are not ill? A. During infancy from birth to 2 years. Yes 91%. No 9%. D. To adults? Yes 33%. If T. B. 17%. No 66%. 5. Do you order Certified Milk for your patients during illness? Yes 55%. Sometimes 23%. No 22 %. 6. Do you favor continuing the production of Certified Milk? Yes 99.5%. No .5%. 7. Are you familiar with the methods of Commercial pasteurization? Yes 63%. Somewhat 15%. No 22%. 8. Do your patients ever consult you as to their milk supply Yes 60%. Babies only 1%. Occasionally 28%. No 11%. 9. Have you had for the past 5 years any cases of Tuberculosis developing in infants being fed only on Certified Milk? No 95%. Yes 5%. Of which 5 were cases of Pulmonary Tuberculosis; 5 Intestinal Tuberculosis; 3 Tubercular Glands; 8 Tubercular Meningitis. 10. Have you had for the past 5 years any cases of Tuberculosis developing in infants being fed only on Commercial Milk? No 66%. Yes 27%. Uncertain 7%. Of these 12 were cases of Joint Tuberculosis; 4 Tuberculosis of the Mastoid; 27 Tuberculosis of the Lungs; 69 Tuber cular Meningitis; 1 Tubercular Peritonitis; and 2 Tuberculosis of the Spine. The exact diagnosis was not given in the remaining cases. 11. Have you had any cases of Tuberculosis of older children or adults in your practice in the past 5 years in which you can trace the sources to the milk supply? 12. Were any of these cases using Certified Milk? The answers to these questions were too infrequent and too inaccurate to warrant any conclusions being drawn. 13. Has Certified Milk given you entire satisfaction? Yes 73%. No 20%. Not always 37%. Generally 4%. 14. Kindly state your complaints, if you have any as to A. Production? Inadequate 2%. Uncertain 37%. Dirty B. Distribution? Poor service .2%. Unable to get it 6%. C. Price Too high for poor people 60%. D. Results of use? Pasteurized better 5%. Not always satisfactory 5.5%. 15. Have Have you had in your practice during the past 5 years any acute infections that you consider due to the milk supply, such as Diphtheria, Scarlet Fever, Typhoid or Septic Sore Throat? Suspected 14. Diphtheria 5. Typhoid 60. Intestinal disturbance 12. Total 91. 16. Were any of these cases receiving Certified Milk? Yes 7%. 17. Are you using Certified or Commercial Milk in your own home? Certified 45%. Both 20%. Commercial 35%. 18. What is the source of milk supply of any hospital with which you are connected and to which you send your patients? Do not know 20%. Certified Milk 40%. Commercial 65%. Both 15%. 19. Is the milk supply of the hospital carefully investigated by the management? Yes 40%. Do not know 44%. No 16%. What conclusions, if any can be drawn from these replies? In the first place, it is very evident that most medical men living |