But a Thousand a Year - libraryweb.orgdigitized/books/But_a_thousand_a_year.… · "But a Thousand a Year" ... 1 to 5 Years. 24 18 17 No 34 Municipal 19 Milk 29 Stations. 11 17 169

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G1AR1T1ES ^August 5. 19O5

"But a Thousand a Year"The Cost and the Results in Rochester of Feeding Clean

Milk as Food for the Hand-Fed Baby

GEORGE W. GOLER, M. D.Health Officer, Rochester, N. Y.

THE CHARITY ORGANIZATION SOCIETY1O5 East Twenty-second Street

NEW YORK

Central Library of Rochester and Monroe County · Historic Monographs Collection

" . . . the ill-kempt city, and the undisguised insolence of the municipality that babbled away the lives of men-Life was cheap, however. The soil spawned humanity as it bred frogs in the rains, and the gap of the sicknessof one season was filled to overflowing by the fecundity of the next."

RUDYARD KIPLING, IN Otis Yeere.

"But a Thousand a Year'THE COST AND THE RESULTS IN ROCHESTER OF FEEDING CLEAN MILK AS FOOD

FOR THE HAND-FED BABY

George W. Goler, M. D.Health Officer, Rochester, N. Y.

ALL OF THE DEATHS UNDER FIVE YEARS FROM ALL CAUSES IN THE CITY OFROCHESTER, N. Y.

18891890189118921893189418951896

18971898189919001901190219081904

JULY DEATHS.

Under 1 Year.

1338881

101998292

108

784

4347515037263215

801

1 to 5 Years.

1818152616181618

145 929

7118316125

1611

111 412

AUGUST

Under 1 Year.

839493

10485725659

646

4447445438433448

847

DEATHS.

1 to 5 Years.

241817 No34 Municipal19 Milk29 Stations.1117

169 815 1.744

131018 Municipal14 Milk8 Stations.

20166

105 452 864

r

Look over the figures on the Iine8 aboveand you will see recorded all of the deathsfrom all causes that occurred under fiveyears of age for the months of July andAugust for sixteen years, from 1889 to1904, in the city of Rochester, New York.The figures are divided into two periodsof eight years each; in the first periodthere were no municipal milk stations;in the second, municipal milk stationswere established during July and August.

According to the United States Census,and to the state enumeration, Rochesterhad in 1890, 133,896; in 1892, 144,834;and in 1900, 162,608 people. The figuresgiven in the table, however, have no rela-tion to population. They represent theactual number of deaths that took placefrom all causes, under five years of age

for the period considered. The deathsfrom all causes are included in this tablebecause it is assumed that milk as foodaffects the health of all young children.

When prior to 1896 an examination ofthe mortality tables was undertaken, wewere appalled at what appeared to be theunnecessarily large number of deaths inchildren under five years of age. It alsoseemed remarkable to find that the largernumber of these deaths occurred in themonths of July and August. Look-ing about for a cause, our attention wasdrawn, as in may other cities, to the con-dition of the milk supply, and, after ex-cluding other related factors, it appearedthat the milk supply was the really greatcause for this awful mortality. Accord-ingly a systematic examination of cows,

Rochester (N.Y.)Public LibraryLocal History


THE "CLEAN" MILK FARM.

At the left 18 the portable room in which the milk is bottled and packed in ice. To the right, in order, are the bottle-wa8hing tent, a tent where bottles andutensils are sterilizea, and the tent of the nurse.


INFANTS' MILK DEPOT, ROCHESTER.

Distributing Center at a Police Station.

stables and dairies was undertaken, andtherein we found ample cause for themortality which we believed could betraced directly to them and the productthey* put forth. We found in many ofthese establishments conditions whichneither print nor pictures could adequatelydescribe. The stables were dirty, fes-tooned with cobwebs and badly drained;the surroundings, sinks of mud and cowmanure; the utensils dirty, often contain-ing layers of sour milk with admixture ofcountless millions of bacteria; and themilk itself so imperfectly cared for andbadly cooled that it often soured beforereaching the consumer. Up to this period,children were fed upon such milk withhardly a protest upon the part of those re-sponsible for their food. Here, then, seemedto be the main cause of sickness anddeaths in infants. What could we doabout the matter? The milkmen con-tended that they were taking the samecare of the cows and milk that they had

always taken of them, and that they couldnot take any better care of the milk forthe price current at that time—five centsper quart. In the commercial sense, andas they saw it, the milkmen were right.Work with the milkmen alone at thattime seemed hopeless, so we determined,at least during the summer season, to gointo the milk business ourselves, and, asat that time it was customary to Pasteur-ize the white mixture of bacteria, dirt,and other foreign substances, known asmilk, we made the mistake in the begin-ning, of Pasteurizing our milk.

This is the way we began our work:

TheBeginning.

A pamphlet of eight pageswas published in English,German, Italian and Yid-

dish containing in the simplest form thechief points relating to the care and thefeeding of infants. It was entitled: Howto Take Care of Babies During HotWeather. Across its face in large red


But a. Thousand a Year

letters was printed: "GIVE THE BABYWATER/' In type large and distinct werethese two sentences:

"No other milk, no other food, not evena wet nurse can take the place of milkfrom the child's own mother."

"Don't feed bananas, candy, popcorn,sugar, or anything else but milk; unlesstold to do so by your physician."

The headings of the pamphlet were:TO KEEP A BABY WELL.

1. Give it pure air day and night.2. Give it no food but mother's milk,

milk from the bottle, or food directed bythe physician.

3. Whenever it cries or is fretful, donot offer it food, GIVE IT WATER.

4. Be sure that it gets enough sleep,two naps during the day at least.

5. Do not put too much clothing on it.6. Bathe it in a tub every day.7. Don't handle it; let it alone.

These headings were briefly discussedin the body of the pamphlet.

Then we started a milk station incharge of a trained nurse, with a womanassistant. In one of the most denselypopulous portions of the city a vacantstore was rented. Behind a roughcounter, a large sink was installed and thenecessary table, racks, etc., were erected.An oil stove furnished heat for the appa-ratus in use. Milk was procured fromwhat the milk inspectors thought to beone of the best farms in the vicinity. Atthe store the milk was diluted, sweetenedand put up in four different mixtures offour, five, seven and eight-ounce nursingbottles of the Siebert type; Pasteurizedat 180 degrees Fahrenheit for twentyminutes, cooled and sold at cost, varyingfrom two four-ounce bottles for one cent,to one cent each for eight-ounce bottles;A deposit of three cents was required oneach bottle and rubber cork. In the firstinstance the mother or nurse was required

PACKING THE MILK BOTTLES IN ICE BEFORE SENDING THEM TO THE CITY.


" But a Thousand a Year "

to come to the milk station and bringthe baby, where, in the absence of advicefrom the physician, the baby was weighed,and a milk mixture prescribed accordingto the weight of the child, and not accord-ing to its age. The nurse talked with themother about the air, water, food, sleep,recreation and clothing of her child,using the little pamphlet as her guide,and then giving the mother one of thepamphlets, called attention to the care ofthe child as there directed.

On August 1, a second station wasopened, and both stations were run to theirfull capacity until September 1. The effectof these stations, aided by the general im-provement in milk inspection and thehelpful comments of the press, the ad-vance in medical practice and the aid ofthe physicians, may be seen by the differ-ence in mortality shown in the tables atthe beginning of this article.

For two more years the milkA Clean Milk -r, • T ,%. v

Campaign. was Pasteurized, thoughconsiderable trouble was

had with sour milk, and in finding aman to furnish reasonably clean milk.After the first year four stations in allwere required for the needs of fourquarters of the city. Then, in 1899, weestablished our central station on a farm,and instead of Pasteurizing milk, withall its contained filth and bacteria, westrove to keep dirt and germs out of themilk, and began to sterilize all of theutensils, bottles, etc., and to put out milkthat was clean. Clean milk, or milkapproximately clean, having no more than20,000 bacteria, per c. c. needs no applica-tion of heat to render it fit food for babies.Heat applied to milk alters it, makes itscurd tougher and more difficult to digest,often gives rise to indigestion, diarrhoea,of constipation in the infant, and, further,the application of heat to milk in theoperation of Pasteurizing or sterilizingleads people to think they may cure a con-dition that is more easily prevented bycare in the handling of milk used for food.

We conduct our milk station work fromJuly 5 to September 1, that being thetime of year when babies most requireclean milk, and from these stations weput out about 40,000 bottles of milk eachseason. Beside the station on the farm,

which, because of its situation, does notsell milk, there are four stations in thefour quarters of the city which we believemost need clean milk. Each station is incharge of a trained nurse who is providedwith a table, chairs, scales for weighingthe baby, a supply of pamphlets, paperand twine for wrapping up milk bottles,and a large refrigerator kept well stockedwith ice. These stations may be locatedin a small vacant store, in the windowcorner of a bakery, hardware store, etc.,in one part of a school building, or inone corner of a police station. As thetime approaches each year for doing thework, the stations are arranged for bothon the farm and in the city. Our centralstation we have had on three differentfarms in six years. For the centralstation we select a farm where the cattle,barn and surroundings are in good con-dition, and where the farmer is willing totake more than usual care of his cows.We do not seek an extraordinary fine ap-pearing farm, but a farm where the ordi-nary conditions existing may be improvedupon so as to make them fit for our pur-pose. For several years the nurse boardedwith the farmer, but for the past twoyears she has provided her own meals,cooked them and lived in a tent adjoiningthe central station.

A suitable place selected, we agree withthe farmer to take his milk at a fixedprice, four and one-half to five cents aquart, and to. get all the ice from him atmarket price. We then erect a milklaboratory or central station. It consistsof a portable wooden house, built in sec-tions, sixteen by twenty-two, containingshelving, tables, milk utensils, bottles,boxes for shipping milk and the necessarycleaning utensils. At the rear of thishouse, a long platform is built the widthof the house and extending forty feet be-yond it. Next to the house, and just out-side of it, a sink is erected to which run-ning water is piped from a large cistern.The drainage from the sink is pipedaway in an open drain. Bothwater pipe and drain pipe are laidtemporarily on top of the ground. Anawning, or tent fly, covers that part ofthe platform reserved for washing bottlesso that a cool and sheltered place is pro-vided for this purpose. Next beyond this


AT ONE OF THE MILK STATIONS.

is a tent twelve by fourteen where thesterilizers are mounted on oil stoves wherethe nurse gets her meals. The sterilizersare of the Arnold type, oblong in shape,fitted with large removable trays in whichmore than a gross of bottles may besterilized at one time, and in which, whenthe trays are removed, the milk pails, cans,rubber corks, etc., may be sterilized. Be-yond the sterilizing tent, separated byfour feet of space, is the twelve by four-teen tent where the nurse lives, whennot engaged in her work, and where shesleeps guarded by the farmer's dogs.From the rear of the portable house tothe nurse's tent a series of long flies arestretched over the tent, so that in badweather one may walk on the platformwithout getting wet.

Work in the portable la-How the Work boratory is carried on as

Carried On. follows: In the late morn-ing of the day before the

milk is to be distributed to the city sta-tions the cans and utensils are washed,sterilized and afterward enclosed in cheesecloth bags for use the next morning. Thebottles are washed, rinsed, sterilized,placed in racks on the tables, their mouthsbeing stopped with cotton batting to pre-vent dust from entering them; then thewhole premises are thoroughly cleaned,and everything, so far as may be, put inreadiness for use the next morning.Shortly after four A. M., the nurse and

three assistants are ready for duty. Ofthe assistants, a woman to wash bottlesreceives $1.10 per day; a man to helpand to deliver the milk, $9 per week, agirl to help fill bottles, $3.50 per week.The nurse receives $21 per week andan allowance of $3.50 per week forboard. One assistant goes to the barn,observes the condition of the cows, andthere the sterile milk pails are taken fromthe cheese cloth bags, the cows' udderswiped off with a clean, moist piece ofcheese cloth, and the milking proceeds.The pails into which the cows are milkedare not the usual milk pails. They arecovered at the top, having but a four-inchopening from which a collar rises an inchin height. Over this collar and securedby a rim, a double thickness of cheesecloth is placed, and the cow is milked di-rectly through this cheese cloth diaphragminto the pail. So soon as the pails arefull they are taken to the laboratory, newdiaphragms of cheese cloth are fitted, andthe pails sent back for more milk. Nowthe various milk mixtures are made, fourin number, sugar is added and the milkis racked off into the nursing bottles.These are then corked with rubber corks,placed in wooden shipping trays, holdingfour dozen each, covered with broken iceand shipped to the different city stations.Milk so prepared contained an average, asshown by successive daily counts, of lessthan 10,000 bacteria per c. c , while theordinary milk sold contained more than


11 But a Thousand a Year "

fifty times as many bacteria per c. e.Milk from the city milk stations will keepsweet for days at room temperature, andthus requires no ice in the house. Nothaving been Subjected to heat, it is moreeasily digested by infants than Pasteurizedor sterilized cows' milk. It does notpoison the baby by adding a large numberof bacteria to a child's digestive apparatusas does ordinary milk. As it is given tothe mother properly diluted and sweetenedit requires no addition of other substances.And as it is already in a sterile nursingbottle, it is not necessary to do anythingto it other than to remove the rubber cork,fit a clean nipple onto the bottle, warm it,or for older children, pour it into a cleancup. For these reasons such a milk ap-proximates the ideal milk for the hand-fed baby.

When the milk depots were organizedan objection urged against them wasthat the milk would be used by a lot ofchildren that would better die anyhow.This harsh criticism is unworthy ofanswer. If, however, it were true thatthe milk would be used solely by the poorand people in moderate circumstances, theanswer is that the milk stations werereally designed for such people. But itis a fact that all classes of people patron-

ize the milk stations. To get milk fromthem, men ride miles on bicycles andpeople send in from neighboring lake re-sorts: all smilingly gratified for the milkthey receive from the stations. Best ofall, however, is the real gratitude ex-pressed by the poorer people when theyare shown by the nurses a few simplerules in the booklet, and are given themilk at a cost of a few cents a day. Asone mother anxious for living childrensaid: "May God bless you. I have lostthree children with summer complaint,and I think the milk and the book keptmy fourth baby/'

So far as figures can, those at the be-ginning of this article show what Roch-ester has been able to accomplish in re-ducing its mortality among infants underfive years of age, at an average expendi-ture of $1,000 a year for a season of twomonths.

Every season in the larger cities thou-sands of children die victims of poisonedmilk. Here in Rochester we have demon-strated what may be done through eightyears' work. What we have done, otherand larger cities may do at an approxi-mate cost of $1,000 per season for each200,000 of population, and with quite asgood results.


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But a Thousand a Year - libraryweb.orgdigitized/books/But_a_thousand_a_year.… · "But a Thousand a Year" ... 1 to 5 Years. 24 18 17 No 34 Municipal 19 Milk 29 Stations. 11 17 169