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 UNITED STATES PUBLIC HEALTH SERVICE 
 
 RUPERT BLUB, Surgeon Gbneeal 
 
 COMMISSION ON MILK STANDARDS 
 
 'I 
 
 THIRD REPORT OF THE 
 
 COMMISSION ON MILK STANDARDS APPOINTED BY 
 
 THE NEW YORK MILK COMMITTEE 
 
 REPRINT No. 386 
 
 FROM THE 
 
 PUBLIC HEALTH REPORTS 
 
 February 16, 1917 
 (Pages 271-296) 
 
 /7-/6 V7^ 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 
 1917 
 
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 ADDITIONAL COPIES 
 
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 THE SUPERINTENDENT OF DOCUMENTS 
 
 GOVERNMENT PRINTING OFFICE 
 
 WASHINGTON, D. C. 
 
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 5 CENTS PER COPY 
 
 D. of D. 
 JUN 12 1917 
 
I; 
 
 COMMISSION ON MILK STANDARDS. 
 
 THIRD REPORT OF THE COMMISSION ON MILK STANDARDS APPOINTED BY THE 
 NEW YORK MILK COMMITTEE." 
 
 PREAMBLE. 
 Purposes of Milk Standards. 
 
 Proper milk standards are essential to efficient milk control by- 
 public health authorities. In the first place health authorities must 
 ascertain that the chemical composition corresponds with established 
 definitions of milk as food, but their more important duty is to 
 prevent the transmission of disease. This means the prevention of 
 the transmission by milk of infant diarrhea, typhoid fever, tuber- 
 culosis, septic throat infections, scarlet fever, diphtheria, and other 
 infectious diseases. In the interests of milk consumers public health 
 authorities must take positive action to prevent the transmission 
 of any of these diseases, in addition to their duty of preserving the 
 food value of milk. 
 
 The milk producer is interested in proper standards for milk, 
 and should support a movement to secure proper standards, for the 
 reason that these contribute to the well-being and dignity of the milk 
 industry itself. Proper standards, rightly enforced, distinguish 
 between the good-milk producer and the bad-milk producer. This 
 inevitably wiU lead to the improvement of dairy farming, and 
 eventually to an increase in the financial prosperity of the milk 
 producer himself through better prices for better milk. It will 
 enable the producer to get properly paid for the quality of milk he 
 produces, and thus put that industry for the first time upon a depend- 
 able basis. 
 
 The milk dealer finds the classification of milk resulting from milk 
 standards to his financial advantage for the reason that it identifies 
 clearly first-class milk and distinguishes it from second-class milk. 
 Such a distinction gives to the seller of first-class milk the commercial 
 rewards which such milk deserves, and the official label creates a 
 market for first-class milk which the dealer alone is unable to create. 
 
 For milk consumers the setting of definite standards accompanied 
 by labeling with official control of the labels makes it possible to 
 
 1 Previous reports were published in the Public Health Reports, May 10, 1912, pp. 673-700, reprint 
 No. 78; and Aug. 22, 1913, pp. 1733-1756, reprpt No. 141. Reprint from the Public Health Reports, vol. 
 32, No. 7, Feb. 16, 1917, pp. 271-296. 
 
 83598°— 17 3 
 
4 COMMISSION ON MILK STANDAEDS. 
 
 know the character of the milk which is purchased, and to distinguish 
 good milk from bad milk. The establishment of standards for qual- 
 ity, and of labels on retail packages indicating the quaUty, compels 
 the industry not only to purchase milk on a quality basis, but also to 
 sell milk on a quaHty basis. The selling of milk strictly on a quality 
 basis, which includes not only chemical composition but sanitary 
 character, makes it possible for consumers by an inspection of the 
 label intelligently to select milk which in quality and price is most 
 suitable for their needs. 
 
 Administrative Equipment. 
 
 Standards are useless imless properly guarded and enforced. The 
 chief objection that has been raised to a grading system for milk is 
 the difficulty of insuring that milk labeled as of a certain grade is 
 actually of that grade when sold to the consumer. 
 
 The prime requisite for eflScient milk control is that health depart- 
 ments shall be adequately equipped with men, money, and laboratory 
 facilities. The commission is of the opinion that satisfactory results 
 can not be expected from laws when there is not sufficient appropria- 
 tion, and when there is no machinery for their enforcement. A sur- 
 vey of the money appropriated for milk control shows that in the 
 majority of municipalities this is entirely insufficient for public 
 needs. 
 
 The key to the solution of the problem of the proper use of grade 
 labels is the. laboratory. The establishment and operation of an 
 efficient milk testing laboratory is commonly supposed to be an item 
 of great expense. This, however, the commission is convinced, is a 
 mistake, since there are numerous laboratories scattered all over the 
 land not only private, but public, which are inexpensive and operated 
 at low cost. By efficiency methods a large number of tests can be 
 made at a very low cost. Even small communities can afford to 
 maintain and operate such laboratories. Where for any reason it is 
 not possible to do this, it has proven to be practicable for one com- 
 munity to enter into laboratory arrangements with another, and even 
 several can combine in the use of a common laboratory. 
 
 Grading of Milk. 
 
 There is no escape from the conclusion that milk on the market 
 must be graded just as other commodities such as wheat, grain, beef, 
 etc., are graded. The milk merchant must judge not only of the food 
 value but also of the sanitary characteristics of the commodity in 
 which he deals. There is no good reason for believing that fruit 
 beginning to decay is particularly unhealthful, but it should not be sold 
 on a par with sound fruit. Small apples have as much food value as 
 
COMMISSION ON MILK STANDARDS. 5 
 
 an equal quantity of large ones, but the latter properly command a 
 higher price. So, too, with milk; the high-grade product, fresh and 
 cold, will cost more to buy from the producer, and should sell for 
 more to the consumer than does the low-grade product. The com- 
 mission's most important work has been the attempt to separate milk 
 into grades and classes. Tlie commission has endeavored to make 
 its grading system as simple as possible, and at the same time to dis- 
 tinguish between milks which are essentially different in their sani- 
 tary and other character. The commission is convinced that the 
 experience of the last three years has fully demonstrated the value of 
 the grading system in the communities in which it has already been 
 applied, both from a public health and an economic standpoint. The 
 commission believes that the grading of milk offers a satisfactory 
 solution for most of the sanitary and economic problems which have 
 hitherto prevented efficient milk control, and that it is feasible for 
 small communities as well as large communities to adopt a grading 
 system and to secure its benefits. 
 
 CHIEF SUBJECTS CONSIDERED. 
 
 The commission during its deliberations over a period of five years 
 and on the occasions of its eight meetings and the numerous meetings 
 of its subcommittees has given attention to a great variety of subjects. 
 
 The more important conclusions it has reached are the following: 
 
 (1) Chemical Standards for Milk. 
 
 The lack of uniformity in chemical standards used by different 
 mmiicipalities and States throughout the United States and Canada 
 has led the commission to believe that it is desirable for them to 
 give expression to their opinion concerning proper chemical standards 
 for milk. The commission recognizes that chemical standards do 
 not involve pubhc health questions excepting in so far as they safe- 
 guard the food value of milk. Nevertheless, as milk is a food, 
 chemical standards are necessary for defining its nutritive value. 
 
 The chemical standards suggested are the work of a special com- 
 mittee, composed of chemists, which has carefully considered the 
 natural composition of milk, as well as the Federal and State stand- 
 ards already established. The standard of 3.25 per cent fat and 
 8.5 per cent solids-not-fat, here proposed, is in accordance with the 
 recommendations of the Association of Official Agricultural Chemists, 
 and has been adopted by the United States Department of Agri- 
 culture and by a larger number of States than has any other standard. 
 (The word "standard" used in connection with milk is not intended 
 to imply excellence, but simply to express the lowest possible standard 
 
6 COMMISSION ON MILK STANDAEI>S. 
 
 or limit that the law permits for a pure or normal milk. The same 
 meaning applies to the word used in connection with milk products.) 
 
 The Babcock test makes easily practicable the determination of 
 fat and solids-not-fat in milk. Such examinations of milk can be 
 readily adopted and executed by any health board laboratory at a 
 very moderate expense. It is believed that such chemical standards 
 as are suggested will help to raise the standards of dairying in this 
 country, and that the provision regarding substandard inilk is a 
 liberal one. 
 
 Cow^s milk. — Standard milk should contain not less than 8.5 per 
 cent of soUds-not-fat and not less than 3.25 per cent of milk fat. 
 
 Shim milk. — Standard skim milk should contain not less than 
 8.75 per cent of milk solids. 
 
 CVea?}i-.— ^Standard cream should contain not less than 18 per cent 
 of milk fat, and should be free from all constituents foreign to normal 
 milk. The percentage of milk fat in cream over or under that 
 standard should be stated on the label. 
 
 Adjusted milks. — On the question of milks and creams in which the 
 ratio of the fat to the solids-not-fat has been changed by the addi- 
 tion to or subtraction of cream or milk fat the commission has hesi- 
 tated to take a position. On the one hand they are in favor of every 
 procedure which will increase the market for good milk and make 
 the most profitable use of every portion of it. On the other, they 
 recognize the sensitiveness of milk, the ease with which it is con- 
 taminated, and the difficulty of controlling such processes as stand- 
 ardizing, skimming, homogenizing, souring, adjusting, etc., so as to 
 prevent contamination and the use of inferior materials. On this 
 subject the commission passed a resolution presented by a special 
 committee, as follows: 
 
 The committee believes that it is probably necessary to admit standardized and 
 adjusted milk. They believe that such manipulation should be controlled and that 
 such milk should be distinctly labeled as to its modifications. 
 
 Milk in which the ratio of the fat to the solids-not-fat has been changed by the 
 addition to or subtraction of cream should be labeled "adjusted milk;"' the label 
 should show the minimum guaranteed percentage of fat and should comply with the 
 same sanitary or chemical requirements as for milk not so standardized or modified. 
 
 The committee very carefully considered the subject of the agita- 
 tion which has taken place regarding percentage of solids-not-fat 
 due to the fact that in some large cities much of the milk contains 
 less than 8.5 per cent solids-not-fat. While the commission is dis- 
 posed to admit that these conditions may exist, yet it believes that 
 these conditions can be remedied, if not immediately at least grad- 
 ually. On the other hand, experience has shown that to lower the 
 standard would in a few years result in the lowering of the general 
 quality of the milk placed on the market, since commerce always 
 tends to approach the minimum standard. The commission there- 
 
COMMISSION ON MILK STANDARDS. 7 
 
 fore thinks it is unwise to reduce the standard for soli ds-not -fat 
 below the percentage of 8.5. In those communities where such a 
 standard can not be rigidly enforced at the present time the commis- 
 sion suggests that the standard be gradually applied. 
 
 Regulation of market milk on basis of guaranteed percentage compo- 
 sition. — (a) Sellers of milk should be permitted choice of one of two 
 systems in handling market milk. They may sell milk, first, under 
 the regular standard; or, second, under a guaranteed statement of 
 composition. 
 
 (b) Any normal milk may be sold if its percentage of fat is stated. 
 In case the percentage of fat is not stated the sale should be regarded 
 as illegal unless the milk contains at least 3.25 per cent of milk fat. 
 
 (c) As a further protection to consumers it is desirable that when 
 the guaranty system is used there be also a minimum guaranty of 
 milk solids, not fat, of not less than 8.5 per cent. 
 
 (fZ) Dealers electing to sell milk imder the guaranty system should 
 be required to state conspicuously the guaranty on all containers in 
 which such milk is handled by the dealer or delivered to the consumer. 
 
 {e) The sale of milk on a guaranty system should be by special 
 permission obtained from some proper local authority. 
 
 (2) Bacteria and Bacterial Testing. 
 
 Bacteria and bacterial testing have undoubtedly occupied more of 
 the commission's time than any other subject, this topic being consid- 
 ered at each of its meetings, Every phase of the relationship of bac- 
 teria to the sanitary character of milk, as weU as to the infectious dis- 
 eases transmissible by milk, has been discussed by the seven bacteri- 
 ologists who are members of the commission. The significance of 
 bacteria in milk and methods of bacterial testing have been consid- 
 ered in detail, not only from the personal standpoint of the bacteriolo- 
 gist, but from the administrative standpoint of the eight health offi- 
 cers who are menabers of the commission, as weU as the two agricul- 
 tural experts. Because of frequent conferences with members of the 
 dairy industry, as well as a knowledge of the action taken by munici- 
 paUties on this subject, it is belicA^ed that aU phases of the r-elation- 
 ship of bacteria to milk have been impartially considered and that the 
 conclusions reached fairly represent the place which bacterial testing 
 should occupy. 
 
 Tlie commission recognizes that the number of bacteria in milk is 
 controlled in the majority of instances by three factors: Dirt, tem- 
 perature, or age. Only in the minority of instances are the bacteria 
 of specific diseases present. The routine laboratory methods for 
 examining milk have therefore as their chief purpose the control over 
 dirt, temperature, and age. Tlie difficulties of detecting the specific 
 bacteria of disease by laboratory methods prevent laboratories from 
 
8 COMMISSION ON MILK STANDABDS. 
 
 undertaking such detection as a routine. For this reason laboratory 
 methods are as yet of little value in safeguarding milk against specific 
 diseases. The only practical way for protecting milk from infection 
 by the bacteria of infectious diseases is by medical, veterinary, and 
 sanitary inspection, and by pasteurization. Nevertheless the com- 
 mission believes that large numbers of bacteria that are not specific 
 disease germs have a health significance. 
 
 The routine laboratory methods for determining the total numbers 
 of bacteria in milk are beUeved to furnish a general indication of the 
 safety of milk. Small numbers indicate fresh milk produced under 
 cleanly conditions, and kept cool, and such milk is safer than milk 
 containing large numbers of bacteria which is either dirty, warm, or 
 stale. In addition to this, the relation which large numbers of bac- 
 teria bear to the sanitary character of milk is shown b}'' certain facts, 
 among which the following are worthy of mention : 
 
 Relation of large numbers of bacteria to infant mortality. — The com- 
 mission believes that the numbers of bacteria in milk have a relation 
 to the infant mortality, for the following reasons: 
 
 (a) Evidence furnished by clinical observations of groups of 
 children fed on milk containing small numbers of bacteria and 
 large numbers of bacteria shows a higher death rate in the latter 
 than in the former. 
 
 (b) In general, a reduction in infant mortality in cities results 
 from a substitution of milk containing small numbers of bacteria 
 for milk containing large numbers of bacteria. 
 
 (c) Bacteria causing no specific intestinal infections in adults may 
 cause infant diarrhea, and milk containing large numbers of bacteria 
 more often contains species capable of setting up intestinal inflam- 
 mation in infants than milk containing small numbers of bacteria. 
 
 Bacterial counts and decency. — On this subject the commission 
 passed the following resolutions: 
 
 (a) Because high bacterial counts .indicate milk is either warm, 
 dirty, or stale, the bacterial count is an indicator of decency in milk 
 character, entirely apart from its significance as an indicator of the 
 safety of milk. 
 
 (6) In determining the sanitary character of milk and the grade in 
 which it belongs, decency must be considered as desirable for its 
 own sake, entirely apart from the consideration of safety. Decency 
 is important as a characteristic of foods and drinks, because it gives 
 pleasure to the consumption of food, while the lack of decency 
 means distaste, displeasure, and even disgust. 
 
 (c) The bacterial count is a sufficiently accurate measure of decency 
 to justify the health officer in condemning milk with a high bacterial 
 count because it is lacking in this characteristic. 
 
COMMISSION ON MILK STANDARDS. ' 9 
 
 Bacteriological laboratory testing of milk. — On the subject of labora- 
 tory examinations of milk for bacteria the commission beheves that 
 the interests of pubhc health demand that the control of milk sup- 
 plies, both as to production and distribution, should include regular 
 laboratory examinations of milk by bacteriological methods. They 
 stated by resolution that — 
 
 Among present available routine laboratory methods for determining the sanitary 
 quality of milk the bacterial count occupies first place, and that bacterial standards 
 should be a factor in classifying milk of different degrees. of excellence. 
 
 The adoption and enforcement of bacterial standards will be more effective than 
 any other one thing in improving the sanitaiy character of public milk supplies. 
 The enforcement of these standards can be carried out only by the regular and frequent 
 laboratory examinations of milk for the nimibers of bacteria it may contain. 
 
 It is of the utmost importance that standard methods should be adopted by all 
 laboratories for comparing the bacterial character of milks, since by this means only 
 is it possible to grade and classify milks and properly enforce bacterial standards. 
 
 Concerning the methods which should be used by milk laboratories 
 for determining the numbers of bacteria the commission unani- 
 mously resolved: 
 
 That there be adopted as standards for making the bacterial count the standard 
 methods of the American Public Health Association Laboratory Section. 
 
 One of the chief objections raised against pasteurization is the 
 claim that it is frequently employed to cover filthy methods, the 
 milk producer using less care in his methods if he knows that the 
 milk is to be subsequently pasteurized. To meet this objection the 
 commission believes there should be bacterial standards for raw milk 
 as well as bacterial standards for pasteurized milk. In the case of 
 pasteurized milk, standards should be required of the milk before 
 pasteurization as well as after pasteurization. 
 
 Reliability of bacterial tests. — The commission has considered the 
 numerous criticisms that have been raised as to the unreliability of 
 bacteriological analyses, and has made extensive inquiry as to the 
 force of these criticisms. An opinion concerning the reliability of 
 laboratory tests for numbers of bacteria has been reached based on 
 voluminous statistics secured for the most part by groups of observers 
 working together, as well 'as by individuals. One of these researches 
 alone carried out by members of the conmaission in cooperation with 
 others included the testing of over 20,000 samples of milk. In other 
 instances repeatedly the same sample of milk was tested 100 times. 
 Some variations in the analysis of duplicate samples are inevitable, 
 due to the fact that the bacteria are not in solution, but are floating 
 in the milk more or less clustered together in clumps, each of which 
 will count only as a single colony. Under such conditions only an 
 approximate agreement can be expected. 
 83598°— 17 2 
 
10 COMMISSION ON MILK STANDARDS. 
 
 The results of extensive study justify the commission in the con- 
 clusion that the analysis of duplicate samples of milk made by routine 
 methods in different laboratories may be expected to show an average 
 variation of about 28 per cent, with occasional samples of wider varia- 
 tion. In some good laboratories the variation may not be greater 
 than 10 per cent. Variations in results diminish with the numbers 
 of samples analyzed. If five samples of the same milk are tested, 
 the results may be relied upon as fairly accurate, and always suffi- 
 ciently accurate to place any particular milk supply unhesitatingly 
 in grade A, B, or C. The object of bacterial tests of milk samples for 
 the numbers of bacteria should be primarily to determine the sani- 
 tary character of the milk supply from which the sample is taken, 
 rather than the character of a single sample of milk. It is strongly 
 urged by this commission that no grading of milk should be made 
 upon the analysis of single samples, and that no prosecutions or court 
 cases should be brought upon the bacterial analysis of a single sample 
 of milk. 
 
 Interpretation of bacterial tests. — The commission has put its opinions 
 on this subject in the form of resolutions, as follows: 
 
 Whereas milk is one of the most perishable foods, being extremely susceptible to 
 contamination and decomposition; and 
 
 Whereas the milk consumer is justified in demanding that milk should be clean, 
 fresh, and cold, in addition to having the element of safety; and 
 
 Whereas milk which is from healthy cows and is clean, fresh, and which has been 
 kept cold, will always have a low bacterial count; and 
 
 Whereas milk that is dirty, stale, or has been left warm, will have a high bacterial 
 count; therefore it is resolved: 
 
 First. That the health officer is justified in using the bacterial count as an indicator 
 of the degree of care exercised by the producer and dealer in securing milk from 
 healthy cows and in keeping the same clean, fresh, and cold; and 
 
 Second. That the health officer is justified in condemning milk with a high bacterial 
 count as being either unhealthy or decomposed, or containing dirt, filth, or the decom- 
 posed material as a result of the multiplication of bacteria due to age and temperature. 
 
 Third. That the health officer is justified in ruling that large numbers of bacteria 
 are a source of possible danger, and that milk containing large numbers of bacteria is 
 to be classed as unwholesome, unless it can be shown that the bacteria present are 
 of a harmless type, as for example, the lactic acid bacteria in buttermilk or other 
 especially soured milks. 
 
 Grading hy the bacterial count. — Concerning the number of tests 
 which should' be made in order to determine the grade of a milk 
 supply, the commission recommends that the grade into which a 
 milk falls shall be determined bacteriologically by at least five con- 
 secutive bacterial counts, taken over a period of not less than one 
 week, nor more than one month, and that at least four out of five of 
 these counts (80 per cent) must fall below the limit or standard set 
 for the grade for which classification is desired. 
 
 The grading of milk has necessarily been based on its sanitary 
 character, primarily as determined by the bacterial test. The en- 
 
COMMISSION ON MILK STANDARDS. 11 
 
 forcement of grading, therefore, requires the apphcation of the bac- 
 terial test in a manner sufficiently comprehensive to fairly determine 
 the sanitary character of milk so that it may be assigned to the grade 
 in which it belongs. Such an administrative system greatly modifies 
 the former conception of milk inspection by public health officials. 
 The inspection service under the grading system becomes subordinate 
 to the bacterial laboratory, or at least must look to the bacterial 
 laboratory as a guide. If bacterial tests are recognized as an indica- 
 tion of the sanitary character of milk, then the bacterial laboratory 
 tests should precede the dairy inspection since they will pomt out 
 to. the dairy inspector the location of misanitary milk. In the 
 enforcement of the grading system, therefore, the milk inspection 
 service should be reorganized in such a manner that the bacterial 
 laboratory makes its tests first, in order to determine the sanitary 
 character of the various milks offered for sale on the city market, 
 and the inspection service then takes up the task of discovering the 
 location and causes of the defects which the laboratory has discovered 
 and of remedying them. The laboratory service and inspection 
 service consequently must be centralized under one head and their 
 work thoroughly coordinated in order to give the greatest economy 
 and efficiency. 
 
 Bacterial standards for cities of different sizes. — In establishing the 
 bacterial standards for a city it is important to take into considera- 
 tion the necessary age of the milk, the distance it is hauled, and the 
 methods employed in its hauling, in addition to the sanitary condi- 
 dition of the mdk at its source. It will always be possible for a com- 
 munity having very few dairies, easily controlled, which consumes 
 milk produced within its own limits, or within transportation of 12 
 hours or less from the sources of supply, to insist upon and maintain 
 a better bacterial standard than can a city where the milk is hauled 
 many miles into town to be consumed within 24 hours after it is pro- 
 duced from numerous dairies difficult to control. The smaU city 
 for these reasons can and should always maintain a better bacterial 
 standard than the large city. 
 
 Microscopic examination. — Under certain conditions the examina- 
 tion of milk for bacteria by the microscopic method serves a useful 
 purpose. In its favor it has the advantage of quick and immediate 
 results, which in the hands of reliable workers have proven to agree 
 remarkably well with the results obtained by the plate method. 
 At times it gives useful information as to the types of bacteria present. 
 On the other hand, the microscopic method fails to distinguish be- 
 tween dead and living bacteria, and therefore its value in the exami- 
 nation of pasteurized milk is uncertain. Its chief value has been 
 in securing quick information regarding the character of raw milk, 
 and for this reason it is most useful at the producing and shipping 
 end of the line rather than at the city end. 
 
12 COMMISSION ON MILK STANDARDS. 
 
 (3) Pasteurization. 
 
 The pasteurization of milk has been discussed at every meeting 
 held by the commission. Its effect on bacteria, its effect on milk, 
 its effect on public health, the questions of time and temperature 
 and efficient control have aU been repeatedly and carefully consid- 
 ered in detail. It is believed that the commission has not neglected 
 to take into account any of the important contributions which have 
 been made to modern knowledge on this subject. In connection 
 with pasteurization the commission has also carefully considered the 
 subject of the degrees of safety furnished to milk by the tuberculin 
 testing of cattle and medical inspection of dairy employees. 
 
 After a thorough consideration of the various times and tempera- 
 tures used, and different forms of apparatus recommended by various 
 authorities, the commission decided upon the following definition of 
 pasteurization: , 
 
 That pasteurization of milk should be between the limits of 140° F. and 155° F. 
 At 140° F. the minimum exposure should be 20 minutes. For every degree above 
 140° F. the time may be reduced by 1 minute. In no case should the exposure be 
 for less than 5 minutes. 
 
 In order to allow a margin of safety under commercial conditions, 
 the commission recommends that the minimum temperature during 
 the period of holding should be made 145° F., and the holding time 
 30 minutes. 
 
 Regarding the methods of pasteurization, the commission beUeves 
 that pasteurization in bulk when properly carried out has proven 
 satisfactory, but that pasteurization in the final container is pref- 
 erable. 
 
 The commission thinks that pasteurization is necessary for all 
 milk, excepting grade A raw milk. The majority of the commis- 
 sioners voted in favor of the pasteurization of all milk, including 
 grade A raw , but since the action was not unanimous the commission 
 recommended that the pasteurization of grade A raw milk be optional. 
 
 The process of pasteurization should be under efficient supervision. 
 The supervision should consist of a personal inspection by the milk 
 inspector. The intervals between inspections should be not more 
 than one month. The inspector should score the pasteurizing plant 
 bj- a score card. 
 
 Specimens of milk for bacterial analysis should be taken at the 
 different stages in pasteurization and subsequent handling. 
 
 All plants handling 1,000 quarts of milk or more a day should be 
 required to be equipped with automatic temperature regulators, flow 
 regulators, and recording thermometers. The records of these must 
 be examined by the Department of Health not less often than once 
 a month. 
 
COMMISSION ON MILK STANDARDS. 13 
 
 Where pasteurization is done with small apparatus not so equipped, 
 the proprietor should be required to examine the temperature of the 
 milk in the heater at the first and last of each run, and keep a record 
 of such temperatures, which record shall be submitted to the depart- 
 ment of health not less often than once a month. 
 
 For the use of small dealeis in cities, and small producers for towns 
 and villages, efficient pasteurizers costing less than $200 are avail- 
 able. The commission, therefore, thinks that milk ordinances for 
 towns and villages, as well as for large cities, and also State milk 
 laws, should provide compulsory pasteurization, except for grade A 
 raw milk. 
 
 The efficiency of pasteurization should be controlled by bacterial 
 tests before and after heating. 
 
 Scurvy and 'pasteurization. — The commission has assumed that the 
 low temperature of 145° F. for 30 minutes as recommended by this 
 commission for pasteurization destroys none of the food constituents 
 of milk. Inquiry conducted by the New York City Department of 
 Health into the records of the infant-milk depots, where sometimes 
 over 25,000 infants are fed daily on pasteurized milk, appears to bear 
 out this assumption. In view of the fact, however, that recent hos- 
 pital experimental studies suggest that an exclusive diet of pasteur- 
 ized milk may give rise to a subacute scurvy or similar nutritional 
 disease in infants, which was entirely prevented, and even cured, by 
 the feeding of orange juice or other antiscorbutic food, the commission 
 recommends that orange juice be added to the diet of infants that are 
 fed on pasteurized milk. The commission wishes also to reaffirm its 
 advocacy of the adoption of pasteurization by mmiicipalities as a 
 public-health measure. 
 
 The tuberculin testing of dairy cows. — The commission has noted 
 recent developments in connection with the manner of administering 
 tuberculin as a diagnostic agent and goes on record as approvmg the 
 use of tuberculm by the usual subcutaneous method, always, how- 
 ever, in connection with physical diagnosis, and with due regard to 
 the methods prescribed by the United States Bureau of Animal 
 Industry. Other methods of using tuberculin should be regarded 
 still as under judgment. 
 
 The commission believes that health officers should encourage the 
 use of tuberculin as an ideal diagnostic agent when in proper hands, 
 and extend its use as rapidly as possible, realizmg its practical limita- 
 tions owing to the enormous number of cattle and their migrations 
 and the hmited number of veterinarians qualified to use this test. 
 
 It should be remembered also that tuberculin testing is a means of 
 meetmg only one of the many problems of milk control. 
 
14 COMMISSION ON MILK STANDARDS. 
 
 (4) Grades of Milk. 
 
 The commission believes that all milk should be classified by divid- 
 ing it into three grades, which shall be designated by the letters of the 
 alphabet. It is the sense of the commission that the essential part is 
 the lettering and that all other words on the label are explanatory. 
 In addition to the letters of the alphabet used on caps or labels, the 
 use of other terms may be permitted so long as such terms are not the 
 cause of deception. Caps and labels shall state whether milk is raw 
 or pasteurized. The letter designating the grade to which the milk 
 belongs sh all be conspicuously displayed on the caps of bottles or tl le 
 labels of cans. 
 
 The requirements for the three grades shall be as follows: 
 
 GRADE A. 
 
 Rair milk. — Milk of this class shall come from cows free from disease as determined 
 by tuberculin tests and physical examinations by a qualified veterinarian, and shall 
 be produced and handled by employees free from disease as determined by medical 
 inspection of a qualified physician, under sanitary conditions, such that the bacterial 
 count shall not exceed 10,000 per cubic centimeter at the time of delivery to the 
 consumer. It is recommended that dairies from which this supply is obtained shall 
 score at least 80 on the United States Bureau of Animal Industry score card. 
 
 Pasteurized milk. — Milk of this class shall come from cows free from disease as deter- 
 mined by physical examinations by a qualified veterinarian, and shall be produced 
 and handled under sanitary conditions, such that the bacteria count at no time exceeds 
 200,000 per cubic centimeter. All milk of this class shall be pasteurized under official 
 supervision, and the bacteria count shall not exceed 1,0,000 per cubic centimeter at 
 the time of delivery to the consumer. It is recommended that dairies from which 
 this supply is obtained shall score at least 65 on the United States Bureau of Animal 
 industry score card. 
 
 GRADE B. 
 
 Milk of this class shall come from cows free from disease as determined by physical 
 examinations, of which one each year shall be by a qualified veterinarian, and shall 
 be produced and handled under sanitary conditions, such that the bacteria count at 
 no time exceeds 1,000,000 per cubic centimeter. All milk of this class shall be pas- 
 teurized under official supervision, and the bacterial count shall not exceed 50,000 
 per cubic centimeter when delivered to the consumer. 
 
 It is recommended that dairies producing grade B milk should be scored, and 
 that the health departments or the controlling departments, whatever they may be, 
 strive to bring these sources up as rapidly as possible. 
 
 Milk of this class shall come from cows free from disease, as determined by physical 
 examinations, and shall include all milk that is produced under conditions such that 
 the bacteria count is in excess of 1,000,000 per cubic centimeter. 
 
 All milk of this class shall be pasteurized, or heated to a higher temperature, and 
 shall contain less than 50,000 bacteria per cubic centimeter when delivered to the 
 consumer. 
 
 Whenever any large city or community finds it necessary, on account of the length 
 of haul or other peculiar conditions, to allow the sale of grade C milk, its sale shall 
 be surrounded by safeguards such as to insure the restriction of its use to cooking and 
 manufacturing purposes. 
 
COMMISSION ON MILK STANDABDS. 15 
 
 Grades for small cities and towns. — This commission recognizes that 
 because of climate, size of the community, nearness to the sources of 
 supply, ease of transportation, and progress ah-eady made in improv- 
 ing the general milk supply, and in educating the dairymen and the 
 pubUc, different communities are in position to secure varying degrees 
 of excellence in their standards for the grades of milk. This com- 
 mission, therefore, urges that its standards for grades A, B, and C 
 milk be regarded as minimum standards, and that any commimity 
 may adopt higher requirements for its grades if its conditions make 
 this feasible and desirable. 
 
 As a guide to health officers in the estabhshment of grades best 
 adapted for their local communities, the following general broad 
 principles are offered: 
 
 (1) A careful preliminary survey of the milk situation should be made before the 
 requirements of the several grades are adopted. 
 
 (2) No matter how excellent the general milk supply of a community, it is not all 
 of a single standard of excellence, hence there are actually different grades of milk in 
 every community, and the recognition of such grades is always advantageous. 
 
 (3) Grades in any community should always be such as to separate into two, or at 
 most three, classes the milk supply of that special community. "^Tiere little or nothing 
 has been done toward improving the general milk supply, it may be desirable to 
 adopt temporary grades (but not below the minimum requirements suggested by this 
 commission), with a time limit as to when more rigid requirements for the grades will 
 be enforced. 
 
 (4) Grades as adopted in any community should be such as not, under any circum- 
 stances, to sanction the sale of milk below the minimum standards which it is feasible 
 for that community to require. 
 
 (5) Whatever departures are made by any community from the exact definition of 
 grades as recommended by this commission, several fundamental principles are 
 recognized by the commission as of universal application, and from these there should 
 be no variation. These fundamental principles are: 
 
 (a) Grade A milk, in a general way, is milk which complies with requirements of 
 such character and degree that, for all practical purposes, no real advantage would be 
 gained by further and higher requirements. The standards for this grade should there- 
 fore be placed high enough to attain this end, but not so high as to limit too greatly the 
 supply, or, through unduly raising the price to the consumer, to limit too gi'eatly the 
 demand . 
 
 (6) Grade B milk is all the remaining milk of the community which is suitable for 
 drinking purposes, after pasteurization, but which does not comply with the high 
 requirements for grade A milk . 
 
 (c) Grade C milk is milk which falls below the minimum requirements for milk 
 suitable for drinking purposes, even after pasteurization. Its use must be confined to 
 cooking and manufacturing purposes. Recognition of this grade of milk ia not recom- 
 mended by this commission except in communities in which such recognition is an 
 economic necessity. 
 
 (6) The fundamental objects in grading milk are: 
 
 (a) To aid in making safe for human consumption all milk which can legally be sold 
 for drinking purposes ; 
 
 (6) To distinguish between classes of milk which, while all are safe, are of different 
 degrees of excellence in respect to cleanliness and care in handling 
 
16 COMMISSION ON MILK STANDARDS. 
 
 Each community should, therefore, endeavor to grade its milk 
 supply so as best to attain these objects without departure from the 
 broad general principles above laid down. 
 
 (5) Cream. 
 
 Cream should be classified in the same grades as milk in accordance 
 with the requirements for the grades of , milk, excepting the bacterial 
 standards, which in 18 per cent cream shall not exceed five times the 
 bacterial standard allowed in the same grade of milk. 
 
 Cream containing other percentages of fat shall be allowed a modi- 
 fication of this required bacterial standard in proportion to the change 
 
 in fat. 
 
 (6) Butter. 
 
 There is evidence that much of the butter offered for sale on city 
 markets is produced from cream of an inferior grade. The source 
 of such cream is in many instances farms where dairying is only inci- 
 dental and there are no facilities for sanitary care or refrigeration. 
 
 The stations where this cream is gathered, and the plants where it 
 is manufactured into butter are often in a most unsanitary condition. 
 It is believed that sanitation in the production and handhng of fluid 
 milk is far in advance of sanitation in the butter industry. It is the 
 opinion of the commission that steps should be taken at once to bring 
 about a reform in the production and handling of butter, and that 
 this can best be done by the establishment of standards and grades 
 which will distinguish between the superior and inferior product. 
 The commission has deliberated on the subject of butter for a period 
 of three years, and has made a detailed study through several of its 
 standing committees, in addition to conferences with leading repre- 
 sentatives of the industry itself. The conclusion of the commission 
 on this subject is as follows: 
 
 Definition. — Standard butter is the clean, nonrancid product made by gathering, 
 in. any manner, the fat of fresh or ripened cream or milk into a mass, which also con- 
 tains a small portion of other milk constituents, with or without salt, or added harmless 
 coloring matter, and contains not less than 82 per cent of milk fat. 
 
 Butter should be graded as to its sanitary quality and market score, and this com- 
 mission recommends such methods as were recently adopted by law in Minnesota 
 and Iowa, whereby the grading of butter on such a basis will be started as a voluntary 
 matter. 
 
 In the interest of public health, cream used in the manufacture of butter should be 
 pasteurized before being used. 
 
 Grade A butter should be made from grade A milk or cream. 
 
 Grade B butter should be made from grade B milk or cream. 
 
 The sale of butter should be restricted to the product obtained from milk or cream 
 that has been produced in such a manner that it could be sold when fresh as grade A 
 or grade B milk or cream, as defined by this commission. Such milk or cream shall 
 be handled before manufacture under strictly sanitary conditions by persons free 
 from communicable disease. 
 
COMMISSION ON MILK STANDARDS. 17 
 
 If the sale of butter that is made from an inferior grade of milk or cream is permitted, 
 such milk or cream should in all cases be pasteurized, and the butter properly labeled. 
 
 If butter ia manufactured from rectified milk or cream, the fact shall be so stated 
 on the label, and such butter should be considered as of the same class as renovated 
 butter. Such butter shall be classified as grade C. 
 
 All containers in which butter is sold shall be marked with the grade of the poorest 
 milk or cream that is used, with the name and location of the plant at which it is manu- 
 factiu'ed, and with the date of manufacture. 
 
 (7) Ice Cream. 
 
 The commission has had the subject of ice cream under considera- 
 tion for three years. It has been in the hands of a special committee. 
 
 In 1914 several series of bacteriological examinations of ice cream 
 were carried out by the bacteriologists of the commission, all of whom 
 handed in reports to the commission showing the character of ice 
 cream from samples taken in their own localities. There was also 
 made available for the commission special work done on this subject 
 by the Department of Agriculture at Washington, and by a number 
 of pubhc health authorities. 
 
 The commission voted that ice cream shall be regarded as a food 
 rather than a confection in the sense of the pure-food law. The 
 commission also voted that the milk and cream used in the manu- 
 facture of ice cream should conform to the standards recommended 
 by the commission for milk and cream; also, that all milk and cream 
 used in the manufacture of ice cream be pasteurized. 
 
 Concerning the definition of ice cream, which was discussed at sev- 
 eral meetings, the commission decided upon the following: 
 
 Ice cream is a frozen product made from pasteurized cream and sugar, or pasteur- 
 . ized cream and pasteurized milk and sugar, and shall contain not less than 8 per cent 
 milk fat. It shall not contain any preservatives, neutralizing agent, saccharine, 
 renovated or process butter, fats, or oils foreign to milk or to other ingredients allowed. 
 It may contain wholesome eggs, harmless coloring matter, flavoring, sound, clean, 
 mature fruits and nuts, pastries, and approved thickening not to exceed 0.5 per cent. 
 
 Ice cream should be kept frozen until dispensed. Synthetic cream 
 (the product made by emulsifying homogenized butter with milk or 
 skim milk) should not be recognized for ice cream or other cream 
 purposes unless the methods and ingredients used be approved by 
 the proper authorities. 
 
 Health officers are advised to allow nothing to be sold under the 
 name of ice cream unless it comes under the above definition, mth 
 the further provision that it be manufactured and handled in a sani- 
 tary manner, the method of determining proper sanitation to be 
 controlled by local officials. 
 
 Where there are no bacterial standards, the bacterial content 
 should be used as a guide in checking sanitary conditions. 
 
 The use of substitutes for -cream, such as emulsified fats, other 
 than milk fats, should not be allowed for ice cream or other cream 
 
18 COMMISSION ON MILK STANDARDS. 
 
 purposes. If used, the finished product should not be labeled ice 
 cream. 
 
 Grading. — Concerning the character of the products used in ice 
 cream, the commission decided to recommend that milk products 
 used in the manufacture of ice cream be restricted to the products 
 of the grade A and grade B classes. 
 
 Grade A ice cream should be made from grade A milk or cream, 
 and the finished product should contain not more than 100,000 
 bacteria per cubic centimeter. 
 
 Grade B ice cream should be made from milk or cream not lower 
 than grade B, and the finished product should contain not more 
 than 1,000,000 bacteria per cubic centimeter. 
 
 The commission recommends the use of a suitable score card in 
 grading the sanitary condition of ice-cream factories. 
 
 A suggested score card is included in the appendix of this report. 
 
 (8) Condensed Milk. 
 
 The commission recognizes that in the manufacture of condensed 
 milk, evaporated, powdered, and condensed milk products, the sani- 
 tary character of the raw milk used affects not only the keeping 
 qualities but also the safety and decency of the finished product. 
 It is clearly to the best interests of the public and the condensed- 
 milk industry that condensed milk should be so labeled that the 
 product prepared from fluid milk of a good quality may be dis- 
 tinguished from that prepared from inferior milk. 
 
 The commission therefore recommends the passage of Federal, 
 State, and municipal legislation which will permit the manufacturer 
 to state upon the label that his product has been prepared from grade 
 A milk, and he shall be protected in the use of such a label. 
 
 (9) Skim milk. 
 
 The cdinmission passed a resolution regarding the chemical stand- 
 ards for skim milk at one of its earhest sessions, recommending that 
 skim milk should contain not less than 8.5 per cent of milk solids 
 not fat. 
 
 In addition to this, regarding the food value of skim milk, the 
 commission recommends that: 
 
 Whereas the pressure of the cost of living is increasing rapidly and vast quantities 
 of nutritious and available food are now going to waste, and laws prohibiting the sale 
 of skim milk have no public health significance; therefore, the commission recom- 
 mends that the use of skim milk as a food be approved, and urges the repeal of laws 
 wherever they exist that prohibit the sale of skim milk as a food. 
 
COMMISSION ON MILK STANDARDS. 19 
 
 (10) Buttermilk. 
 
 Concerning buttermilk the commission considered the subject at 
 three of its sessions. As a definition of buttermilk the commission 
 suggests : 
 
 That the sale of buttermilk should be restricted, first, to the product resulting from 
 the churning of milk or cream that is produced under 8u<^h conditions that when fresh 
 it could be sold as grade A or grade B milk or cream, as such grades have been defined 
 by this commission; or, second, to the product resulting from the skimming, souring, 
 or treatment in any way of grade A or grade B milk, so that it resembles buttermilk 
 (the true character of such imitation or artificial buttermilk to be distinctly stated on 
 the container in every case), provided that all such buttermilk shall be handled during 
 and after manufacture in a sanitary manner approved by the local health authorities, 
 and that it shall be kept at a temperatiu"e below 50° F. from the time of manufacture 
 until delivered to the consumer. 
 
 The commission recommends that all milk, cream, or skim milk 
 entering into the manufacture of buttermilk be pasteurized, unless 
 it can be shown that such milk or cream corresponds to grade A 
 raw milk. 
 
 All buttermOk should be sold in bottles or cans that are properly 
 sealed and labeled, with the name of the manufacturing plant, with 
 either the day or date of manufacture, with the grade of milk from 
 which it was manufactured, and with a statement as to whether it is 
 manufactured from a raw or pasteurized product, and whether it 
 is artificially or naturally prepared. 
 
 (11) Clarification. 
 
 The process of the clarification of milk has come into such wide 
 use that the commission has felt it necessary to take cognizance 
 of it, but it does not believe that it should be recommended as a 
 required standard method. In its favor are the following points: 
 
 (a) It removes visible dirt. 
 
 (b) It removes inflammatory products, including many of the causative germs. 
 
 (c) It performs the work of the strainer, but in a much "hiore efficient manner. 
 
 Against it are the following points : 
 
 (a) It removes visible dirt, but not all disease-producing germs and hence misleads 
 the consumer as to the real purity of the milk. 
 
 (b) It does not remove urine or the soluble portions of feces; nevertheless, the milk 
 appears clean. 
 
 (c) It adds another process requiring handling of the milk, complicating the situa- 
 tion. 
 
 (d) It largely destroys the value of the dirt test, though not more so than good strain 
 ing. 
 
 (e) It breaks up clumps of bacteria and distributes them through milk. 
 (/) The exact nature of the material removed is not yet fully understood. 
 
20 COMMISSION ON MILK STANDAUDS. 
 
 (12) Homogenization. 
 
 Concerning the subject of homogenized milk or cream, the com- 
 mission bases its attitude on the principle of correct labeUng. It is 
 of the opinion that in the compounding of milk or cream, no fat other 
 than milk fat from the milk in process should be used, and that no 
 substance foreign to milk should be added to it. 
 
 The use of condensed milk or other materials for the thickening of 
 cream is opposed unless the facts are clearly set forth on the label of 
 the retail package. 
 
 Homogenized milk or cream should be marked as such, stating the 
 percentage of fat it contains. 
 
 (13) Licenses. 
 
 A milk dealer should be required to have a permit or license to sell 
 any grade or class of milk, and to use a label for such grade or class. 
 Such permit or Ucense should be granted only after the local health 
 board has determined that the milk of the dealer actually belongs to 
 the grade, and it should be revoked and the use of the label forbidden 
 when it is detennined that the milk is not in the grade or class desig- 
 nated. 
 
 (14) Labeling. 
 
 All milk should be labeled and marked with the grade in which it is 
 to be sold. In dating milk, uniform methods should be adopted. 
 Besides the letter of the grade and the words ''raw" or "pasteur- 
 ized," there should be added sufficient statements to identify the 
 milk as to its source and the time at which it was produced, bottled, 
 or pasteurized; and no term descriptive of the quaUty of the milk 
 other than the officially adopted grades should be authorized, unless 
 such term is of a generally accepted meaning. 
 
 In dating milk uniform methods should be adopted for all grades of 
 both raw milk and pasteurized milk, using the day of the week or the 
 day of the month. 
 
 The sale of milk which is mislabeled or misbranded should be pun- 
 ished by revoking the dealer's license, reducing the milk to a lower 
 grade, or by fines, or suitable penalties. 
 
 APPENDIX L— FACTORS OF PRIMARY IMPORTANCE IN DAIRY PRACTICE 
 FOR CONTROLLING THE SANITARY CHARACTER OF MILK. 
 
 In its last report the Commission placed in an appendix detailed 
 regulations for the control of sanitary conditions in dairies and milk 
 receivmg stations. 
 
 The regulations given there have varymg degrees of value in con- 
 trolling the character of milk. Many add expense to the cost of 
 production, and some, whil6 they improve external appearances in 
 the dairy, do not materially affect the quality of milk. The grading 
 
COMMISSION ON MILK STANDAEDS. 21 
 
 system deals primarily with the character of the product, and the 
 dairyman should give his special attention to such factors as will 
 most effectively improve the character of the product. 
 
 Hence dairy inspectors should aim to place primary emphasis upon 
 the factors that most largely affect the quality of the milk. The 
 Commission urges all health officers and dairymen to separate the 
 factors of primary importance from those of secondary importance. 
 ITie following statements are not intended to replace more elaborate 
 regulations given elsewhere but to show where the primary emphasis 
 should be laid and to distinguish the more important measures from 
 those that are of secondary importance in controlling the quality of 
 milk. 
 
 In what follows it is assumed that other standard '"egulations are 
 adopted, and that no milk is to be shipped from cows evidently dis- 
 eased, or with sore udders, or milk handled by employees sick with 
 any infectious disease, or carriers of disease germs. 
 
 Where milk is to be sold in a raw state, it is assumed that all cows 
 will be under veterinary supervision, and tuberculin tested once each 
 year, and dairy employees will be under regular medical inspection. 
 
 Under these conditions it is the opinion of the Commission that 
 the following factors are most essential in putting on the market 
 milk which is clean and contains a low bacterial count. 
 
 1. Financial Stimulus. 
 
 This factor miderlies all others. Unless the dairyman can be con- 
 vinced that it is to his financial advantage to produce clean milk, 
 any attempt to purify the milk supply by legal statutes will be largely 
 futile. To produce such a financial stimulus some form of grading 
 milk is necessary in which the public will have confidence as being 
 thoroughly reliable. This will involve: 
 
 (a) The health officer. — The milk must be graded by the proper 
 authorities, and this should include constant bacteriological exami- 
 nation of the milk furnished by each producer for the purpose of 
 grading. 
 
 (b) The dealer. — The milk should be paid for by the dealer accord- 
 ing to its grade. The most effective results will be obtained so far 
 as concerns cleanliness and sanitary character when the dealer pays 
 the producer for milk on a scale based upon its bacterial count in 
 addition to other factors. 
 
 The dealer should also thoroughly sterilize all milk containers by 
 steam before returning them for refilling. It has been found that 
 one of the greatest sources of trouble is the fact that the dealer 
 returns to the producer cans which are not only not sterilized, but 
 sometimes not even washed clean. No producer can furnish good 
 milk in such cans, but the dairyman is almost sure to be blamed for 
 a condition for which the dealer is wholly responsible. 
 
22 COMMISSION ON MILK STANDAEDS. 
 
 2. To produce milk of grade A or B, the producer will find the 
 following factors the most efficient in controlling its cleanliness and 
 its bacterial count : 
 
 (a) Milking. — Cows should have clean udders. Hands of the milker should be clean 
 and dry. A small-topped milk pail should be used. With clean methods no strainer 
 is needed, but if one is used it is preferably of cloth (cheese cloth) which has been 
 sterilized by boiling. It is important that the same cloth shall not be used for the 
 morning's milking and again for the night's milking. Two strainer cloths should be 
 boiled, one used for the morning and the other for the night's milking. 
 
 (b) Sterilizing. — All milk vessels should be washed with a brush and with washing 
 soda, or with alkaline powder and water, should be rinsed in clean water and sterilized. 
 Where steam is available, this should be used for sterilizing, either as a jet of live 
 steam or under pressure. Where steam is not available an abundance of boiling water 
 should be used. 
 
 (c) Cooling .—The milk shall be cooled promptly to as low a temperature as is 
 feasible with facilities available. Where this is done in a water tank and it is desired 
 to stir the milk to facilitate the process, a wooden paddle of any kind must not be used. 
 A metal stirrer may be used, which must be thoroughly washed and sterilized with 
 boiling water each day. The lower the temperature to which the milk can be cooled, 
 the easier it will be to produce milk of low bacterial count. 
 
 While other factors in milk production have their influence, 
 extended tests show that 90 per cent of the high bacterial counts are 
 attributable to the neglect of the above. 
 
 The above sanitary measures have special reference to the preser- 
 vation of the sanitary character of milk during the process of milk 
 production on the dairy farm. It is recognized that in addition to 
 these, precautions must be observed in the milk factory or shipping 
 station and on the railroad and in the city delivery station. In some 
 cases the chief trouble is after the milk has left the dair}^ In ship- 
 ment three factors control the quality of the milk at its destination: 
 Time, temperature, and cleanliness of utensils. Thorough refrigera- 
 tion of milk in its progress from the dairy farm through the shipping 
 station, on the railroad, and in the city station is essential to prevent 
 large multiphcation of bacteria. Washing and sterihzing of all 
 vessels in which milk is contained, and of aU apparatus with which 
 it comes in contact is vital if contaminations are to be prevented that 
 can easily destroy the sanitary character of milk which may have 
 left the dairy farm in fu'st-class condition. There is very little value 
 in the practice of sanitary measures by the dairy farmer if the milk 
 in the hands of the dealer is not properly refrigerated and handled 
 in a sanitary manner. 
 
COMMISSION ON MILK STANDARDS. 
 Score Card for Ice-Cream Manufacturing Plants. 
 
 23 
 
 Location 
 
 Above groirnd 5 
 
 Free from contaminating surroundings (no score if bad ) 3 
 
 Protected from street dust 3 
 
 Not cormected with any other room 2 
 
 No other business in same establishment 2 
 
 Construction 
 
 Wei! lighted (natiu-al) 2 
 
 Well ventilated 1 
 
 Thoroughly screened 2 
 
 Water-closet does not open directly into establishment 2 
 
 Separate room for washing utensils 2 
 
 Floor: Smooth, water-tight, well drained 4 
 
 Walls and ceiling: Smooth and tight 2 
 
 Equipment 
 
 Steam at all times 5 
 
 Hot water at all times (no credit unless running hot water) 3 
 
 Sterilizer for utensils ; 3 
 
 Connections for sterilizing apparatus 2 
 
 Pasteurizer: 
 
 Holding machine i 
 
 Automatic recording device 1 
 
 Refrigeration: Mechaniail (proper ice box, 1) 2 
 
 Freezer: Type, cormections, etc 2 
 
 Sanitary piping 2 
 
 Wash basins and towels ample '. 1 
 
 Utensils: 
 
 Condition 1 
 
 Ample for the service 1 
 
 Racks for 1 
 
 Employees: 
 
 Health certificates for 1 
 
 Clean suits provided 1 
 
 Methods . 
 
 Freedom from flies 2 
 
 Protection of material: 
 
 Before manufacture 3 
 
 During manufacture .• 3 
 
 After manufacture 3 
 
 Utensils and apparatus sterilized (washed in hot water, 1) 3 
 
 Cleanliness: 
 
 Floors 3 
 
 Windows 1 
 
 Apparatus 3 
 
 Walls and ceiling , 1 
 
 Utensils 3 
 
 Employees 3 
 
 Character of materials used: 
 
 Milk and cream, grade A (grade B, 4; grade C, 1) 6 
 
 C;ondensed milk, eggs, etc 2 
 
 Thickeners, none used 1 
 
 Artificial coloring, none 1 
 
 Degree of refrigeration of final product 2 
 
 Perfect. 
 
 30 
 
 \ 
 
 Total . 
 
 Allow. 
 
 k 
 
 APPENDIX 2.— HISTORY OF THE COMMISSION ON MILK STANDARDS 
 APPOINTED BY THE NEW YORK MILK COMMITTEE. 
 
 Milk Grading Previous to the Commission's Organization. 
 
 In 1907 there was held a milk conference in Washington called by 
 the Commissioners of the District of Columbia to report upon the 
 milk supply of that city. At this conference Dr. A. D. Melvin offered 
 a resolution proposing that milk be classified into three classes: 
 
 Class 1, certified milk; class 2, inspected milk; class 3, pasteurized milk. 
 
 In the first two classes the cows were to be tuberculin tested and 
 the milk to have bacterial standards. The conference recommended 
 this classification. The proposal was notable because it provided 
 
24 COMMISSION ON MILK STANDARDS. 
 
 for the pasteurization of all milk, with the exception of milk from 
 tuberculin-tested cows, produced under sanitary conditions. 
 
 In 1908 the Board of Health of New York City adopted a classi- 
 fication of milk as follows : 
 
 Class 1, milk (ordinary market milk, raw or pasteurized); class 2, selected milk; 
 class 3, inspected milk; class 4, guaranteed milk; class 5, certified milk. 
 
 Class 1 represented the bulk of the supply, and no provision was 
 made requiring either pasteurization or a bacterial standard. 
 
 ^'' Organization of the Commission on Milk Standards. \ 
 
 In 1910, December 2 and 3, the New York Milk Committee held a 
 conference on milk problems of leading milk authorities in America, 
 at which the following resolution was adopted; 
 
 Resolved, That pending the adoption of national standards the conference on milk 
 problems of the New York Milk Committee indorse the classification of milk recom- 
 mended by A. D. Melvin, Chief of the Bureau of Animal Industry of the United States 
 Department of Agriculture, approved by the milk conference of the District of Co- 
 lumbia' 1907, and published in Circular 114 of the Bureau of Animal Industry, and in 
 Bulletins Nos. 41 and 56 of the United States PubUc Health and Marine Hospital 
 Ser\'ice. 
 
 (This classification designates three kinds of milk: Certified; in- 
 spected; pasteurized.) 
 
 This same conference also passed the following resolution: 
 
 Whereas it has been demonstrated by the papers and the discussions at this con- 
 ference held at the invitation of the New York Milk Committee that it is imperative 
 that definite standards and regulations should be adopted to govern the production 
 and handling of dairy products for the prevention of disease and the saving of lives; 
 
 Resolved, That the New York Milk Committee be requested to invite between 
 12 and 20 recognized experts on milk problems to meet in conference, and that those 
 experts be asked to make a unanimous report, recommending proper milk standards 
 on which Congress or State authorities may formulate milk legislation. 
 
 In accordance with this resolution, in March, 1911, the New York 
 Milk Committee, which is a voluntary organization working for the 
 improvement of the milk supply of New York City and the reduction 
 of infant mortality, invited 20 experts to become members of a 
 commission on milk standards. These men were selected from a 
 list of more than 200 men of prominence in medicine, sanitation, 
 public health, and laboratory work, who were recognized as authori- 
 ties on the milk question. 
 
 The members at the present time are as follows: 
 
 Dr. Carl L. Alsberg, Chief, Bureau of Chemistry, United States Department of 
 Agriculture, Washington, D. C. 
 
 Dr. John F. Anderson, of E. R. Squibb & Sons, New Brunswick, N. J. 
 
 Dr. B. L. Arms, State Bacteriologist, Montgomery, Ala. 
 
 Prof. H. W. Conn, Director of Laboratory of State Board of Health, Middletown, 
 Conn. / 
 
COMMISSION ON MILK STANDARDS. 25 
 
 Dr. W. A. Evans, Department of Preventive Medicine, Northwestern University, 
 Chicago, 111. 
 
 Dr. Charles J. Hastings, Medical Officer of Health, Toronto, Canada. 
 
 Dr. J. N. Hurty, Secretary, State Board of Health, Indianapolis, Ind. 
 
 Dr. J. H. Landis, Health Officer, Cincinnati, Ohio. 
 
 Dr. E. C. Levy, Health Officer, Richmond, Va. 
 
 Dr. A. D. Melvin, Chief, Bureau of Animal Industry, United States Department 
 of Agriculture, Washington, D. C. 
 
 Dr. J. S. Neff, Narberth, Pa. 
 
 Dr. Charles E. North, 30 Church Street, New York City. 
 
 Dr. William H. Park, Director of Laboratories, Department of Health, New York 
 City. 
 
 Mr. R. A. Pearson, President, College of Agriculture, Ames, Iowa. 
 
 Dr. M. P. Ravenel, Department of Preventive Medicine, University of Missouri, 
 Columbia, Mo. 
 
 Prof. M. J. Rosenau, Department of Preventive Medicine and Hygiene, Harvard 
 UniA^ersity, Cambridge, Mass. 
 
 Prof. H. C. Sherman, Department of Chemistry, Colimibia University, New York 
 City. 
 
 Dr. L. L. Van Slyke, Agricultural Experiment Station, Geneva, N. Y. 
 
 Mr. C. H. Wells, Health Officer, Montclair, N. J. 
 
 Dr. William C. Woodward, Health Officer, Washington, D. C. 
 
 In the list of names above there are eight public health oflFicers, 
 
 seven bacteriologists, three chemists, and two agricultural experts. 
 
 Thirteen out of the number have been educated as physicians; two' 
 
 of the members have had long practical experience in the milk industry" ; 
 
 six have been connected with the production and control of certified 
 
 milk. 
 
 Purposes. 
 
 While this commission was created by and its expense is borne by 
 
 the New York Milk Committee, it has not been the intention of the 
 
 committee that the commission should have the New York City milk 
 
 problem solely in mind. It was desired that the commission should 
 
 make recommendations regarding milk standards and legislation 
 
 that might be adopted by any city or town in the United States or 
 
 Canada. 
 
 Meetings. 
 
 The first meeting of the commission was held at the New York 
 Academy of Medicine on May 22, 1911. The subjects discussed 
 included bacterial standards, chemical standards, and the grading 
 and classification of milk. Several committees were appointed to 
 report at the next meeting. 
 
 The second meeting of the commission was held at the New York 
 Academy of Medicine, October 5 and 6, 1911, at which the reports 
 of standing committees were received and resolutions adopted con- 
 cerning bacterial standards, chemical standards, and grades and 
 classes of milk. Special committees were appointed to consider 
 certain specific matters. The commission tentatively recommended 
 
26 COMMISSION ON MILK STANDAEDS. 
 
 that milk should be classified as follows: Certified; inspected; market; \ 
 cooking; that there be bacterial standards and that the last two 
 classes should be pasteurized. 
 
 January 4, 1912, the New York City Department of Health made an 
 amendment to its sanitary code providing for a new classification of 
 milk, as follows: 
 
 Grade A, for infants and children, including: Certified, guaranteed, inspected (raw), 
 selected (pasteurized); grade B, for adults, including: Selected (raw), pasteurized; 
 grade C, for cooking, including both raw and pasteurized. 
 
 It is noteworthy that this grading system made some use of the 
 recommendations of the Commission on Milk Standards, but omitted 
 any bacterial standards for grade B or grade C milk, and permitted 
 the sale of raw, unpasteurized milk in all grades. At the same time 
 it was recognized that this action of New York City was a great step 
 in advance, and an indication that the commission's work gave 
 promise of taking practical form. 
 
 First Report. 
 
 The third meeting of the commission was held at Homer, N. Y., 
 January 25, and at the New York Academy of Medicine, January 
 26 and 27, 1912. At this meeting minor matters were voted upon 
 and preparations made for the pubhcation of a report of all of the 
 commission's work. The first report appeared in the Pubhc Health 
 Reports of the United States Public Health Service, volume 27, No. 
 19, May 10, 1912; 70,000 copies of this report were distributed. 
 
 The fourth meeting of the commission was held in Chicago, October 
 29 and 30, 1912, at the time of the National Dairy Show. At this 
 meeting the commission attended the annual convention of the Inter- 
 national Milk Dealers' Association, and took part in a discussion of 
 the classification of milk and milk standards with the leading repre- 
 sentatives of the milk industry of the United States and Canada. 
 
 The fifth meeting of the commission was held in Richmond, Va., 
 on May 2 and 3, 1913. By this time the commission had the benefit 
 of numerous criticisms and suggestions which had been called forth 
 by the first provisional report. At this meeting the commission made 
 some radical modifications of its standards and grades, as follows : 
 
 (1) That in classifying milk the grades be designated by letters only, and not by 
 such words as "certified," "inspected," "selected," etc. 
 
 (2) That the classification be changed to include only three grades: 
 
 Grade A, consisting of two classes, raw milk with a bacterial standard of 100,000 per 
 cc, from tuberculin-tested cows (employees medically inspected); pasteurized milk 
 with a bacterial standard of 100,000 per cc. before pasteurization and 10,000 per cc. 
 after pasteurization. 
 
 Grade B, consisting of one class, with a bacterial standard of 1,000,000 before pas- 
 teurization and 50,000 after pasteurization. 
 
 Grade C, consisting of one class, over 1,000,000 before pasteurization and 50,000 / 
 after pasteurization. 
 
COMMISSION ON MILK STANDARDS. 27 
 
 Second Report. 
 
 ''^ The second report of the Commission on Milk Standards was pub- 
 lished by the United States PubUc Health Service in the Pubhc 
 Health Reports of August 22, 1913, and contained the new grading 
 system as above recommended. This report was endorsed by the 
 American Pubhc Health Association at .its annual meeting at Colo- 
 rado Springs, September 9-13, 1913. 
 
 (January 1, 1914, the New York City Department of Health amended 
 their grading system so as to conform in its essential features to the 
 new grading system recommended by the Commission on Milk 
 Standards. This was soon followed by action by the New York 
 State Department of Health in establishing a grading system for 
 all towns and cities in the State. Later on the cities of Newark, 
 N. J., Jersey City, N. J,, Richmond, Va., Kansas City, Mo., adopted 
 similar though not identical grading systems. The grading of milk 
 is also being considered at the present time by the pubhc health 
 authorities of several othei: municipaHties as well as States.) 
 
 The sixth meeting of the commission was held at the New York 
 Academy of Medicine, April 13, 1914. At this time special attention 
 was given to milk products and reports presented by the members 
 of their own investigations on the sanitary and bacterial conditions 
 of the ice cream and butter in various parts of the United States 
 and Canada. 
 
 The seventh meeting of the commission was held in the Hotel 
 Biltmore and the New York Academy of Medicine, May 7 and 8, 1915. 
 On this occasion the Commission met the officers of a number of 
 commercial organizations, including the National Ice Cream Dealers' 
 Association, the National Creamery and Butter Makers' Association, 
 and the International Milk Dealers' Association. The dehberations 
 dealt chiefly with the subjects of butter, ice cream, and other milk 
 products, and also with the questions of the control of certified milk 
 and dairy inspection. 
 
 A special committee of the commission met in Washington on 
 January 17, 1916, with the Joint Committee on Definitions and 
 Standards appointed by the Bureau of Chemistry of the United 
 States Department of Agriculture. The object of this meeting was to 
 permit the members of the Commission on Milk Standards to present 
 to the joint committee the results of the work of the Commission on 
 Milk Standards, and to urge the Joint Committee on Definitions and 
 Standards, which represents the food and dairy commissioners of 
 the various States, the agricultural chemists, and the United States 
 Department of Agriculture, to approve of the adoption of uniform 
 milk standards for aU of the States, and of the bacterial testing and 
 grading of milk according to its sanitary character. / 
 
28 
 
 COMMISSION ON MILK STANDARD! 
 
 The eighth meeting was held May 19 and 20, _„0„00? .§9^.®?,? 
 York Academy of Medicine. This meeting was especially effective 
 because of the extensive work performed by the standing committees 
 of the commission which held their own independent meetings in 
 various parts of the United States several weeks in advance of the 
 general meeting. As a consequence of this preparatory work, each 
 committee brought in most complete and extensive reports of the 
 subjects with which they had to deal. These subjects included: 
 Ice cream, butter, condensed milk, standards for small communities, 
 the significance of bacterial counts, essentials of dairy scoring, 
 adjusted milk, clarification, pasteurization, tuberculin testing and 
 other minor matters. This present report is a summary of the 
 conclusions reached by the commission as a result of all of the ses- 
 sions, and may be regarded as superseding the previous reports. 
 
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