Full text of Milk : The Indispensable Food for Children, Care of Children Series No. 4, Bureau Publication No. 35

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U. S. DEPARTMENT OF LABOR

CHILDREN’S BUREAU
JULIA C. LATHROP. Chief

M

I L

K

THE INDISPENSABLE FOOD FOR CHILDREN

BY

DOROTHY REED MENDENHALL, M Bi

CARE OF CHILDREN SERIES No. 4
Bureau Publication No. 35

WASHINGTON
GOVERNMENT PRINTING OFFICE

1918

U-Ss


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A D D IT IO N A L COPIES
OF THIS PUBLICATION MAY BE PEOCUEED FROM
THE SUPERINTENDENT 03? DOCUMENTS
GOVERNMENT PRINTING OFFICE
"WASHINGTON, D. C.
AT

5 CEN TS P E R C O P Y


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CONTENTS.
Page.

Introduction.......................................................................................................... ...........
[The effect of war on the health and nutrition of our children. Milk has
no substitute in the diet of the child.]
Effect of war on the production and consumption of m ilk.....................................
6
[Danger of loss of dairy herds in a period of food shortage. Amount of
milk now produced and used as milk. Increase of price followed by
diminished use of milk. Decreased use of milk may cause diminished
production.]
The nature of milk as a food.............. ...................................... ....................................
[The adequacy of a food or diet. Essential constituents and digestibility _
of milk. A pint and a half of milk a day a desirable allowance for an
average child.]
What kinds of milk can be Used for infants.. . . . . . . ...... ............... - ......................... 12-26
12
Breast milk: The best food for ba bies.. ....................................................... ..
Artificial feeding of young children...................................................................... 13-26
Cows’ milk: The best substitute for breast m ilk.............................. ......... 13-16
Pasteurized m ilk....................................................... ..............................
14
Sterilized m ilk...........................................................................................
15
Canned m ilk. .....................................................................*...................- •- 16-26
Certain proprietary or patent foods....... ...............................................
16
Condensed milk (sweetened)......................................... ? ....... *.............
17
Evaporated milk (unsweetened condensed m ilk)...............................
13
Dry milk or milk powder........................................................................
23
What kinds of milk can be used for the older child and for cooking....................
26
[Butter and the use of margarines. Cheese.]
Summary................................................................. - ........... .*..........................................
28
[Ultimate victory can come only to the nation that carefully conserves
the stamina of its children, upon whom depends the future of the race.]
List of references......................... ....................................................... ............................. 30-32
Other general references on m ilk..........................................................................
62
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MILK
THE INDISPENSABLE FOOD FOB CHILDREN.

INTRODUCTION.

Our Nation, with the majority of all civilized nations, finds itself
plunged into a world war. As the atmosphere clears, after the first
tremendous endeavor to create armies and to feed and equip our own
soldiers as well as the population of our allies, thinking people are
asking themselves how our home population is to maintain its
health and the standards of living which have cost us so much effort
to achieve. How will war affect the health and welfare of our chil­
dren? What can we learn from the experience of European coun­
tries, already at war over three years, in regard to the influence on
child life of the changes and privations inevitably produced by the
war? What dangers and disasters may we avert if we take imme­
diate precautions to prevent war conditions from affecting our child
population in the adverse ways so plainly shown in Europe ?® 1®
The necessity of our Nation’s feeding an ever-increasing number
must be granted; also, that this food can be obtained in only two
ways— by increased production or by decreased use of food in this
country. The saving of food in this latter way may be brought
about partly by persuading individuals to eat less and to choose cer­
tain types of food which can not be exported, and partly by elimi­
nating waste. It is probably safe to assert that curtailing the total
amount of his daily diet will be beneficial for the average adult.
More than this, we are willing to agree that substitution of one type
of food for another of the same type can be safely carried out by the
average healthy American adult to-day if the substitution is intel­
ligently planned.
On the other hand, the average child in America can not have its
usual amount of food safely curtailed, nor is it wise during childhood
to attempt, except in the case of cereals, to exchange or substitute
the important articles of food. The results of underfeeding or
indiscriminate food substitution in childhood are startlingly shown
abroad as a result of the war, and are beginning to be evident in our
own great cities.
i The circled figures used throughout refer to corresponding figures in the list of references found on pp.
30 to 31.

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M I L K , T H E IN D ISP E N SA B L E FOOD FOR C H IL D R E N .

Above all, the public must understand that milk is an essential
food, not only for infants but for children of all ages, for pregnant,
and nursing mothers, and for the sick and wounded.® Milk has no
substitute in the diet of the child. ® ® *‘The regular use of milk is the
greatest single factor of safety in the human diet.” Hitherto our
national health has depended largely on our use of dairy products,
for milk and its products have formed at least one-fifth of our national
food. To obtain this proportion of dairy products for the American
diet we have in the past had to import large quantities, especially of
cheese. Now such imports have entirely ceased.
Of European countries, Great Britain, Germany, Austria-Hungary,
and Belgium were formerly large importers of butter and cheese.
Such commodities were obtained largely from Scandinavia, Den­
mark,'and Russia ;® but England and Belgium can no longer get this
necessary food from Europe. Therefore the United States, which
hitherto has not produced enough for her own consumption and has
only exported relatively small quantities of dairy products, is called
upon to supply these countries as well as France, Italy, and our other
allies. Our export trade in 1917 in butter is estimated to have
increased 8 times, in condensed milk 16 times, and in cheese 26 times
over that of 1913,1 and our total export trade in these three articles
reaches now the equivalent of nearly 2,000,000,000 pounds of milk
(over 908,000,000 quarts) annually.®
EFFECT OF WAR ON THE PRODUCTION AND CONSUMPTION
OF MILK.

In Europe the milch cow has been sacrificed because of the neces­
sity for meat or the inability to obtain fodder, since large areas
of cultivated, fertile land have been laid waste or abandoned and
farm labor has been drafted into the army. The United States
must supply our allies’ lack in dairy products. The number of
milch cows in the->United States must be increased or the entire
world will face the calamity of a shortage in milk, the essential food
for the child. We do not realize, as Mr. Hoover points out, “ the
critical importance of maintenance of our domestic animals in a
period of food shortage. We can not even raise our own young
without them. ” ®
The need of the conservation and increase of dairy herds is shown
in the fact that the increase of population in this country has not
’ Exports of butter, cheese, and milk from the U nited States:


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Butter.

Cheese.

Pounds.
3,585,600
26,835,092

Pounds.
2,599,058
66,087,213

Condensed
milk.
Pounds.
16,525,918
259,102,213

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been accompanied by a relative increase in the number of milch
cows. To-day the United States produces only about a quart1 of
milk per capita per day. Moreover, the per capita milk production
has not increased since 1900 and will undoubtedly fall rapidly unless
immediate steps are taken to conserve and augment the number of
dairy cows in the United States. There seems to be a difference of
¡opinion as to whether our dairy cows have already begun to be
sacrificed owing to changes in the price of fodder and the fluctuations
tin, the demand for dairy products caused by increases in the price of
milk. That such a decrease in the number of cows will ultimately
result unless radical steps are taken to save the dairy industry seems
certain. As feed has increased recently 100 to 200 per cent in price
in this country, while the price of milk has advanced only 20 per
-cent, how can the production of- milk be a paying business proposi­
tion to the farmer who has to buy feed? As the United States
Department of Agriculture and the United States Food Adminis­
tration point out, it is a most short-sighted policy to permit the
; decline of the number of milch cows in the country, for it is obvious
that “ it will be easier to recover wheat acreage than the lost herds.
We should, moreover, as a war measure, take immediate steps to
increase the dairy cattle in the United States and to develop herds
in those sections of our country now without dairy interests, in order
that milk products may be available to all our people.
Butter, cheese, and condensed milk, because of their ease of trans­
portation and their high nutritive value relative to their bulk, are
the forms of milk that must be shipped abroad. The form that
should be used in this country, as will be brought out later, is whole
milk for the use of children and skim milk for household cooking and
commercial purposes. Roughly speaking, two-fifths or more of all
milk produced in this country goes into butter production and twofifths is used as milk. We may, then, estimate that per capita, if we
produce only a quart of milk, we use to-day less than 0.8 pint of this
quart as milk, and that this proportion is steadily falling.
It is indeed possible that in the near future the United States may
have to take the same steps that have been taken in England and in
Italy, regulating the sale of cream or even curtailing the use of butter,
in order that our Child population may receive the more adequate
and economical nourishment offered by whole milk. We may also
profitably study the way the Germans have controlled the milk situa­
tion. Germany protected the nutrition of her childern under 6
•U. S. Department of Agriculture giv es:© 105 gallons per capita annual production of m ilk in the
United States; 1.15 quarts per capita daily production in the United States. Assuming 40 per cent of
m ilkproduced is used as m ilk ,0.9 pint will he the average daily consumption of milk in the United States.
U. S. Food Administration giv es:® 70 gallons per capita annual production of m ilk in the United
States; 0.82 quart per capita daily production of milk in the United States. Assuming 40 per cent of
m ilkproduced is used as milk, 0.65 pint will he average daily consumption of milk.


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M I L K , T H E IN D ISP E N SA B L E FOOD FOB C H IL D R E N .

years of age by fixing the price of milk early in the war, and by insur-,
ing the use of milk for nursing mothers, weaned infants, young chil­
dren, and the sick. The adult civilian population in Germany has
been practically deprived of milk, as the army’s need is filled next,
and the total milk supply has fallen to 60 per cent of thè production
previous to the war.® ©
^
.......
i ^
Even before our Nation entered the war there had been a wide
increase in thè prices of our most important foods, as well as am
actual deficiency in certain foodstuffs. There seems also good e v i­
dence that the nutrition of our children had begun to suffer a cor­
responding deterioration.
■
f,
; ,0
In the autumn of 1917 the price of milk was advanced throughout,
the country about 2 cents a quart to the consumer, and must advance'
again unless the cost of distribution can be controlled or diminished.
As a direct result of the advance in the price of milk, in our large
cities less milk has been taken by the average family, especially by the
family with a small income. Because less milk was bought, less milk
was brought into the cities, and, as a result, demoralization o f the
dairy industry is threatened. Farmers will not produce market milk
at a price below cost or if there is any doubt of their being able to
dispose of their product.
In New York City, according to the report of the mayor’s milk
committee, the total supply of milk for the city is stated to have been
reduced 25 per cent and the consumption of milk in certain sections
of the city-—the tenement region—to have decreased 50 per cent.
Both of these changes were attributed to the increased price of milk
this autumn.
b
A survey was made including all the boroughs of New York City
during the second week of October, 1917, under the joint auspices
of the department of health, the New York Association for Improving
the Condition of the Poor, and the mayor’s committee on milk.®
Information was obtained from 2,200 families each containing two
children under 6 years of age. The striking feature of this report
is the proof that in certain sections of the city the quantity of milk
used by infants and children had been reduced, due to the increased
cost of milk, below the minimum necessary for the maintenance of
health..
,
The information collected in this survey was as follows:
The 2,200 families visited represented 12,439 individuals, of which 4,467 were
adults, 2,534 were children from 6 to 13 years old, 5,438 were children under 6 years.
The total amount of milk purchased b y these families at the present time is 3,193
quarts daily; a year ago it was 4,797 quarts daily. This represents a decrease of 1,604
quarts. This decrease, to be sure, is slightly offset by an increased consumption of
condensed milk, according to the survey, of 141 tins daily.
It is well tò compare these figures with the following estimated amounts which
physiologists and pediatrists regard as the normal milk requirement *' * * 8,194
quarts: 121 families 'viere getting more m ilk than they did a year ago, 599 families


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were getting the same amount, 1,480 families were getting less milk, and of these 120
families were getting no milk; 420 families were getting more condensed milk.
Of the 120 families which had dropped milk altogether, 73 substituted canned con­
densed milk, 909 of the 1,480 were getting from 25 to 50 per cent less milk, and 1,213
of the 1,480 families were substituting tea and coffee for milk,
In the 2,200 families visited, 982 had babies less than 1 year of age. Of these 582
received less milk than in 1916, 316 received the same amount, 79 received more milk
than in 1916, and 25 had dropped milk entirely.
Of 807 families 268 had changed from grade A to grade B milk, 67 had changed
from grade B to grade C milk, and 474 had changed from bottled to dipped milk;
2,148 children under 6 years of age were drinking tea and coffee.

A similar state of affairs is threatening to develop throughout the
country, and it is time for the Nation to realize what will result from
a decreased use of milk by our children. It is the duty now of every
individual community to see that its children have milk of good
quality and in sufficient amount to assure their normal development.
To do this the price of milk must be controlled or fixed, and the milk
supply to infants and children carefully safeguarded. The malnu­
trition of our children was, even before 19J.4, a serious national
problem and one demanding urgent attention. Poverty and ignorance
of-dietary essentials have been ever-present factors in the malnutri­
tion of the young, and war conditions can not fail to increase the
gravity of the situation and the difficulties of maintaining the health
of the Nation.
THE NATURE OF MILK AS A FOOD.

Milk is often stated to be a perfect food. By this we mean that
it contains all the essential elements for normal human growth and
development.
The adequacy of a food or diet depends briefly on its containing: ©
1. Enough of the right sort of material to build up and repair the
living tissues of the body. These body-building substances in the
food are called proteins, and are found especially in milk, meat, fish,
eggs, and in certain vegetables, especially beans and peas.
2. Enough substances to furnish the required energy of the body.
Fats, starches, and sugars are the chief energy foods, and are trans­
formed in the body into energy for work and into body heat.
3. A variety of .mineral substances, which are needed in the growth
and functioning of the parts of the body, such as the skeleton, the
brain, the blood, etc.
4. An adequate amount of certain substances whose nature is not
yet fully known but whose presence in the diet has been demon­
strated to affect body growth in animals or man. These substances,
known as vitamines, growth determinants, or the unknown dietary
factors, are therefore essential elements in our food.
5. No substance poisonous to the average individual nor one which
will not allow of normal digestive processes.


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M I L K , T H E IN D IS P E N S A B L E POOD FOR C H IL D R E N .

In addition, to be properly digested and of the utmost nutritive
value, articles of diet must also be of pleasing taste, palatable, and
preferably of a consistency and appearance similar to the foods m
customary use by the race.«
Clean milk fulfills all of these requirements for an adequate food
better than any other single foodstuff.
Milk is, then, in a sense, .a complete food; if used as the sole food
it will sustain life and allow growth. It is used as an exclusive diet
for young children, but after infancy supplementary foods need to
be included in the diet for the best development. For one reason,
milk— which, jn respect to all its ingredients, ranks among the most
digestible of animal foods—is so completely digested that there is
practically no waste. Though this complete digestibility renders
milk one of the most efficient foodstuffs, a certain amount of noildigestible material in the food—so-called roughage— is necessary to
regulate the discharges from the digestive» tract. For this reason,
and for several othere, a mixed diet after the first year of life is better
than an exclusive mille diet.
Milk has in the curd a protein of a more valuable nature in regard
to its ability for building or renewing body tissues than that found
in vegetables or even in meat. There is no other animal protein
procurable at so low a price. © ©
Milk as a source of energy, or as fuel for the body, compares most
favorably with other foods. The energy value of a quart of milk is
about equivalent to that of a pound of lean meat or to eight eggs.
As a source of energy cereals are, however, far cheaper than either
milk, meat, or eggs; and, therefore, cereal and milk is the ideal combi­
nation of foods to furnish body energy in childhood.
Calcium salts (lime), supplied in our food, are necessary not only
for bone formation but for the development of the important organs
of the body, especially the glands of internal secretion.
Of all foodstuffs milk is the cheapest and most abundant source of
calcium and milk also provides other'important mineral salts, such as
potassium and phosphorus. Therefore, since growth is measured by
bone formation, and since the child must have a steady abundant
supply of these essential minerals, milk should be included in every
child’s diet.
Relative amount o f calcium, oxide.
.38gms.

In 1 cu p milk.
.11

In b cup carrots.
In 1 egg..............

In 2 slices of bread..

.05
.01


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{Blunt.) (§)

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Scale of i00. '

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Unfortunately cows’ milk is low in iron content, even as compared
with human milk, and this important mineral must be supplied in
other foods. The prolonged exclusive use of milk after early infancy
tends to produce an anemia from lack of iron in the blood. Iron
can best be introduced into the diet through the early use of fruit,
vegetables, and whole cereals.
The abundance, character, and digestibility of its proteins and its
large mineral content make milk, as we have shown, a most desirable
food; but, after all, the most valuable properties of milk lie in its
containing an abundance of the unknown dietary factors-—the
vitamines which control growth and health. One such substance is
found chiefly in milk fat and the organic fat of certain other animals,
but is not present in vegetable oils or in pork fat. Eggs and green
vegetables, such as spinach and chard, do contain appreciable amounts
of this vitamino, but milk is our chief source. The cream of a quart
of milk contains as much of this vital substance as is found in all
the skim milk left after the cream is removed. A second recognized
vitamine is present in all foods consumed in their natural state and
in sufficient abundance to maintain health. In the manufacturing
of purified foodstuffs, such as the polishing of rice or in the milling of
flour, © @ this substance may be lost, and a diet made up entirely
of denatured foods may cause disease or even death, due to a de­
ficiency in this essential substance.
A food like milk which, given in moderate amounts, combines
enough of both of these vitamines to allow of normal growth and
development, has a value in the human dietary greater than that of
any other single food.
It is true that appetite in many cases has to be considered, and an
exclusive diet of any single food substance becomes distasteful to
the large majority o f us and tends to lower digestive processes and
to cause impaired nutrition. However, this does not mean that the
child should be allowed to refuse milk as a substantial part of his
daily diet, if the diet includes, as it should, several other forms of
food. All normal children are better for at least 11 pints of milk a
a day. Poverty, of course, may prevent this amount being provided
for every child, but, if her means permit, the mother who does not
furnish sufficient milk for her children and train them to drink it is
not fulfilling her duty. Healthy children can be made to like a varied
diet, to eat what is good for them, and to finish the entire meal
provided. Patience, persistence, and tact are needed to teach
proper food habits to the young, and, to be effective, this discipline
must be maintained from birth.
Milk may be given to the child in cooked form, as soup, weak cocoa,
or flavored milk shake.® If used as a drink, it should be taken


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M I L K / T H E IN D ISP E N SA B L E FOOD FOR C H IL D R E N .

toward the last of the meal, for many children will not take sufficient
other food if they fill themselves up first with milk.
Children who have too rich or too abundant a diet may seem to
do better with less' or even without any milk, but here the fault is
not primarily the quantity of milk but the total amount of food.
On the other hand, an exclusive milk diet after the first year is.
ultimately harmful, and milk should not be included in the diet o f 1
the child to such an extent as to prevent the taking of an ordinary
amount and variety of food. Many children can take and thrive
on a quart or more of milk a day. Very rarely a child has an idid-1
syncrasy for milk protein and is made violently ill by milk.
W HAT KINDS OF MILK CAN BE USED FOR INFANTS.

Among the lower animals the young are not as a rule bom until
near the period when they can dispense with maternal nourishment
and forage for themselves. It is important to keep in mind the fact
that the human infant was evidently intended to be dependent on ;
the mother’s nourishment for at least the first year of life, as the
infant does not develop teeth nor acquire the power of taking other
than liquid food for many months after birth.
Any infant that has to be artificially fed during the first months
of life is then in a sense a premature child, as it has been deprived of
maternal feeding long before the normal period of separation from
its mother. The giving of any other food than human milk to a
young infant is, therefore, introducing a foreign substance into its
partially developed digestive system, the dangers of which vary with
the individual as well as with the composition of the artificial food
selected and are still little appreciated.
/*
BREAST MILK: THE BEST FOOD FOR BABIES.

For these reasons breast milk— the natural food for the human
young— is the best food under any circumstances for the young
infant. There is nothing “ just as good” as mother’s milk. The
fact that the milk of a particular woman may not agree with her
child or that it may be inadequate does not alter the truth of the
general proposition: Breast milk is best fo r babies. Never before
in the history of civilization has it been so urgent a matter that every
child should have breast milk for as long a time as possible, in order
that every child that survives birth may have the best chance for
life and health. Never before have so many nations had to count
on replacing the man-power lost in war by the infants born to these
nations. To-day the survival of great races depends on the con­
servation of child life.


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Also, never before has there been greater stringency of foodstuffs
x in the entire world, or greater urgency for economy in every Amer­
ican home. Whatever the present percentage of artificial feeding
among our young infants, and it is sometimes estimated that one-fiftli
of all infants under 1 year of age are weaned before the fourth month
of life,1 two things may be positively stated. The first is that taking
the infants who survive the accidents and perils of birth, undoubtedly
those infants who are artificially fed die during the first year of life in
a far greater proportion than those breast fed for at least the first six
months; and the second point is that, judging by the work done in our
large cities in the past few years, the number of children breast fed
and the length of period of breast feeding can be greatly increased by
careful supervision of the mother before and after the birth of the
child.
Breast feeding during war time is a high patriotic duty as it is a
sure method of reducing infant mortality and of conserving the
national food supply. Breast feeding is better for the child, better
for the mother, and incidentally better for the family pocketbook.
If other nations have already made a patriotic appeal to mothers
to share their breast milk with children other than their own, surely
the American mother will help win the war by nursing her own
child for as long a period as it can thrive on her milk and by length­
ening this period by every effort in her power.
ARTIFICIAL FEEDING OF YOUNG CHILDREN.

The only foods that we have that were intended as the exclusive
food of young animals are milk and eggs. If we except the germ of
seed all other substances suitable for their nourishment are taken
from partially or fully grown animal or vegetable structures. For
this reason we should expect milk, eggs, and the germ of seed to
contain the vital elements for the maintenance of young life, and all
experiments go to prove that they do.
Unfortunately, egg and seed do not lend themselves to the early
or exclusive feeding of the human infant. To be sure, nfants in
Japan are occasionally fed even from birth on a soy-bean mixture,
but considering the difficulties and dangers of such substitution, *and
judging by the high infant death rate in Japan, it seems superfluous
to argue for any other principal form of artificial food for the infant
than some form of milk, when this can be obtained.
COW S’ M IL K : TH E BEST SUBSTITUTE FOR BREAST MILK.

Although cows’ milk, as compared with milk from other domes­
ticated animals, such as the goat, is not in some respects nearest in
1 In the nine cities in which infant m ortality studies have been made b y the Children’s Bureau, it was
found that of the 21,962 infants who lived to be 3 months of age, 4,457 or 20.3 per cent had been weaned.


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composition to human milk, the development of the dairy cow has
brought about its almost exclusive use in this country as a substitute
food for infants.
The fact can not be challenged that for children under 2, other
than those breast fed, cows’ milk is an absolute necessity if disease
and death are to be kept within bounds and if the coming generation
is to survive and is to sustain the national standards^ Milk for the
use of our allies and our soldiers in the field must bo supplied, but it
is equally necessary that the young children of the United States
should be furnished with a supply of cows’ milk, sufficient to form
their chief source of food and adequate to produce in them normal
growth and development. Production must be increased, and the
price of milk and use of dairy products by the adult home population
controlled, if necessary, to assure our children this indispensable
food. “ Children first” must be part of the national food slogan.
Cows’ milk having been accepted as necessary during the early
years of life the question next to be settled is what form of cows’
milk—raw, pasteurized, sterilized, partly evaporated, or dried—is
the safest, and the best adapted to the nourishment of our children,
and which type of milk is best suited to transportation and available
in all localities.
In general, we must grant that cows’ milk to be a safe food for
anyone must be clean and free from the germs of disease. In regard
to an infant’s food these points are even more important than in the
question of food for older children or adults.
Cows’ milk should not only be pure but the fresher it is and the
fewer manipulations it has been subjected to, the less possibility
there is of its having been altered in any of its essential properties
as a complete food. Our knowledge of the fundamental nutritive
qualities of milk is still incomplete, so that we can not absolutely
affirm that heat, chemicals, or mechanical manipulation do not in
some essential way alter its nature as a food.
For these reasons fresh, clean, raw cows’ milk is the ideal form of
artificial food and therefore the most desirable for the human infant.
The modification of cows’ milk to adapt it to the needs and digestive
ability of the average child is covered in another bulletin of the
Children’s Bureau, Infant Care, and will not be discussed here.
P A S T E U R IZ E D M ILK .

Even though pure cows’ milk is the milk of choice for infants,
it is not always possible to obtain raw milk in a state suitable to be
fed to a young infant. Milk fit to be used raw must be produced
under conditions which insure rigid, scientific inspection of the dairy,
the cow, and the care given to the milk, and which also allow of the


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THE

IN D IS P E N S A B L E

FOOD

FOR

C H IL D R E N .

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milk being used in a relatively short time after it is produced. In
our large cities— where milk has to be furnished to thousands of
infants, where it has to be supplied from a large number of small
and large dairies so that adequate inspection is difficult, and where
it must be transported long distances and kept for a long time—
ordinary raw milk is not a safe food for infants.1 Safe raw milk
can be obtained in our large cities, but only at a price prohibitive
except to families with incomes far above the average.
The question of pasteurization must, therefore, be briefly con­
sidered.® In 'pasteurizing milk it is generally heated to 145° F.
and held at this temperature 30 minutes. This process when done
by the best commercial methods, destroys 99 per cent of the bacteria
(germs) present in milk and considerably delays its souring. How­
ever, the important result of pasteurization is that, i f properly done,
it effectually kills any disease germs likely to be present, such as
the germs of tuberculosis, diphtheria, or typhoid fever. For this
reason, to render milk a safe food for the infant population, pasteuriza­
tion is carried out to some extent in the majority of our cities of
10.000 inhabitants or over and 50 per cent or more of the milk that
is used in seven of our largest cities is pasteurized.
Pasteurized milk is not sterile, and it will not keep unless quickly
chilled and kept ehilled until used; and it should be used within 36
hours after being pasteurized. Stale pasteurized milk may be more
dangerous than stale raw milk, because putrefaction, if started, will
progress more rapidly in milk which has been pasteurized.
ST E R IL IZ E D M ILK .

The further question of sterilization of milk raises another point.
Milk boiled, or heated to 212° F., is often spoken of as sterilized
milk. Milk is not sterile, that is, free from all forms of living organ­
isms, unless it* is subjected to this high temperature for an hour or
more, and on successive days. Boiling for five minutes does kill
all ordinary bacteria and does render milk for all intents and purposes
a sterile food. Boiling, however, changes the chemical and physical
properties of milk quite appreciably, which is not true, at least to
any marked degree, in the case of pasteurization. The curd of
boiled milk is distinctly more digestible, though more constipating,
than the curd of either raw or pasteurized milk, since the curd of
i The requirements of a pure m ilk vary greatly in different localities. In New Y ork City a grade A
mm<■ (raw) must have come from a tuberculin-tested herd in good physical condition and from a dairy
scoring at least 25 points on equipment and 50 points on m ethods; its bacterial content must not exceed
60.000
per cubic centimeter, and it must be delivered in labeled bottles 36 hours after production. A grade
A m ilk (pasteurized) must have come from healthy cows examined annually and from dairies scoring at
least 25 points on equipment and 43 on m ethod; its bacterial content must not exceed 30,000 per cubic centi­
meter and no m ilk supply averaging more than 200,000 bacteria per cubic centimeter shall be pasteurized
to be sold under this designation; it must be delivered m labeled bottles within 36 hours of pasteurization.
In so-called “ certified” m ilk the requirements are even more stringent than for grade A milk. The greater
part of the milk consumed in this country is below grade A requirements.


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M I L K , T H E IN D ISP E N SA B L E EOOD FOB C H IL D R E N .

milk which has been subjected to such a high temperature forms a
fine, easily broken down clot in the stomach.® This modification
of the easein or curd of cows’ milk to render it more like the curd of
mother’s milk and therefore more digestible can be brought about,
however, in several ways other than by boiling.
The possibility of the change or loss of some of the essential nutri­
tive properties of milk by the effects of high temperatures has been
much discussed and very generally disagreed upon, especially the
effect of heat on the mineral matter and on the undetermined factors
which induce growth— the vit amines. ® (§>(§) Boiled milk, however,
has been used very extensively in Europe for the feeding of young
infants and with apparently great success.
CANNED M ILK.

To-day, in large areas of our country there are no milch cows.
In other large areas, including some of our big cities, it is becoming
increasingly difficult to obtain a good grade of bottled milk, raw
or pasteurized, at a price thought possible by the average parent.
The dangers and delays in transportation, the difficulties of distribu­
ting milk rapidly and in an iced condition, the expense of this rapid
transportation, distribution, and' refrigeration are such that the
question of canned milk for infant feeding is forced on our attention.
Milk in a condition allowing of safe transportation for long distances,
is at the present crisis a necessity. The problems arising from war
conditions, especially our duty to assist our allies in feeding their
child population, the necessity of our maintaining an adequate
food supply for our own soldiers in cantonment at home or abroad,
and the possibility in the near future of having to supplement the
food of our men in prison camps in Germany if their starvation is
to be averted ® — all these are additional circumstances which force
us to consider the varieties and relative merits of different forms of
canned milk.
As regards infant feeding, there are four kinds of canned milk
now available:
Certain proprietary or patent foods.
Condensed milk (sweetened).
Evaporated milk (unsweetened condensed milk).
Dry milk or milk powder.
The relative merits of each of these will be briefly discussed.
C E R T A IN P R O P R IE T A R Y O R P A T E N T FO OD S.

Proprietary or patent foods, so called, are of two types. We may
divide them into class A, those having milk— usually in the form,
of dry milk— as one of their ingredients, and class B, those having
no milk in their composition.®

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The latter class of proprietary foods consists largely of combina­
tions of sugar and starch, which are of no greater efficiency in an
infant’s diet or for the nourishment of older children and invalids
than certain flours, cereals, and sugar purchasable in bulk and at a
much lower price in any grocery store. Patent foods of this type
should be used only in combination with cows’ milk, and they are not
a complete food without this milk. As modifiers of milk, or additional
foods to be used with milk, they are an unnecessarily expensive product.
Proprietary foods of class A embrace those forms of patent
food containing milk in their combination. They may or may not
be a sufficiently complete food for an infant, but they all have the
disadvantage of being considerably more expensive than is necessary
for an adequate infant food. The foodstuffs present in any pro­
prietary food can be purchased more reasonably uncombined and
these ingredients can be combined more judiciously for each infant
separately than when given out under a trade name for the whole
infant public. Infants have been reared successfully on patent
foods, but many infants have been unnecessarily sacrificed to the
hit-or-miss principle of prescribing one combination of foodstuffs to
meet the need of all children.
C O N D E N S E D M ILK (S W E E T E N E D ).

What is commonly known as condensed milk is a sweetened milk.
Evaporated milk is an unsweetened condensed milk. Commercially,
condensed milk is usually made by adding to fresh milk large quan­
tities of cane sugar, heating the milk to dissolve the sugar, and then
evaporating the whole, until its bulk is two-fifths that of fresh milk
or less, and its sugar content is about 40 per cent by weight. Sweet­
ened condensed, sweetened evaporated, or sweetened concentrated
whole milk under our food and drug regulations must be the product
of evaporation of whole, fresh, clean cows’ milk and must contain at
least 8 per cent fat and not less than 28 per cent total milk solids.®
The product is heated to a considerable temperature for a short period
to dissolve the sugar, but it is notsterilizedin the canning.® The high
percentage of sugar, however, tends to preserve it. Since the heat
used in the entire process is only from 180° to 200° F., and is applied
for a brief time, the more resistant forms of germs may persist in such
milk, though they do not grow or increase in a properly canned
product.
Condensed milk is a semifluid substance of a very sweet flavor, and
is put on the markets in varying sized and priced cans. The high
sugar content of this milk practically prevents its freezing in trans­
portation, so that it has been the chief form of canned milk shipped up
to this time. If made properly it will keep well until opened, but it is


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M I L K , T H E IN D IS P E N S A B L E ' FOOD FOE C H IL D R E N .

best when fresh. Once opened this form of milk tends to spoil and
should be taken from the tin, kept iced, and used within a very few
days.
This product was the first form of canned milk put on the market.
The early French inventions along this fine, dating back over a hun­
dred years, are said to have been called forth by Napoleones efforts to
obtain a milk that could be transported for the use of his armies. It
is interesting to note here that canning milk first became a successful
business enterprise because of the urgency in this country of feeding
the soldiers of the North in the Civil War.® Milk was demanded that
would keep under transportation and still be of _a bulk to make trans­
portation possible. The condensed milk business receivod a tre­
mendous impetus at this time.
During the present war, the demand for canned milk has again
become insistent, and its production, especially for export trade, has
been greatly stimulated. The use of canned milk will undoubtedly
become widespread, both in this country and in the countries of
Europe, and it is most essential that the best forms of these products
shall be generally used, especially the canned milk which is- best
adapted for nourishment of infants and young children, and for use
as a food for convalescents.
Sweetened condensed milk has been used in the feeding of infants
for several generations and has been also of considerable use in the
general nourishment of the household. As an infant food it has the
drawback of an enormously high sugar content. With a 40 per cent
proportion of sugar (sucrose), condensed milk must be so diluted for
the average infant that the percentage of the other ingredients of
the original milk is brought below the proportion best adapted to
growth and development, if we take woman’s milk as the standard.
If the sugar content is left high by diluting the milk less, frequent bad
results from the intake of too much sugar or from sugar indigestion
occur. Children who apparently thrive on condensed milk— that is,
who can stand a high sugar food— are not found as a rule to have a
good muscular development; though often fat, they are flabby and
pale and do not show the average resistance to disease. Animal
experimentations also go to prove the relative inadequacy of con­
densed milk as .food for the young.® Condensed milk is not sterile
and so may- possibly contain disease germs. It spoils if left open to
the air, or if not kept iced, and must be used up quickly after being
opened. These are additional reasons why condensed milk is not
a safe food for infants in the hands of an average mother, without
medical supervision. For occasional use, or for use as a food in certain
emergencies under the skilled direction of a competent physician,
condensed milk has served a useful purpose.


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It is, however, certainly not the form of canned milk to choose for
the adequate nourishment of children or adults where fresh milk
can not be obtained and transportation of food products from too
great distances must be considered. We should also recognize that
condensed milk has the disadvantage of a high water content even
after evaporation, and is unnecessarily bulky for shipping.
E V A P O R A T E D M ILK (U N S W E E T E N E D C O N D E N SED M IL K ).

Commercially, this product, is made by taking fresh milk, adding
nothing to it, evaporating it down to one-half or two-fifths the original
bulk, placing it in cans, and then sterilizing the contents by subjecting
the cans to steam under pressure. The temperature must be “ high
enough and maintained long enough to insure absolute sterility to
the product and to give the milk sufficient body to prevent the
separation of the butter fat in subsequent transportation and
storage.” ©
.
It is a difficult matter in the process of condensing or evaporating
milk to have a product of a uniformly good quality and composition,
or to be able to detect such faults. Any form of condensed milk will
usually give unmistakable evidence if it has spoiled before opening,
and hence there is little danger of putrid canned milk being used.
There are, however, two real dangers in the use of any condensed
milk. One lies in the fact that the quality of milk used in canning is
frequently not the best; also in the case o f sweetened condensed milk,
an unsterile product, the possibility of disease germs surviving in
poorly processed milks must be considered. The second danger is
the fact that once opened condensed milk or evaporated milk is
easily contaminated, deteriorates rapidly, and so becomes unfit for
use as an infant food.
Evaporated milk has the consistency, taste, and appearance of
thin cream. If properly made it is a sterile product and will keep
unopened indefinitely, but it is stated to be “ best when fresh.”
The regulations governing evaporated milk under the pure food and
drug laws are those governing all condensed whole milks, but it must
contain not less than 25.5 per cent of total solids, and 7.8 per cent of
milk fa t.© The relative proportion of the original ingredients of
milk—-the so-called “ milk solids” — is about the same in the analyses
given of sweetened condensed and evaporated (unsweetened con­
densed) milk. The sweetened condensed milk differs not only in the
high content of cane sugar but has as a rule each of the milk solids in
a slightly higher proportion probably due to a greater degree of con­
densation than is usual in evaporated milk.


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M IL E , THE INDISPENSABLE FOOD FOB CHILDREN.

Average composition (Hunziker). @

Condensed
(sweetened).

W ater...............................................................

26.5
9.0]

Milk solidsj

sugar.................................
lash.
........................
Cane sugar.......................................................

Evaporated
(unsweetened
condensed).
73.0
8.31

i ! : i 32- 6
1.8]
40.9
100.0

27.0
1.5)
100.0

Evaporated milk, if used when the can is first opened, is a safe
food, because it is free of all germ life. It resembles in this point
boiled milk, and like it, is superior in point of sterility and also in
digestibility to pasteurized or raw milk, since the digestibility pf
both the fat and casein is probably increased by the exposure of the
milk to high temperature in processing.
The butter-fat, milk-sugar, and mineral content is not appreciably
altered in quantity by condensation, but the minerals are rendered
less soluble by the process of sterilization. In the process of con­
densation some of the protein or curd is lost from the mechanical
adhesion of the curd to the heated surfaces. The effect of the change
in solubility of the minerals present has not been found to cause any
appreciable difference to the child. From the feeding experiments
recently conducted on animals, it does not seem probable that either
of the vitamines, so far determined, is injured by high temperature.
B y diluting with equal parts of sterile water, evaporated milk can
be reconstituted approximately as ordinary milk.
Evaporated milk has been and can be of great use in the general
nutrition of the household, and it certainly has a more tenable place
in the feeding of infants and young children, when fresh milk can
not be obtained, than condensed milk. We must recognize the facts
that it will freeze, and is therefore not suitable for transportation in
cold weather; that it must be carefully handled after opening if it
is to remain a sterile food and one fit to give an infant; and that
even though condensed to one-half to two-fifths of its original bulk,
it is still bulky to transport. Also all condensed milk is relatively
high in price as compared with a grade A raw milk. Condensed milk
is now retailing at 25 cents and evaporated milk at 15 cents a pound,
and since both these milks are reduced one-half or more in bulk,
these prices are about the price o f* l quart of reconstituted milk.
All these reasons make evaporated milk far from the ideal substitute
for fresh milk.


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D R Y M ILK O R M ILK P O W D E R .

The dry-milk industry began as a means of saving the skim milk,
the by-product in the manufacture of butter and cream. On many
farms to-day great quantities of skim milk are still wasted or
uneconomically used in the feeding of animals. The movement to
utilize this product in fnaking more skim-milk powder or in the
making of skim-milk cheese is an enterprise that should meet with
the cooperation and assistance of all interested in the proper nourish­
ment of our population.
Milk powder is now made in over 30 factories in this country® and
by at least four essentially different processes.1 Skim-milk powder
was the first type produced in this country and is still the principal
form on the market. It has a wide wholesale demand for use in
bakeries and in the manufacture of ice cream and milk chocolate,
The retail sale of any milk powder has never been great, and the use
of skim-milk powder in family cooking has never received the attention
which this valuable form of protein food deserves.
Milk is now also dried as whole milk, as milk with one-half the fat
removed (half-skim milk), and as buttermilk, while the different
constituents of the milk itself— the butter fat, casein, whey, or m ilk
sugar— are separated by certain dry-milk concerns and put on the
market as powders.
Under the food and drug regulations dried milk must be “ the
product resulting from the removal of water from milk, and contain
not less than 26 per cent milk fat and not more than 5 per cent of
moisture.” ©
The essential point here as in every canned-milk product is that
the original milk shall be of a high quality. No good canned m ilk
can be produced from stale or impure milk.
After the question of the quality of milk used is settled, the impor­
tant thing apparently in all processes now used in preparing m ilk
1 The principal processes b y which dried m ilk is made to-day are briefly as follows:
A . M ilk is fed in a thin stream over tw o steam-heated cylinders or drums, about one-eighth of an inch
apart and revolving in opposite directions. The milk exposed to the heat of the cylinders dries as a thin
film and comes off the revolving cylinder as a sheet, which is easily crushed into a fine powder. The
cylinders, which are some 60 inches long and 24 inches in diameter, are charged w ith steam under tw o or
three atmospheres of pressure causing the heating surfaces to have a temperature of about 250° to 280° F.
This process, known as the Just patent in the United States and as the Just-Ha tmaker patent in
E ngland, is said to be the invention of J. It. Hatmaker, of London.
B. The m ilk is first pasteurized and then condensed in the vacuum pan at a low temperature (130° F .)
to about one-fourth o f its bulk. This condensed product is forced under high pressure through minute
openings in a metal disk into a hot-air chamber. The atomized liquid surrounded b y a current of hot air
instantly dries and falls to the bottom of the chamber as a snowy powder, the moisture rising as a cloud
of steam. The mixture, of the liquid and air in the evaporating chamber is stated to be about 180° F.
This m ethod was originally developed in France and is called there and in England the Bevenot de Neveu
process. In this country it is known as the Merrell-Gere process.
C. A third method of making dried m ilk, b y reducing it to approximate dryness in a vacuum pan
equipped with a mechanical stirrer, is also used in this country. It has the advantage of exposingthe ■nilito a low though prolonged temperature.


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m i l k , th e indispensable food fob ch ild ren .

powder is the degree of heat; and the period of heating of the milk
in the process of drying. The processes differ very materially in
these points, and it is difficult to tell exactly whether the properties
of milk are more apt to be changed by being held at a low temperature
(approximately 145° F. in process C) for hours, or at a high tem­
perature (approximately 175° F. in process B or 275° F. in process
A) for a very short time. Theoretically milk should suffer greater
change the higher the temperature to which it is subjected, so that
milk put out by processes in which a temperature not over 180° F.
is used ought to be preferable. Such dry milk has the property of
being completely soluble and of reconstituting in cold water, which
is a tangible advantage.
In the early days of manufacturing milk powder, before the fresh­
ness of the milk was insisted on, some form of alkali was commonly
added in the process of drying to neutralize the acidity of the milk;
as well as to render the casein more soluble. Cane sugar or malt
sugar was also frequently added.
By the perfection of the different steps used in the process, and
especially by control of the temperature employed, milk powder
to-day can be made of milk or any of its constituents without the
addition of any foreign substance and yet be completely soluble in
water. In the best preparations of dry whole or half-skim milk the
constituents are also little, if any, altered from their natural state in
fresh milk. The butter fat retains the globular form and readily
emulsifies when mixed with water, the actual size of the fat glob ides
are apparently reduced by the drying process, the albumen is hot
coagulated, and the casein is not toughened in drying and is still
miscible in water. From recent animal experimentation it seems
positive that the growth-promoting property of fresh milk is not
appreciably diminished in milk powder made by the best methods.
Whether or not dry whole milk is a complete food or whether, like
sterilized and pasteurized milk, when fed alone to infants it may
occasionally produce some degree of scurvy can not be definitely
stated. In France and England, where it has been most used as an
infant food, <§) no evidence is offered to show that scurvy follows its
long or exclusive use.
Fermentation or bacterial decomposition of milk powder can not
occur, as bacterial action does not take place in a substance with
a moisture content under 5 per cent or 3 per cent as it is in the best
milk powder.
All products containing milk fat keep better when placed in the
cold and not exposed to light or »air. One great drawback to the
production of dry whole or half-skim milk has been the fact that
the powder made by the old methods quickly became rancid. The


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manufacture of dry milk has been so improved that even dry whole
milk is now put up in a form by the best processes that will keep
unopened for at least a year and for many months even when opened
without the detection of any rancid or “ tallow” flavor, which is the
first sign of deterioration. Nevertheless, the production of dry milk
should be carefully regulated to meet the demand, and all canned
milk should be dated to insure its use as food within a reasonable
period.
.;
...
-*
Dry milk is put up in tin receptacles of different sizes, the price
per pound varying with the manufacturer and the nature and char­
acter of the milk dried. Dry skim milk in bulk at wholesale sells
as low as 24 cents a pound and dry whole milk at 42 cents a pound,
which gives a whole milk, when it is properly reconstituted, at about
11 cents a quart. (January, 1918, prices.) The best brands of milk
powder put out specially for infant use, however, retail at a price
which is equivalent to milk from 12 to 20 cents a quart.
In infant feeding, milk powder has been of late years widely used
by physicians in Belgium, France, and England, and with apparently
great success, as far as can. be judged by reported normal gains in
weight and other evidences of good nutrition in children fed exclu­
sively on this form of milk. Physicians in our large cities and in
Germany have also recently been experimenting in the use of dry
milk for infant feeding.
The good points about dry milk may be briefly stated as follows:
(1) Increased digestibility, (2) bacterial purity, (3) keeping quali­
ties—no ice needed, (4) convenience— always ready, (5) palatability,
(6) cheapness— no waste, (7) transportation advantages—small bulk,
does not freeze. Against dry milk it can be said that it is a canned
product, a food subjected to high temperatures in the process of
manufacture, and that there is no guaranty of the quality and
cleanliness of the original milk.
Apparently, if we can judge by the experience abroad, dry milk
from which half the cream approximately has been removed before
drying, so-called “ half-skim ” dry milk, has distinct advantages in
the feeding of very young infants. Possibly this is due to the fact
that in the dilution of this milk a mixture relatively high in protein
and sugar and relatively low in fat is obtained without the addition
of extra sugar or casein, and such a mixture has a high enough
nutritive value to produce normal growth. In older infants—those
over 6 months of age— dry whole-milk mixtures are advocated and
would seem theoretically advantageous, since at this age the child
needs and can digest more fat, and the relatively low sugar of whole
milk can be supplemented by cereals or by sugar, as is usually done
with older infants fed cows’ milk.


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M IL K , TH E

IN D ISP E N SA B L E FOOD FOB C H 1L D B E N .

The following table of the relative composition of dried (1) whole
milk, (2) half-skim milk, and (3) skim milk, is taken from Pritchard.®*
Average percentage composition.
Casein.
1. Full-cream m ilk . . .
2. Half-cream m ilk ...
3. Separated m ilk ___

24.50
30.58
31.40

Albumen.
1.94
2.42
2.49

Sugar.

Fat.

Caloric
value per
ounce.

38.92
39.70
55.00

28.00
15.10
1.00

146 cal.
119 cal.
104 cal.

The composition of whole dried milk has been specially studied
by a number of authorities, and all agree that the milk solids are
increased about eight times that of the original milk. 'Therefore
to reconstitute an average milk with a fat between 3 and 4 per cent
one part of milk powder should be taken to eight or eight and a half
parts of water.
Composition o f whole dry milk. ® A
Fat................................... approxim ately.. 25 to 28 per cent.
Protein................................. ......................... Practically same' as fat.
Sugar............... ......................................... . . 34 to 40 per cent.
A sh................ ................. ....... ................. , . 6 to 7 per cent.
Water.............................................. ............. 5 to 7 per cent.

An interesting report on the analyses of specimens of dry milk
from different countries has been made by Sommerville, @ 71who gives
as the mean analysis:
Fat.................. ................................................ . ............................. 28. 5
Sugar............ ................................................... ............... ........... . 36.8
Protein......... . . . .......................................................................... 24.3
Salts......................................... ........ ................... ......................... 5.6
W a ter. ..................................................................... .
4.8

The fact that the powder form of dry milk makes it possible to
give it in as concentrated a form as desired— that is, with any
quantity of water—makes dry milk a particularly useful form of food
in cases of certain types of vomiting in infancy or wherever small
amounts of fluid of high nutritive value are required.
The desirability of milk powder— the most concentrated form of
milk—for use in traveling or for transportation to places where fresh
milk is not available is self-evident. The French picturesquely
characterize dry milk as “ la vache en placard,” “ the cow in tile
cupboard.” There are also certain occasions where for the sake of
economy, even when fresh milk is available, dry milk seems to have
a legitimate use to-day. Such a. situation might occur when only
one bottle feeding a day has to be given to an infant whose parents’
means are limited.
For dispensary, hospital, or day-nursery use milk powder is
distinctly more economical than any other form of cows’ milk, for


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the cost of all equipment, including kitchen outfit, ice, refrigerating
xplant, and the large number of bottles is eliminated, as well as much
of the service needed to prepare and dispense milk preparations.
The use of dry milk, as directed by a physician, needs only the equip­
ment and intelligence to boil water and measure in tablespoons.
The only other canned milk which stands any comparison with a
good milk powder for inf ant use is evaporated m ilk.. This product,
however, has been sterilized at high temperatures for a long period,
which may or may not affect the essential properties. Good dry milk
can be made without pasteurization, though pasteurization is part
of one of the best processes, and in the two processes most used the
actual drying by the exposure of the milk to a high temperature,
either around 175° F. where the milk has been previously pasteur­
ized or around 275° F. where the milk has not been pasteurized, is
practically instantaneous. Apparently this short high temperature
exposure does not injure the essential nature of the vitamines as far
as the present evidence goes.
Experience has taught the specialist concerned with the feeding of
infants that a certain proportion of infants fed exclusively on boiled
milk and water, or condensed milk and water, or on certain patent
foods with or without the addition of sugar will develop more or less
pronounced signs of scurvy. Recent investigation has made it seem
probable that some infants whose sole food is pasteurized milk, sugar,
and water, without the addition of fruit juice or vegetable water, will
finally cease to grow, and may show also symptoms of scurvy of a
more or less definite character.® It is possible, therefore, that any
milk, other than fresh raw milk, when used alone, may prove an
inadequate or injurious food for infants and may not allow of normal
growth either in weight or length. Such milk used exclusively will
produce in a certain proportion of infants more or less distinct
symptoms of scurvy, due either to the loss in heating of some undefined
substance— probably not a vitamine®— or due to infection by bac­
teria or their products, the result o f the milk’s being stale when
used.® AnexWoie, whenever an infant is fed a canned or sterilized
or even a pasteurized milk, fruit or vegetable juice should be begun
early until we know exactly in what particulars these milks differ
from fresh, clean, raw milk.
Up to this time, in the United States, little attention has been paid
by the dry-milk manufacturers to putting out a product suitable for
the use of infants and at the same time cheap enough to attract gen­
eral notice. As yet very little milk of the best quality and produced
under the most hygienic circumstances is dried. Much of the dry
milk on the market is made from milk of an inferior quality and still
contains bicarbonate of soda or some other alkali used to neutralize
it, and the price of grade A dry milk on the market is considerably


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M I L K , T H E IN D ISP E N SA B L E FOOD EOE C H IL D R E N .

higher than the highest price asked for fresh grade A milk- Wholemilk powder or half-skim-milk powder made of grade A milk to which
no addition of any foreign substance has been made should be avail­
able on the retail market to-day at a price equal to the cost of
production plus a reasonable percentage of profit to the manufac­
turer and retailer. At the present prices of milk wholesale a grade A
milk powder could probably be put out, if the retailing could be con­
trolled, at a price allowing it to be reconstituted at 12 cents a quart.
There is a distinct need for the production of milk powder to-day.
By this means more milk suitable for the use of young infants can
be put on the market, and the children in Europe and in the distant
parts of the United States can be adequately nourished, since good
milk can be transported around the globe.
Dry skim milk, dry casein, and dry whey, are forms of dry milk
especially adapted for the use of the sick child, and are foods already
well known to the medical profession under special trade names,
which of course mean a high-priced product. The separate constitu­
ents of milk bring a lower price than dry whole milk, and they could
be available for hospital use, or, in the case of skim milk, for use in
household cooking if their properties and legitimate retail prices were
knowm.
WHAT KINDS OF MILK CAN BE USED FOR THE OLDER
CHILD AND FOR COOKING.

When it conies to the question of the nourishment of the child over
2 years of age, we can state two things absolutely: First, milk is an
indispensable food for the growing child, essential for its proper
growth and development, and, second, clean fresh milk is the best
form of milk for the use of children of all ages. The reasons for these
statements have already been discussed in the previous section and
need not be reenumerated.
If good raw milk or pasteurized milk can not be obtained, moder­
ately fresh canned milk— either evaporated or dried—-may be used
instead of fresh milk, under certain conditions.
Every growing child is better and more cheaply nourished if it is
given clean wrhole milk, either as a drink or in the cooked food mak­
ing up the daily diet. A pint and a half of whole milk daily is the
safe amount thought desirable to nourish the young child (from
1§ months to 12 years of age) when the rest of the diet is balanced.
If canned milk is used instead of fresh milk, the quality of the
milk used in canningshould begood, and the amount of milk given must,
be the equivalent of at least a pint and a half of whole fresh milk.
There is a great danger that mothers unaccustomed to the use of
canned milk may not properly apportion the amount of milk to be


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27

given to the child and for this reason allow either too little or more
If skimmed milk is
used instead of whole-milk powder, milk fat, which contains one of
the essential factors necessary to produce normal growth in children,
should be added to the diet in the form of butter or cream.
We should learn to distinguish between the property of butter
due to the vitamine content and its property, common to all fats,
of furnishing energy when consumed in the body. As far as its use
as body fuel is concerned, butter is the equivalent of any edible
animal or vegetable oil. Considering it in relation to its vitamine
content no other fat is probably the equivalent of milk fat.® ® Pork
fat and vegetable oils have, as far as is now known, little or no growthproducing power.® Beef fat, however, does contain this essential
vitamine, and margarine made from beef fat, especially margarine
in the manufacture of which skim milk is used, has apparently about
the same growth-producing power as butter.® If we include suffi­
cient whole milk (1£ pints) in the child’s daily food, beef-fat mar­
g a r i n e may be safely given instead of butter and for reasons of
economy this may be a wise procedure. Lard, vegetable oil, and
nut margarines are not substitutes for butter or for beef-fat mar­
garine, as they are only fuel fats and not fats plus substances' which
determine body growth.® Milk, butter, eggs, and beef drippings
have been and are the chief, source of the important vitamine found
especially in animal fats. All of these foodstuffs are now exceed­
ingly high in price and there is great danger that in the families of
the poor where formerly beef drippings and even suet pudding®
have been the chief source of animal fat, vegetable oil or nut mar­
garines—-which are not equivalent either to beef fat or to butter—
may be substituted as the only table fat in the diet of the growing
child.
The experience abroad, in the case of wounded men during the
present war, has pointed out another important attribute of milk.
The presence of milk fat in the diet apparently promotes not only
hody growth but body repair, as seep in the healing of wounds,
according to many references in the war literature. The urgency
of a supply of milk and butter for hospital use and for our men in
prison camps is then also apparent.
Skim milk has a legitimate use for the nutrition of children, if
we look upon this substance simply as a form of protein, that is, a
food similar to lean meat. It does not in any way take the place
of whole milk for the child, because it lacks the essential fat.. No
more valuable or cheaper form of protein—body-building food—
exists than skim milk and, to a large extent, skim milk can be sub­
stituted for meat in the child’s dietary. Pound for pound, skimmilk cheese (cottage cheese) is about equivalent to beef.

S than is necessary or judicious for daily use.


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M I L K , T H E IN D ISP E N SA B L E FOOD FOR C H IL D R E N ;

In household cooking also skim milk can be made to take the
place of whole milk and can be safely substituted for whole milk in '
preparing certain dishes, if, as has already been said, the amount of
animal fat— other than lard— used in the dietary is carefully watched
and not allowed to decrease markedly.
Ordinary cheese is a whole-milk product containing both fat and
protein and is of great value in the dietary of adults and older chil­
dren. Little children can not be given much whole-milk cheese, as
it is somewhat difficult to digest. Skim-milk cheese contains, of
course, no fat. It has the same food value as skim milk- and is not
indigestible.
SUMMARY.

Milk is, then, the indispensable food for children, and whole" milk
in some form must be furnished them, if the nutrition of the average
child is to be maintained and if normal growth in height and weight
is to be assured.
Previous to the present war the United States did not produce d
all the dairy products used in this country, and now, with the cessa­
tion of practically all importation of these foodstuffs, we are called
upon to export large quantities of milk, butter, and cheese to feed
our allies and our soldiers in Europe.
The sharp rise in the price of milk, a rise due to the increased cost
of production, has resulted, in our large cities, in a diminished use
of milk, and has greatly disturbed the regular supply of milk for
city trade. One way in which the price of milk can be controlled
is by reducing the cost of distribution or at least preventing its
increase. Fluctuations in the demand for milk, or diminished use
of milk throughout the country, will inevitably result in a lessened
production and a decrease of the dairy business.
The destruction of the milch cow, the loss of our herds at this i
critical period, would b e , a: calamity of far-reaching consequences !
and one from which the Nation would slowly recover. The herds
of the Nation should be carefully augmented and the: milk produc­
tion per capita actually increased, since in peace times the United
States produced no more and even less milk than that required for
the maintenance of the health of its people. The exporting of milk
must decrease the available supply for home consumption, even if
the production per capita is not allowed to diminish.
The nourishment of our children is the first duty of the Nation.
Every child from 18 months to 12 years of age is better for having
1J pints of milk in its daily diet. Since milk and milk products are
a vital necessity for children, for nursing mothers, and for the
sick and wounded, the public should be made to realize that the
children’s need for dairy products should be assured. If necessary,


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29!

the use of milk, cream, or butter for adult consumption must bej
restricted.
The curtailing of food by the adult population is not a serious mat­
ter and may even be beneficial. The average child to-day does
not have enough of the right sort of food and can not have its food'
out down nor the important articles of its; diet replaced by questionable
substitutes without grave danger of increasing malnutrition in our
child population.’ >!*•"
-* w i'f-i *>
*3#^
1 Clean, : fresh cows’ milk is the best available form of milk for
children after they are weaned. Pasteurized milk, sterilized milk,
or canned milk may be substituted for it when clean fresh cows’
milk can not be obtained.
The transportation of food to Europe and to distant parts of our
own country, where the dairy business has not been developed, makes
thè production of a good quality of pure canned milk necessary.
Evaporated milk (unsweetened condensed) and dry milk are the best
available forms of canned milk for the use of children. Dry milk
(milk powder), if its quality can be assured, appears to be the most
desirable form of milk for distant transportation, for the use of young
children, or for general household use where fresh or pasteurized milk
is not obtainable. Every effort must be made to furnish some form
of clean whole milk for the use of our child population, in order that
war conditions may not have the adverse effect on them so plainly
visible in the countries of Europe.
Lowered nutrition in children means decreased vitality and lowered
resistance to disease. If the nutrition of our children is impaired for
any length of time, full juvenile development will be permanently
arrested. Nor is the physical stunting o f the face the only evil that
serious undernourishment of our child population entails. Intel­
lectual and moral abnormality are largely influenced by physical
health, and a period of malnutrition among the children of America
may easily be followed by a period of intellectual and moral deteriora­
tion.
Victory in arms will be settled in this War by the stamina of our
fighting men. Ultimate victory can come only to the Nation that
carefully conserves the stamina of its children, upon whom depends
the future of the race.


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LIST OF REFERENCES.
(T). Lucas, W. P . : '“ General health conditions in Belgium after two years of relief
■work,” in Journal of American Medical Association, vol. 68, Jan. 6, 1917, p. 27. T .
© . Report on Physical Welfare of Mothers and Children, Carnegie United Kingdom
Trust, vols. I, II, and IV. See especially Bigger, E. CL vol. IV : Ireland, pp. 58-100.
( 3 ) . Pembrey, M. S.: “ The restricted supply of food: Its relation to health and
efficiency,” in Journal of Royal Sanitary Institute, vol. 38 (June, 1917), p . ,57.
London.
@ . McCollum, E. V .: “ Some essentials to a safe diet,” in Annals of American
Academy of Political and Social Science, vol. 74 (November, 1917), p. 95.
( 5 ) . Kellogg, Vernon, and Taylor, Alonzo E .: The Food Problem.
Introduction
b y Herbert Hoover, p. V II, New York, 1917.
(«). Turnor, Christopher H .: Our Food Supply. London, 1918.
© . Roorbaeh, G. B.: “ The world’s food supply,” in Annals of American Academy
of Political and Social Science, vol. 74 (November, 1917), p. 1.
(g), The Agricultural Situation for 1918, Part II, Dairying: Dairy production
should be maintained. U. S. Department of Agriculture, Office of the Secretary,
Circular No. 85. Washington, 1918.
( 9 ) . U. S. Food Administration Bulletin No. 6, p. 23, Aug. 10, 1917.
© . Taylor, Alonzo Englebert: Report on Milk Supply in Germany. U. S. De­
partment of State, 1916.
@ . Milk Prices and the Poor Wage Earner. Weekly Bulletin of the Department
of Health, City of New York, vol. 8, Nov. 3, 1917, p. 345.
@ . Ten Lessons on Food Conservation, p. 46. U. S. Food Administration, Wash­
ington, 1917.
@ . Jordan, W. H .: “ The importance of milk as a food,” in Annals of American
Academy of Political and Social Science, vol. 74, (November, 1917), p. 188.
@ . Rose, Flora: Milk: A Cheap Food, Lesson III, Cornell reading course for the
farm home. Published by the New York State College of Agriculture at Cornell
University, Ithaca, N. Y ., January, 1917.
@ . Milk the Best Food We Have. U. S. Food Leaflet No. 11, 1918. (In press.)
McCollum, E. V., and Davis, Marguerite: “ The necessity of certain lipins in
the diet during growth, ’ ’ in Journal of Biological Chemistry, vol. 15,1913, p. 187; Ib id .:
“ The essential factors in the diet during growth,” vol. 23, 1915, p. 231.
@ . McCollum, E. V .: “ The supplementary dietary relationships among our
natural foodstuffs,” in Journal of American Medical Association, vol. 68, May 12,
1917, pp. 1379-1388.
;
m
(g). Hunt, Caroline L.: School Lunches. U. S. Department of Agriculture
Farmer’s Bulletin No. 712. Washington, 1916.
(j$). Ayers, S. Henry: The Present Status of the Pasteurization of Milk. U. S.
Department of Agriculture Bulletin No. 342. Washington, 1916.
@ . Brenneman, Joseph: “ Coagulation of cow ’s milk in the human stomach,” , in
Archives of Pediatrics, vol. 34 (February, 1917), p. 81.
•
(§). Lane-Claypon, Janet E .: Milk and its Hygienic Relations, Ch. X IV . London,
1916.
@ . Brenneman, Joseph: “ The use of boiled milk in infant feeding and elsewhere,”
in Journal of American Medical Association, vol. 67, Nov. 11, 1916, p. 1413.
(S). Daniels, Am y L., and Stuessy, Sylvia: “ The nutritive value of boiled m ilk,”
in American Journal of Diseases of Children, vol. 11 (January, 1916), pp. 45-54.
30


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31

©■ Taylor, Alonzo Englebert: “ The diet of prisoners of war in Germany,” in
Journal of American Medical Association, vol. 69, Nov. 10, 1917, p. 1575.
(§). Savage, Wm. G.: “ Milk and artificial food for children,” in The Child, vol. 6
(March, 1916), pp. 287-291. London, 1916.
<§>. Food Inspection Decision No. 170. U. S. Department of Agriculture, March
31, 1917.
® . Hunziker, Otto F .: Condensed Milk and Milk Powder. Published by the
author, Lafayette, Ind., 1914. ;
\<§). Washburn, R . M., and Jolies, C. H .: Studies of the Values of Different Grades
of Milk in Infant Feeding, Bulletin 195. University of Vermont and State Agricul­
tural College, March, 1916.
® . Food Inspection Decision No: 158. U. S. Department of Agriculture. April 2
1915.
(§). References on the use of dried milk for infants:
a. Aviragnet, E. C., Bloch-Michel, L., et Dorlencourt, H .: Bulletin de
Société de Pédiatrie de Paris, vol. 14, Feb. 13, 1912, p. 78.
b. Bonnamour: A rch ives, de Medicine des Enfants, vol. 16 (May, 1913),
p. 321. *
c. Cazalàsi Xavier: Thèse, Le Lait Desséché. Lyon. 19.12. (Contains a
good bibliography.)
cl. Frazer, R .: Journal of Royal Sanitary Institute, vol. 38 (March, 1917),
p. 26.
e. Gauthier, C.: Lyon Medical, vol. 107, October 14, 1906, p. 630.
/ . Hussy, Alfred: Archly fûr Kinderheilkunde, vol. 46, p. 63 Stuttgart
1907'.
g. Kühl, Hugo: Hygienisehe Rundschau, vol. 23, June 15, 1913, p. 709.
h. Lane-Claypon, Janet E .: Milk and its Hygienic Relations, eh. 12. Lon*
don, 1916. i. Millard, C. K illick: British Medical Journal, Jan. 29, 1910, p. 253.
j. Naish, A. E .: Pediatrics, vol. 26 (May, 1914), pp. 247-251.
k. Porcher, Chas.: La Province Médicale, vol. 23, Aug. 31, 1912, p. 385.
Paris, 1912.
l. Pritchard, Eric: Medical Press and Circular, vol. 97, Feb: 25 1914 pp
192-195.
’
’
m. Ibid. Pediatrics, vol. 26 (June, 1914), pp. 300-305.
n. Sommerville, David: Public Health, vol. 18 (October, 1905), p. 40.
o. Sommerville, D., and Harper, Frances M.: Medical Press and Circular,
vol. 132, June 6, 1906, p. 602.
p. Still, G. F.: Common Disorders and Diseases of Childhood, p. 58. Lon­
don, 1912.
-© . Hess, Albert F .: Infantile Scurvy, III, “ Its influence on growth (length and
weight),” in American Journal of Diseases of Children, vol. 12 (August, 1916), p. 152.
'© . McCollum, E. V., and Petz, W .: “ The ‘ vitamine hypothesis’ and deficiency
diseases,” in Journal of Biological Chemistry, vol. 31 (July, 1917), p. 229.
© . Pless, Albert F.: Infantile Scurvy, V, “ A study of its pathogenesis,” in Amer­
ican Journal of Diseases of Children, vol. 14 (November, 1917), p. 337.
© . Osborne, T. B., and Mendel, L. B.: “ The influence of butterfat on growth,,”
in Journal of Biological Chemistry, vol. 16, 1913-14, p. 421.
© . McCollum, E. V., and Simmons, N.: “ A biological analysis of pellagra-pro­
ducing diet,” in Journal of Biological Chemistry, vol. 32 (October, 1917), p. 19.
© . Halliburton, W. D., and Drummond, J. C.: “ Nutritive value of margarines
and butter substitutes,” in Journal of Physiology, vol. 51, Sept. 12, 1917, p. 235.
@ . Rearing an Imperial Race, pp. 337-355. Our Children’s Health at Home
and at School. National Food Reform Association, London, 1912. Published for
the National Food Reform Association, London, 1913.


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OTHER GENERAL REFERENCES ON MILK.
Bulletin of the U. S. Hygienic Laboratory No. 5G, Milk and Its Relation to the
Public Health, March, 1909, 2d edition. Washington, 1912.
Rosenau, M. J.: The Milk Question. Houghton-Mifflin Co., Boston and New
York, 1912.
Savage, Win. G .: Milk and the Public Health. The Macmillan Co., London, 1912.
Spargo, John: The Common Sense of the Milk Question. The Macmillan Co.,
New York, 1908.

o


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