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enactment or proposed enactment of laws for the improvement of the milk supply. As a matter of fact, too, very few producers of milk in this vicinity have any accurate idea of the actual cost of production or of the net increase in the cost, if any, brought about by the enforcement of existing dairy regulations. Not knowing the cost of production, the individual producer can not fix intelligently the lowest price at which milk must be sold in order to produce a fair profit, but is guided by general impressions only and by prevailing custom. He does undoubtedly know, however, that the cost of production has been increased by higher prices for foodstuffs and for labor; his monthly expenditures must show this. If he proposes to increase the price of milk merely in proportion to the increase in the cost of production and to the increase in the cost of the farmer's living, the public should not complain. But the increase should be fairly and frankly stated, and the necessity for it should not be used unfairly as a club with which to beat down future legislation for the improvement of the milk supply.

RESULTS.

The results of the milk-inspection service must not be measured by bacterial counts or chemical analyses. These are mere incidents. The purpose of the service is to prevent sickness and to save human lives, and by its efficiency in accomplishing these ends it must be judged. In the first place, then, the milk-inspection service has assisted the health department in discovering outbreaks of typhoid fever and scarlet fever, due to milk infection. Of these outbreaks, seven were of typhoid fever and two of scarlet fever." And the milk-inspection service alone has, after the discovery of such outbreaks, enabled the health department usually to locate the very focus of infection, and commonly to do so in time to take effective action to cut short the progress of the disease.

While the relation between the milk supply and the spread of the diseases named above is important, it is less so than is the relation between the milk supply and infant mortality; the death rate of infants is the commonly accepted standard by which the efficiency of the milk-inspection service of any community is measured. It may be claimed, however, and with some show of propriety, that many factors other than improvement in the milk supply have been at work to reduce the number of infantile deaths; or that a diminishing birth rate may account for the lessening of the infantile death rate, computed as that death rate perforce is, upon the total population and

⚫a For details as to these outbreaks, see page 49.

not upon the basis of the infantile population alone. To eliminate as nearly as possible error from these causes, no effort has been made to gauge the results of milk inspection by the general infantile mortality, but consideration has been limited to one single class of diseases, the intimate relation between which and the milk supply is almost universally conceded; that is, to diarrhea and enteritis occurring among children under 2 years of age.

When a sudden drop in the death rate from any particular cause is practically coincident with the inauguration of measures intended to bring about that very result, when there is no other discoverable cause for such drop, and when the lower death rate persists with the continuance of such measures and continues to fall in proportion, more or less, to their efficiency, it is reasonable to suppose that the relation of cause and effect exists. And such are the circumstances with respect to the improvement in the milk supply of the District of Columbia and the diminution in the mortality from diarrheal diseases among persons less than 2 years old. The beginning of a persistent fall in the general death rate appears when we compare the figures for 1892 with those for 1893. A fall in the death rate of infants under 1 year of age appears at the same time. But no permanent lowering appears in the death rate from diarrhea and enteritis among children under 2 years of age until the second year after the enactment of the milk law. This law was enacted March 2, 1895, and a certain period elapsed before it could be put into effective operation. The death rate from diarrhea and enteritis among infants during the fiscal year following its enactment was 168 per 100,000. The next year it had fallen to 151, the third year to 136, and the fourth year to 110. There have, of course, been slight fluctuations. In the calendar year 1900 the death rate rose to 132 per 100,000, but the annual average for the five-year period, 1900-1904, was only 109, and during 1903 it fell to 91. In 1905 the rate was 104, and in 1906 it was 97. The death rate from diarrhea and enteritis among children under 2 years old during the five-year period preceding the enactment of the milk law, in 1895, was 175 per 100,000. If the same rate had continued during the eleven years that elapsed after its enactment and prior to December 31, 1906, the number of deaths from these causes would have been approximately 5,777, or 1.872 more than actually occurred. And if the number of fatal cases of diarrhea and enteritis, whether averted through the operation of the milk law or otherwise, was 1.872, how much more numerous must have been the cases in which infants were spared attacks of a milder character?

Possibly some of the apparent saving of the lives of 177 infants yearly, and the apparent prevention of sickness, may have been due

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to a diminishing birth rate, but the records of the health department show no reason for believing that it was all due to that cause.

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Some of it may have been due to the improvement in the general sanitary condition of the city; some to a better understanding on the

part of parents as to how to care for their children; and some ta increasing ability on the part of the medical profession to treat sud diseases. These factors, however, had been operating for a long period before the enactment of the milk law, but without apparer: effect. The death rate from diarrheal diseases of infants during the five-year period, 1880 to 1884, was 162 per 100,000; during the nex period it was 168, and from 1890 to 1894 it was 175. Is there any reason to believe that in 1895, the very year the milk law was enacte some circumstance, as yet undiscovered, rendered potent these theretofore inert factors, so that in the period from 1895 to 1899 they mad the death rate from infantile diarrhea and infantile enteritis fall to 135, during the next period fall to 109, during the year 1905 fall to 104, and during the year 1906 to 97? Or was it not the enactment of the milk law in 1895 and the continuous and increasingly efficient enforcement of it that has wrought this result? The facts are here stated, and pending a further study of the matter the reader must be left to draw his own conclusions. This, however, can be said without fear of successful contradiction, that if the enactment of the milk law of 1895 has prevented only one iota of the deaths and the sickness that it seems to have prevented, the milk-inspection service has amply justified its existence.

SUPPLEMENTARY MEMORANDUM-GOVERNMENT OF THE

DISTRICT OF COLUMBIA.

In order that readers of this report who do not reside in the District of Columbia may better comprehend the situation that exists there with respect to the supervision of the milk supply, the following statement is made. Those who are residents of the District of Columbia, or most of them, are probably already familiar with everything that it contains.

The District of Columbia covers only 60 square miles of land. lying on the Potomac River between the States of Maryland and Virginia. According to the Federal census of 1900, it had a population of 278,718. The police census of 1906 showed, however, a population of 326,435, which is manifestly larger as compared with the Federal returns, but is in harmony with police censuses of other recent years. Approximately 30 per cent of the population is colored. view of its large population and relatively small area, the greater part of the District is urban in character, and most of the milk supply is produced in neighboring States., There is in law no delimitation between the present city of Washington and the District of Columbia. The District of Columbia is not self-governing, but is under the control of the Government of the United States. All legislation of any considerable importance is enacted by the Federal Congress, and

all appropriations whatsoever are made by it. For the latter purpose all local revenues are paid into the Federal Treasury. As a very general rule, any appropriation that is made comes one-half from the revenues of the District of Columbia and one-half from the revenues of the United States, but appropriations have occasionally been made wholly from local revenues.

For purposes of administration, the immediate direction of the affairs of the District is intrusted to a Board of Commissioners, two of whom are appointed by the President from among the residents of the District of Columbia, and confirmed by the Senate, the third Commissioner being detailed from the Engineer Corps of the Army. The general duties of the Board of Commissioners are executive, but the Board now has a considerable legislative power relating to matters not deemed of such vital importance as to be reserved for the exclusive jurisdiction of Congress.

Laws and regulations relating to public health are executed and enforced by a health officer, appointed by the Commissioners and responsible to them. There has been no board of health in the District of Columbia since 1878, when the present form of government was established. Prior to that date, and as far back as 1871, there had been a board of health created by act of Congress having jurisdiction over the entire District of Columbia and before that the city of Washington and the city of Georgetown, each then a separate municipal corporation, had their own boards.

24907-Bull. 41-08-46

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