Full text of Milk : The Indispensable Food for Children, Bureau Publication No. 163

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^ I (o 3

CONTENTS
P age

O l GI CO

OI t o

M- CO GO O i 05 O i

CO bo o

GO C i C i o

O O ^

CC CO vO t o

10

M

Introduction________________ __________
The nature of milk as a food____________________________
Characteristics of an adequate diet________________
Components of milk___ __________________________ _
Proteins______________ .__________ _________________
Minerals___ ______________________________________
Vitamins_________________________________________
Fuel___________ ,_______________
Milk as a “ protective food ” _______________ 3 _______
The value of milk as a fo o d -____ ________________________
In pregnancy and lactation . . ^ ■ __. . ^ .____ ____
Milk a protection for mother and child— ____
Breast milk the best food for babies— -.____
In infancy and early childhood-____________
Substitutes for breast milk_________________ — __________
Goat’s milk_____ — ____ _____________
Cow’s m ilk _________________ _____________■m
The purchasing and preparation of milk for infants—
Liquid m ilk __________________________________________
Grades of raw milk_____________________________
Pasteurized milk_________________ =_______________
Preparation of milk____ _________________________
Canned milk__________________________________________
Proprietary or patent foods_________ __________
Condensed milk (sweetened)______ ____________
Evaporated milk (unsweetened condensed)___
Dry milk or milk powder_______________________
Milk for the older child____________________________
Sum m ary___________ _______________________________________
List of references______________________

m


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MILK
THE INDISPENSABLE FOOD FOR CHILDREN
INTRODUCTION
The American people are gradually learning that milk is essential
not only for the normal healthy development o f infants but also
for children o f all ages and for pregnant women and nursing
mothers. Milk has no substitute in the diet of the child. Children
are nourished better and more cheaply i f an abundance of good
whole milk is included in their daily food; also there is less danger
o f serious dietary deficiencies, which are occasionally the cause o f
grave nutritional diseases. Besides, plenty of milk in the diet of
children has the more important effect or preventing a vague ill
health that results from a diet partly lacking in the substances ,
essential to growth and that is followed by failure to grow normally,
lack of appetite and of vitality, and weakened resistance to infectious
disease. The use of milk is the greatest factor of safety in our
diet ( l ) . 1
About one-fifth of the food budget of the average American
family is normally used for milk and milk products. Milk surveys ¿x
and campaigns urging people to drink more milk (2) have resulted
in increasing its use, especially in cities but also in many towns alid
even in rural districts throughout the United States. Milk has
been firmly placed among the health essentials for children.
In view of the established importance of milk and the recent gains
in scientific knowledge concerning it, a revision o f the Children’s
Bureau bulletin on milk published in 19182 was felt to be needed.
The present bulletin is a revision of the material in that publica­
tion in the light of later research by many authorities. As a result
o f studies o f the food requirements o f infants, o f older children,
and o f expectant and nursing mothers the value of milk is now
much better understood. For example considerable advance has
been made in the study o f vitamins in the last seven years. In the
present bulletin the vitamins o f milk have been stressed; and a table
has been compiled from several sources, both in the United States’
and in Great Britain, showing the vitamin content o f different forms
of milk. The relative merits o f the various forms o f canned milk
and o f the processes used are discussed with special attention to
the retention o f vitamins and minerals. Improvements in methods
o f canning are noted.
1 T h e figures in parenthesis used th rou gh o u t refer to correspon ding figures in the lis t
© f referen ces on pp. 3 o - 4 3 .
2 P u b licatio n N o. 3 5 , superseded b y the p resen t bu lletin.

1

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M IL K THE INDISPENSABLE FOOD FOR CHILDREN

The manuscript has been submitted to
fields o f study touched on in the bulletin,
valuable criticisms and suggestions.
It is expected that this bulletin will be
economics and to all persons concerned
and older children and o f expectant and

authorities in the various
and they have given many
of use to teachers of home
in the feeding o f infants
nursing mothers.

THE NATURE OF MILK AS A,FOOD
Milk is said to be a perfect food. By this is meant that it con­
tains all the essential elements, which if taken in sufficiently large
amounts allow normal growth and symmetrical development. Health
and even the maintenance o f life itself may depend on the presence
o f certain indispensable constituents o f diet.
C H A R A C T E R IS T IC S O F A N A D E Q U A T E D IE T

The adequacy o f a food or o f a diet (3) depends on its containing:
1. Enough of the right sort of material to build up and repair the
tissues o f the body. The chief body-building substance is called
protein. Milk, cheese, meat, fish, and eggs furnish the most valuable
forms o f protein, because they are constituted most like the proteins
that form the principal basis o f the structure of the muscles and
organs.
2. A variety o f mineral substances which are needed in the growth,
maintenance, and functioning of the parts o f the body, such as the
skeleton, lungs, brain, thyroid gland, and muscles, and the blood and
other body fluids.
3. An adequate amount o f certain substances whose nature is not
fully known but whose presence in the diet has been demonstrated to
be necessary for health and growth in the lower animals and in man.
These substances, known as vitamins or accessory diet factors, are
indispensable elements in food, although sometimes they are present
only in minute amounts.
4. Enough material to furnish the energy required by the body.
Fat, starch, and sugar are the chief energy foods, and these are
transformed in the body into energy for its activities and into body
heat. A large part of the protein in food is used, even during the
growth period, for energy processes.
5. Only substances that are not poisonous to the average individual
and that will allow normal digestive processes.
In addition, to be properly digested and o f the utmost nutritive
value food should be o f pleasing taste and o f a consistency and ap­
pearance similar to other foods in customary use.
' Clean milk fulfills all these requirements better than any other
single article of food.
Milk is in a sense a complete food ; if used as the sole food it will
sustain life and allow growth. It may be so used in early infancy,
but after that time additional foods must be eaten to supplement the
deficiencies o f milk in certain substances, especially iron. Milk is so
completely digested that it is one of the most efficient foods (4 ); how­
ever, a certain amount o f bulk and of noncUgestible residue in the
diet—so-called roughage—is necessary to regulate the discharge o f
waste from the digestive tract and so prevent constipation. For

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M IL K THE INDISPENSABLE POOD FOR CHILDREN

these reasons by the end o f the first year o f life—and some authorities
say after the first six months—a mixed diet including cereals, fruit,
and vegetables is better than an exclusive milk diet.
C O M P O N E N T S O F M IL K
P R O T E IN S

Milk contains four proteins, o f which two are present in consider­
able amounts. The curd o f milk, which contains all its casein and
part o f its lactalbumin, has been found to be most valuable for build­
ing or renewing body tissues (5). There is no other animal protein
o f known value procurable at so low a price as the proteins in milk.
Grains, legumes, and nuts do afford efficient proteins, more so than
those o f tubers and other vegetables; but in general plant proteins
are not so valuable as animal proteins for tissue building and should
not be relied on solely as a source of body-building protein.
M IN E R A L S

O f all the minerals necessary for the growth o f the child from
conception to adult development, none is o f greater importance to
all parts o f the body than the calcium and phosphorus salts, be­
cause these are the essential building materials for bone, which is
largely calcium phosphate. Since growth is measured by the de­
velopment o f the skeleton and since the child must have a steady,
abundant supply o f calcium, as well as o f certain vitamins, to build
bones and teeth, body organs and fluids, milk should be included in
every child’s diet during the entire period o f growth. “ There-are
but two classes o f calcium-rich foods—milk of animals and the
leaves - of plants.” (6) O f all food sources^of^calcium, milk and
cottage cheese are the cheapest, most easily available, and most
abundant. Milk also provides other important minerals such as
phosphorus and potassium.
When it is realized that 1 quart o f milk will furnish as much cal­
cium as 10 large oranges, 10 large helpings o f spinach, 24 large
helpings of carrots, 32 eggs, or 20 pounds of beef the value o f milk
for growing children can be appreciated.
The relative amounts o f calcium in the foods richest in it are: 3 (7)
G ram

1 cup milk______ ____________
xk cup spinach, cooked (8)
1 orange____________________
1 egg------------------------------------xk cup carrots, cooked_____
2 ounces average beef_____

0. 26
.1
.1
.03
.04
.006

Unfortunately, cow’s milk is low in iron content (9 ), probably even
as compared with human milk (8) (10), and this important mineral
must be supplied by other foods. In spite o f the fact that the form
o f iron in milk seems especially favorable for assimilation, the pro­
longed exclusive use of milk after early infancy tends to produce ane­
mia due to lack of iron in the food. It is generally stated that the in­
fant has considerable iron stored in the liver at birth, which enables it
during the period of breast feeding to thrive on a food as low in iron
3
C alculated fro m T a ble I I I , A p p en d ix B , C h em istry o f F ood an d N u tritio n , by H . C.
Sherm an, second ed ition (T h e M acm illa n C o., N ew Y o rk, 1 9 1 8 ) .


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M IL K THE INDISPENSABLE FOOD FOB, CHILDBEN

as human milk' (10). Iron can best be introduced in the diet through
the use in early infancy of fruit juices, green leafy vegetables, and
egg yolk, and later o f whole cereals, beef, and potatoes.
V IT A M IN S

The character and digestibility of its proteins and the abundance
of its calcium make milk a most desirable food; but another prop­
erty of milk produced under correct conditions lies in its containing
ordinarily some o f all the known accessory diet factors which con­
trol growth and health—the vitamins. Because o f #he fact that the
vitamin content o f cow’s milk depends largely on the way the cows
are fed and on the amount of sunshine they receive it is not always
true that “ milk is rich in all of the known vitamins ’’ (11), but at
least milk from pasture-fed cows is an unusual food in containing
some o f all the known vitamins. Many authorities believe that the
antirachitic factor (see p. 5) should be supplied to all children in
the temperate zones, whether breast fed or bottle fed, in winter by
cod-liver oil and in summer by direct sunshine. After the first
month orange juice should be given ‘as an antiscorbutic to all bottlefed babies and may be given to breast-fed babies.
The following table shows the relative vitamin content of different
forms of m ilk:
T a b l e 1 .—

The vitamin content of different forms of m ilk 1

Form of milk

Cow’s milk:
Fresh, whole, summer, from pasturefed COWS 3
Fresh, whole, winter, from stall-fed
C0WS.3

Vitam m A

R ich_____. . .

Vitamin B

Vitamin C

Good to fair.

Good to fair.

.........do______

Rich to good. .........do___ _
Scalded_____________ - ____---------------- — . . . . . d o ___ ___ _____do______
P o o r .-........... ____ do______
_____d o _ _ ____
Rich to good.
Evaporated (unsweetened condensed) _____ do______ .........do___ ¿21
1"___ do______ _____do______
Poor--------— _____d o _ _-----Rich to good.
_____d o _____ Good to fair.

Vitam m D 3

Probably poor.

Fair to poor. P r o b a b l y very
poor.
. — .d o ______ Probably poor.
Do.
_____do______
Do.
Poor________
Good to poor P r o b a b l y very
poor.
D o.
_____do______
D o.
_____do ____
Poor________ Probably poor.
Fair to poor.
D o.
_____do______ P r o b a b l y very
poor.
Good to poor Probably poor.

1 Adapted from Vitamins in Food (Poster N o. 39 of the American Medical Association, 1922); Food
Products, by H . C. Sherman, pp. 654-S56 (The Macmillan C o., New York, 1924); and Report on the Present
State of Knowledge of Accessory Food Factors, p. 116 (Medical Research Council, Special Report Series
N o .38, London, 1924).
„ ..
, _
_
2 Laboratory evidence so far seems to show that milk is a poor source of vitamm D . Further studies are
needed to determine whether or not the antirachitic factor varies greatly in different forms of milk.
3 The vitamm content of milk depends in general on the character of the diet.

When a food is lacking wholly or partly in any one o f the known
vitamins a special form o f disease may develop; but long before this
happens the person may lose appetite, may fail to grow (if young),
and may be ailing and weakened in resistance to infectious disease
(i2 ).
g flf
.
.
|
t
At least two vitamins (known as vitamin A and vitamin D ) are
found in Connection with the fat of foods (13) and are relatively
stable—not easily injured by heat.
Milk fat, whether in whole milk, cream, or butter, furnishes the
most important and most economical source o f one of these vitamins,

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M IL K THE INDISPENSABLE FOOD FOB CHILDREN

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vitamin A. Egg yolk, leafy vegetables, cod-liver oil, and certain
animal organs, such as liver, are also good sources of this substance.
Some vegetable oils, such as coconut oil, do not contain it, nor does
pork fat. The skim milk left after the cream has been removed by a
separator is almost entirely deficient in vitamin A. However, skim
milk from which the cream has been dipped may contain as much
as 50 per cent o f the amount o f vitamin A in whole milk. Xeroph­
thalmia, an eye disease caused in young children by a lack of
vitamin A in their food, has been found to be especially prevalent
when machine-separated skim milk has been used in place o f whole
milk in their diet (14) (15).
The other vitamin found in connection with fats, which has been
discovered recently (14) (15) (16) (17) (18), affects tooth and bone
formation, promoting calcium deposition; it has been called the
antirachitic factor, or vitamin D. Unfortunately its effect has been
confused with the growth-promoting properties of vitamin A , and
m some instances the result o f the presence o f vitamin D in food has
been attributed to vitamin A. Egg yolk and, to a less extent, milk
fat and coconut oil furnish some o f this vitamin, but such fish fats
as cod-liver oil are its most abundant source. When vitamin D is
excluded from the diet o f the young the disease called rickets may
occur (19). The antirachitic factor, like vitamin A , may be stored
to some extent in the human body (2 0 ); but so far as is known the
human body is not capable o f synthesis o f this or any other vitamin,
so that rickets in a breast-fed child is not only possible but unfor­
tunately common. The percentage o f vitamins in cow’s milk has
been proved to be dependent on the amount of vitamins in the cow’s
food (21), and possibly in the case o f vitamin D it is dependent on
the amount o f sunshine afforded (22) (28) (24). Cow’s milk, there^
fore, should not be depended upon solely to supply the antirachitic
factor in the food of infants or young children. (Table 1.)
Two vitamins are soluble in water and are not associated with the
fat content of foods. Because these water-soluble vitamins, B and
C, unlike vitamin A and (probably) vitamin D, are not stored to any
extent in the body, the necessity for a continuous supply from the
food is most urgent (25) (26).
In foods consumed in their natural state vitamin B is so widely
distributed (27) that it is ordinarily present in sufficient abundance
to maintain health. In the manufacturing o f purified foodstuffs
such as polished rice and lnilled flour vitamin B may be lost, and
a. diet made up entirely o f such denatured foods may cause a par­
ticular disease o f the nervous system (beriberi) or even death,
owing to a deficiency in this essential substance. An infant Qr a
child whose food contains too little o f this factor may show the defi­
ciency first in lack o f appetite, pallor, apathy, and failure to make
nor'mal gains in weight. There is practically none o f this substance
in fats or ails o f any kind, pure sugar, starch, polished rice, or white
flour. Milk is a good source o f vitamin B.
The other water-soluble vitamin (vitamin C) is found especially
in acid fruits, such as the lemon, the orange, and the grapefruit, and
in the tomato. Fruits and vegetables, especially uncooked, are good
sources o f both water-soluble vitamins (28) (29). Vitamin C may
102931 ° — 26— —2


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M IL K THE INDISPENSABLE FOOD FOR CHILDREN

be lacking in cow’s milk if it is stale, if it has been exposed to a
prolonged high temperature, if it has been reheated, or if an alkali
has been added to it. Cows stall fed and not supplied with green
foods rich in vitamins, such as alfalfa, may produce milk very low
in this factor. Summer milk produced by- cows on fresh ;pasturage
may be three to five times as rich in this vitamin as winter milk
produced by cows which have been for months on dry feed. Human
milk may be deficient in vitamin C, and scurvy o f the breast-fed
child has been recorded for many years. As an antiscorbutic*
after the first month, orange juice should be given to all infants
artificially fed and may be given to breast-fed infants. Many chil­
dren kept on a diet low in vitamin C do not have symptoms o f scurvy,
but they are listless and are retarded in growth and development;
this may be due to a prescurvy state, induced by lack o f vitamin C.
Milk which, when produced under the right conditions and given
in sufficient amounts, may contain enough of all these vitamins
(except possibly vitamin D ) to allow normal growth and develop­
ment has a value in the human dietary greater than that o f any
other single food.
FUEL

\ As a source of energy or fuel for the body, milk compares favor^ ably with other foods. The energy value of a quart of milk is about
equivalent to that o f a pound of lean meat or of eight eggs (32).
As a source of energy, grains (in the form o f cereal or flour) are
far cheaper than most other foods. Both the minerals and the pro­
teins of cereals (which are largely inadequate for growth) are sup­
plemented efficiently by milk (33). Therefore bread and milk or
cereal and nfilk is an ideal combination o f foods to furnish protein
and body energy in childhood.
M IL K A S A “ P R O T E C T IV E FO O D ”

It is true that in the period of growth the dietary should be built
around grain products and milk, but it is even moré important that
the surrounding material should be green leafy vegetables and fruit.
Milk has been designated (34) as one of the “ protective foods,” the
greater consumption of which will tend to correct the deficiencies of
the present American diet. This diet is largely made up o f white
bread, meat, potatoes, and sugar. Milk, green vegetables, and fruit
are needed to supplement a diet o f this type, which is lacking espe­
cially in vitamins and minerals (35) (36). “ Both city and country
dietaries in the United States are more often deficient in calcium
than in any other chemical element so far investigated” (37).
THE VALUE OF MILK AS A FOOD
IN P R E G N A N C Y A N D L A C T A T IO N
M IL K

A

P R O T E C T IO N

FOR

M OTH ER

AND

C H IL D

People are just beginning to realize not only that the human
mother is intended to furnish nutriment for her baby for an aver­
age o f at least 18 months (if the prenatal period o f 9 months is
included), blit that the amount and adequacy of her food during this
period and the store of food substances in her body determine

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M IL K THE INDISPENSABLE FOOD FOR CHILDREN

7:

whether or not her baby is well nourished before birth as well as
during the period of breast feeding. It is absurd to expect a mother
living on a limited or deficient diet to build a baby or nourish it after
birth successfully when experience in animal husbandry proves this
to be impossible. “ The nursing mother can not, except in very lim­
ited degree, put into her milk from her bodily reserves that which
she does not receive in her food supply ” (38).
The prevailing view that the pregnant woman’s food can be left
safely to chance or to the whims o f her appetite might hold if people
were not removed from their natural environment and were not liv­
ing largely on devitalized foods and behind glass windows that
filter out the essential light rays (39).
This is not the place to consider the details of the daily food in
pregnancy (40), but the value o f milk in the building o f babies
makes it essential in the pregnant woman’s diet (41). The calcium
content of milk is, of special value in this country, where, as has been
said, the diet is riiore likely to be deficient in calcium than in any
"other one substance"('3f)""( 42) (10).
The demands o f the child’s body for tissue-building substances are
relatively greatest during the time o f most active growth, which is
undoubtedly the fetal period. . The requirement for protein as shown
by the drain on the nitrogenous substances in the mother’s blood
seems to be greatest during the midperiod o f pregnancy, correspond­
ing with the greatest increase in length of_ the fetus and the early
development o f the body, organs and mulclesr The greatest increase
in weight, excepfilhe increase in the last month, is apparently in the
seventh month o f intrauterine life (43).
The retention qf calcium and phosphorus by the fetus is increas­
ingly great through pregnancy, corresponding to the development o f
body organs and fluids and the calcification o f the skeleton and teeth.
The daily absorption by the fetus of calcium oxide during the last
third of pregnancy (44) (45) is estimated to be as great as the daily
average absorption by breast-fed infants (46). The apparent ten­
dency o f the mother’s blood to show a definite fall in the inorganic
contents during the later months of pregnancy corresponds with this
relatively enormous demand for minerals by the fetus and the de­
veloping maternal tissues (47) (48).
There is every reason then to believe that during the later months
o f pregnancy at least the need of the pregnant woman for calcium
is one and one-half times as much, if not twice as much, as that o f the
nonpregnant woman. I f there is an insufficiency o f calcium in the
food during pregnancy the growing fetus will take what it needs at
the expense o f the mother’s organism, and the bones and teeth o f the
mother may suffer (49). I f an abundance of the green leafy vege­
tables is included in the daily food, a quart o f milk a day will in­
sure a calcium intake sufficient for the fetal needs without calling
on the mother’s bones or teeth. It seems practically impossible for
the pregnant woman to obtain enough calcium in her diet unless she
takes daily at least a pint of milk or the equivalent in cottage
cheese.
The complete nature of the combined proteins of milk, its rich­
ness in vitamin A , and the variety o f its mineral salts, besides the
abundance o f Calcium it affords, make milk a more important con
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M IL K THE INDISPENSABLE FOOD- FOR CHILDREN

stituent o f the diet during pregnancy than perhaps in any other
period o f life.
Millions are spent for tooth-repair work, to say nothing o f the
more important preventive dentistry, during both childhood and ma­
turity, but little thought is given to the period when the foundation
o f the teeth is laid down—the prenatal period (50). It is well to
remember that teeth are started in the first months (about the fiftieth
day) after conception, that calcification o f the first or temporary set
is begun in the fifth month, that all the teeth of the first set are in
the jaw at birth, and that by the sixth month after birth practically
all the teeth, temporary and permanent, have been started, and the
entire temporary set are enameled. The nutrition and metabolism
o f pregnancy seem even more important when it is realized that the
temporary teeth are intended to function from the seventh month to
the twelfth year, and that the first permanent molars are in some
ways the most important teeth (51).
With these facts known, who could question the necessity of milk
for the expectant mother, as well as the nursing mother ?
Milk can be disguised in the diet. Although the use o f milk as
a drink is largely a matter o f training, adults who have not acquired
the milk habit in childhood or those, who dislike its taste or are
fanciful in regard to food can be given any desired amount o f milk
in the daily food by a little study (52). A pint o f milk can be
used easily in cooking the day’s food; and in drinks made with
milk, such as cocoa and milk shake (with or without egg), its pres­
ence need not be noticeable. Milk products, such as cottage cheese,
other cheese, skim milk, buttermilk, and cream or butter can be used
instead o f whole milk. Milk powder or evaporated milk can be
used wherever a good grade o f fluid milk is not obtainable. Milk
powder, being a solid, is particularly useful in those conditions in
pregnancy where it is desirable to take small amounts of highly
nourishing foods or where liquids are not easily retained.
B R E A S T M IL K T H E B E S T FOOD F O R B A B IE S

Among the lower animals, as a rule, the young are not born until
near the period when they can dispense with nourishment by the
mother and can 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
o f life as well as the prenatal period, since the infant does not
develop teeth nor acquire the power of taking other than soft food
for several months after birth.
Any infant that has to be artificially fed during the first months
of life is in a sense a premature child, as he has been deprived o f
maternal feeding long before the normal period of separation from
his mother. Giving any other food than human milk to an infant
soon after‘birth, therefore, is introducing a foreign substance into
his partly developed digestive system, and the dangers of such feed­
ing vary with the individual as well as with the composition of the
artificial food selected. These dangers are still little understood.
For these reasons breast milk—the natural food for human
young—is under the right circumstances the best food for the infant.
There is nothing just as good as mother’s milk. The fact that the

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M IL K THE INDISPENSABLE FOOD FOR CHILDREN

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milk of a particular woman may, n o t agree with her child or that
it may be inadequate does not alter the truth o f the general proposi­
tion : Breast milk is the best food for babies. Breast feeding is the
one means o f giving every infant that survives birth the best chance
for life and health.
Besides having great nutritive value breast milk is a protection.
Breast-fed infants have been found to have a lower morbidity rate
as well as a lower mortality rate than bottle-fed infants. Breast­
fed infants are apparently less susceptible to most diseases, are better
able to resist infection, and can stand diseases with less in ju ry, (53).
Whatever the percentage of artificial feeding among infants—
and it has been calculated4 that about one-fifth o f all infants under
1 year of age are weaned before the fourth month o f life—two
things may be positively stated. The first is that infants artificially
fed in the early months of life show a mortality between three and
four times that found to prevail among breast-fed infants (54),
and the second is that judging by the fine, work done in large cities
in the last few years the number of children breast fed and the
length of period of breast feeding can be greatly increased by care­
ful medical supervision of the mother before and after the birth
of the child (55).
The American mother can be taught to nurse her child for as
long a period as it can thrive on her milk. The length of this
period depends very largely on the previous st.ate o f her nutrition,
her prenatal food and hygiene, the way in which breast feeding is
established, and the care with which her physician instructs her
regarding the technique and hygiene of nursing and the food re­
quired to keep up her supply o f milk (56).
The amount and kind o f food required to maintain an adequate
milk supply is far more generally understood than what constitutes
a balanced, sufficient diet during pregnancy. The use of milk to
produce milk is quite generally accepted. The high protein ratio
in food which has been convincingly proved necessary for milk
production in dairy husbandry (57) (58) is best obtained for the
human mother by an abundance o f milk or milk products in her
diet rather than by an increased use o f meat or eggs (59).
A generous diet is necessary during the nursing period, but there
is every ^evidence that the selection o f food is far more important
than a simple increase in its amount. The diet should be specially
rich in protein, for three to four protein calories must be furnished
in the diet for every ounce o f milk produced (60). Besides the ade­
quacy o f the protein in the diet the abundance o f minerals must be
carefully safeguarded to insure sufficient calcium and phosphorus
for bone growth (61) (62) (63). These findings tend to prove the
truth of the statement that “ in order that breast milk may actually
show the superiority that we are accustomed to expect o f it, the at­
tention paid to maternal feeding should take account of the food
consumed by the mother as well as of the extent to which the mother
nurses the child. In the mother’s diet milk should have a prominent
4 I n eig h t o f th e cities in w hich in fa n t-m o rta lity stu d ies h a r e been m ade by th e C h il­
dren’s B ureau , it w as fou h d th a t o f th e 2 1 ,5 6 0 in fa n t s W ho lived to be 3 m onth s o f age
4 ,3 3 X (2 0 .1 per cen t) had been w eaned.
See C ausal F a cto rs in I n fa n t M o rta lity bv
Ito&fert’ M orse W ood bu ry. G eneral T a b le 6 7 , p. 2 1 2 (U . S. C h ild ren ’s B ureau P u blication
N o . '1 4 2 , W a sh in g to n , 1 9 2 5 ) .


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M IL K THE INDISPENSABLE FOOD FOB CHILDBEN

place, since it constitutes such arf important supply o f the nutrients
from which the breast milk is to be formed ” (64).
A relationship has been traced between the composition o f the
milk o f a species as determined by gross chemical analysis and the
normal rate o f growth in the young of that species (65). It is
known now that the superiority of milk is not due to any one con­
stituent and that milk can seem adequate both quantitatively and
qualitatively in regard to protein, fat, sugar, and the inorganic salts,
and still be unable to promote normal growth or to prevent serious
nutritional disease in the young. “Animals can not grow with­
out accessory food factors” (66). Probably the rate o f growth in
the young is also closely related to the amount o f vitamins supplied,
provided that the diet is otherwise adequate and abundant (66). I f
a mother’s diet is deficient in either fat-soluble or water-soluble
vitamins this deficiency sooner or later will affect the value of her
milk (67). It seems reasonable to suppose that the breast milk o f a
mother who is receiving adequate sunlight and who is fed on a diet
rich in the accessory food factors should supply all the vitamins
necessary for growth and normal nutrition, unweakened by heat,
oxidation, or dilution. The common occurrence o f rickets among
breast-fed infants in this country is probably caused by the inade­
quate sunlight and diet received by mother and child.
For a mother to produce good breast milk is better for herself,
better for the child,- and incidentally better for the family pocketbook.
IN I N F A N C Y A N D E A R L Y C H ILD H O O D

The only foods intended for the exclusive nourishment of young
animals are milk and eggs. Except the germ o f seed, all other sub­
stances suitable for their nourishment are taken from partly or fully
grown animal or plant structures. For this reason it would be
expected that milk, eggs, and the germ of seed contain the vital ele­
ments for the maintenance o f young life, and experiments tend to
prove that they do.
Unfortunately, eggs and seeds do not lend themselves to the early,
exclusive feeding o f the human infant. Infants in Japan are occa­
sionally fed even from birth on a soy-bean mixture; but judging by
the high infant death rate in Japan, it seems unnecessary to argue for
this substitute for milk as the principal food for infants when milk
can be obtained.
The statement can not be challenged that for children under
2 years of age breast milk or other milk is an absolute necessity for
proper nutrition, which will enable the coming generation not only to
measure up to the past standards o f healthy growth but to improve
on them steadily. One urgent national problem is to see that every
child in the United States gets his full quota of milk that is standard
in purity and quality.
The necessity for milk in the diet of the child could well rest on
its value as a calcium food alone. A recent study has shown a definite
relation between the needs of growth and maintenance and the amount
o f calcium wfhich must be available. It seems settled that for chil­
dren between 3 and 14 years of age the best storage of calcium occurs
when a quart o f milk is included in the daily diet. Not as good

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M IL K THE INDISPENSABLE FOOD FOB CHILDREN

11

calcium storage is obtained on a pint and a half of milk a day as on
a quart, nor is this absorption as good if part o f the calcium of the
food is obtained from vegetables instead o f from milk (68).
Although the study mentioned in the preceding paragraph does not
include children under 3 years of age, other studies of the use of
calcium by infants (46) and of the amount o f milk taken by the
average breast-fed infant make it proper to assume that the relative
need o f calcium is not less in infancy than in later childhood. The
younger the child the more rapid is the rate o f growth, and probably
the greater is the relative calcium requirement (69). Recent experi­
mentation on animals would suggest that the amount of lime in the
diet directly affects the size and weight o f the bones (TO).
Much less is known concerning the phosphorus needs o f the body
and the availability of the different forms of phosphorus in foods.
The need for phosphorus of a child under 6 probably is adequately
supplied if a quart of milk is included in his food daily. For older
children the extra phosphorus needed should be supplied by whole
cereals, meat, fish, and eggs. W ith some children the addition of
vegetables to the diet favorably affects the storage of phosphorus
(68). A diet rich in milk and in whole grains (cereal or bread) is
never deficient in phosphorus.
The ratio of calcium to phosphorus in the diet seems to be impor­
tant, as well as an adequate supply of the different forms of these
two substances (71). The relative proportion, nearly 3 to 2, of
calcium and phosphorus in breast milk has been found to be a favor­
able feeding ratio for normal calcification of bone in human infants
and in certain animals. The effect o f direct sunlight, or o f the anti­
rachitic substance in cod-liver oil and egg yolk and to a slight extent
in butterfat, is probably to permit a normal adjustment between the
essential minerals supplied to the developing bone, even when the
intake of either mineral is usually low. The waste of these ele­
ments is thus greatly reduced, and maximal storage is obtained (72)
when the antirachitic factor is supplied.
Animal husbandry teaches that the feeding o f animals for profit
requires that “ they must be born in a state of nutrition, obtained
through the mother, such that they may begin their independent
existence with a fund of vitality which insures growth and normal
functions, provided the conditions of living are reasonably favorable.
Success in* animal production also depends on making" the young
animals grow just as fast as they are capable of growing. It is now
proved that it is not possible for animals to grow too fast, and that
the faster the rate of growth in the young the greater will be the
vigor when growth is completed. This statement refers to the sym­
metrical development o f all the tissues. Increase in weight from
excessive fattening or edema is not the same as normal growth’ ’ 5 (73).
5 One deplorable effect o f th e recent splendid drive ag a in st m aln u trition h a s been a
too exact in terp retatio n o f the so-called stan d ard s o f heigh t and w eight, regardless o f the
typ e o f child and th e con ditions o f race, heredity, etc.
W ell-m ea n in g adheren ts to d if­
feren t sy stem s o f e stim a tin g g ro w th an d food needs in childhood w ould actu a lly cu rta il
th e food o f h ealth y children or retard th eir grow th to bring them in to con form atio n
w ith such stan d ard s.
I t is w e ll to rem em ber t h a t children can not n o rm ally grow too
f a s t an d th a t tables g iv in g averages o f h eigh t an d w eig h t fo r age are •not n ecessarily
op tim u m tables but m u st o f n ecessity be low averages since th e y include those children
w ho ha ve been m ore or less stu n ted in gro w th on account o f infectiou s disease, m al­
n u tritio n , and other bad con ditions.


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M IL K THE INDISPENSABLE FOOD FOB CHILDREN

Milk may be given to young children, as well as adults, in cooked
forms, such as soup, weak cocoa, or flavored milk shake (74). White
sauce, milk gravy, creamed dishes, milk puddings, milk sherbets, and
ice cream require milk in their composition. Milk is a valuable food
in any form. I f used as a drink, it should be taken near the end of
the meal, for many children will not take sufficient other food if
they fill themselves up first with milk. Sometimes, but very rarely,
a child has an idiosyncrasy for milk proteins and is made violently
ill by milk.
Appetite must be considered in planning a child’s diet. An ex­
clusive diet o f any single food becomes distasteful and tends to lower
digestive processes, so that nutrition is impaired. However, a child
should not be allowed to refuse milk as a substantial part o f his daily
diet. Every normal child is better for taking at least iy 2 pints o f
milk a day. The mother who does not make every effort to furnish
sufficient milk for her children and to train them to drink it is not
fulfilling her duty. Healthy children can be taught to like a varied
diet, to eat what is good for them, and to finish the entire meal.
Patience, persistence, and tact are needed to teach proper food
habits to the young; and to be effective this discipline must be main­
tained from birth. Young children are very suggestible, and too
often their dislike for milk is started by the distaste the parents show
for it or by unwise attempts to force it against the child’s opposition
(75). Food habits are not learned in a day.
Milk is an indispensable part o f the diet o f pregnant and nursing
mothers and o f all young children. So long as a child is growing
it is well to include a quart of milk daily in his diet, used either as a
drink or in cooking his other food. A pint and a half a day is the
minimum amount of milk which will insure proper growth in the
average child. Children who have too rich or too abundant a diet
may seem to do better with less milk, or even without any; but here
the fault is not primarily in the quantity o f milk but in the total
amount o f food* On the other hand, an exclusive milk diet after the
first year is ultimately harmful. Milk should not be given to á child
to such an extent as to prevent his taking an ordinary amount and
variety o f other food.
SUBSTITUTES FOR BREAST MILK
The use o f the milk o f domestic animals for the nourishment o f
infants who have to be weaned prematurely is as old as legendary
history. Indeed, in many places wild animals were domesticated first
for their direct value as food and then for the production of milk.
The problem o f what milk to feed the infant after weaning has
become increasingly important, for in general the period o f breast
feeding unfortunately has become shortened with advancing civili­
zation.
,
... ,
In this country only two animals, the cow and the goat, are milked.
A variety of other animals—sheep, llama, buffalo, camel, mare, ass,
and reindeer-—are milked in places throughout the world where the
dairy cow has not yet been introduced or can not thrive. The cow,
where the climate and type o f country are suitable for its main­
tenance, gives, on the whole, a better return o f milk for the amount

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M IL K TH E INDISPENSABLE. FOOD FOR CHILDREN

o f food required and the labor expended (76) than does the goat.
There is as yet no conclusive evidence that there is any marked su­
periority in either nutritive value or digestibility of one milk over
the other for infant feeding.
The following table shows the average composition o f milk of
various kinds :
T able 2.— Average composition of milk of various kinds1
Protein
K ind of milk

W om an........................ C ow ....... ............. ...........
G oat.________________
Buffalo (Indian)-------Cam el---- -------- ----------Llam a----------- ------------Reindeer.....................
M are...............................
A ss___________________

Water

Fat

Carbo­
hydrates
(milk
sugar)

Mineral
matter

Approxi­
mate fuel
value per
ounce .

Calories

Casein

Album in

Total

Pec cent

Per cent

Per cent

Per cent

Per cent

Per cent

Per cent

88.3
87.0
85.7
82.2
87.1
86.6
67.2
90.6
90.1

0.4
2.8
3.5
4.3
3.5
3.0
8.4
1.3
.8

0.7
.5
1.0
.5
.4
.9
1.5
.8
1.1

1.1
3.3
4.5
4.8
3.9
3.9
9.9
2.1
1.9

3.3
4.0
4.7
7.5
2.9
3.2
17.1
1.1
1.4

7.0
5.0
4.4
4.8
5.4
5.6
2.8
5.9
6.2

0.3
.7
.8
.8
.7
.8
1.5
.4
.5

18
20
22
30
18
19
58
12
13

1 Adapted from M ilk and Its Uses in the Hom e (U . S. Department of Agriculture, Farmers’ Bulletin
N o. 1359, Washington, 1923), p. 5; and “ A chemical study of woman’s milk, especially its inorganic con­
stituents,” by L . Em m ett H olt, M . D ., Angelia M . Courtney, and Helen L. Fales, in American Journal
Diseases of Children, Vol. X (October, 1915), pp. 239-245

G O A T ’S M IL K

The goat can thrive either singly or in a herd, on hilly or rocky
land, on vacant city lots, along roadways and fences— where there is
not sufficient food for a cow (77). The goat has been called the
“ poor man’s cow.” The value of the goat when kept singly is largely
for families who desire a small quantity of milk and have not the
purse to buy a cow nor the space to keep it.
•Although goat keeping as an industry was introduced into this
country nearly 40 years ago it was confined almost entirely to the
Southwestern States until a renewed interest in goat’s milk produc­
tion was stimulated during the last 20 years by importation o f the
better Swiss breeds.
Keepers of goat dairies, who pay special attention to development
o f milk production, agree as to the low cost of goat keeping where
the best breeds o f goats are used and good pasture is available most
o f the year. The average cost o f feed needed to produce a gallon of
milk in only 6.4 cents (78). In the scientifically developed herds
at the University of California a gallon of milk was produced 23 per
cent cheaper and a pound of butterfat 7 per cent cheaper by the goat
herd than by the cow herd. These figures, however, would not hold
for the average cost o f the production o f goat’s milk and cow’s milk
throughout the United States. The yield of the average goat varies
from 3 pints to 3 quarts a day during the period of lactation of about
eight months, or 800 to 1,000 pounds (78) of milk a year—from
eight to fifteen times her weight. The average cow has a much larger
yield (4,000 pounds (79) annually) and a lactation period longer by
several months.
102931°— 26----- 3


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M IL K TH E IKDISPEHSABHE FOOD FOE CHILDREN

The composition o f goat’s milk varies considerably from that of
cow’s milk. (See Table 2.) The percentage o f fat and that of pro­
tein tend to be considerably higher in goat’s milk. The fat droplets
are smaller, and the emulsification of the fat is more thorough, so
that the cream does not separate readily upon standing (80). The
iron content is said to be, like that o f human milk, higher than that
of cow’s milk (81).
The taste is agreeable if proper precautions are taken in milking.
There is no excuse for allowing milk to have either a “ goaty ” or a
“ cowy ” taste.
The use o f goat’s milk for infant feeding has enthusiastic sup­
porters, and there is no doubt that it can be as well adapted as cow’s
milk to serve as a substitute for human milk. The real acidity is said
to be considerably less than that o f cow’s milk (82), and the curd
formed in the stomach is apparently finer (76),_ It has one preemi­
nent use, which makes it of the greatest value in the early feeding
o f children. Some infants, a relatively small number, show in­
tolerance to cow’s milk, due to idiosyncrasy to any or all o f the pro­
teins of milk (83). This makes a most difficult feeding problem if
for any reason mother’s milk is not available in the early months of
life. Such infants may do well on goat’s milk, if there is no similar
intolerance to its proteins (84). For this reason an available supply
o f goat’s milk powder or evaporated goat’s milk is important.
Evaporated goat’s milk is now. manufactured in Monterey, Calif.

I ll

The goat’s apparent insusceptibility to tuberculosis is offset by its
susceptibility to Malta fever, epidemics o f which in certain Southern
States have been not uncommon. The heating o f goat’s milk before
consumption, as practiced in Europe, would seem to be a wise pre­
caution, although the disease so far has been entirely regional.
C O W ’S M IL K

Whether or not cow’s milk as compared with the milk o f other
domesticated animals is nearest in composition to human milk, the
development o f the dairy cow has brought about the almost exclusive
use of cow’s milk as a substitute food for infants when artificial
feeding as an emergency measure is unavoidable.
The milk o f every animal 'is specially adapted to its o ffsp rin g varying with its average size, its rate of growth, and the length o f
time after its birth before other food can be taken. The difference
in the chemical composition o f cow’s and human milk (85) (86)
therefore is best explained by the fact that the calf doubles its weight
in 47 days and the infant in 180 days (87).
Human milk has a little more than one-third the amount o f pro­
tein in cow’s milk and less than one-half the amount of mineral
salts. The relative proportions o f the different salts differ remark­
ably little, though the percentage o f iron is said to be higher in
human milk than in cow’s milk.
The following table shows the percentage of mineral salts in
human milk and in cow’s milk:


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M IL K TH E INDISPENSABLE POOD FOE. CHILDREN

T able 3.— Mineral salts of human milk and of cow’s m ilk 1
Average percentage of salts in the ash

CaO

H um an m ilk.....................................
Cow’s milk___________ __________

23.3
23.5

M gO

3.7
2.8

PaOs

16.6
26.5

NaaO

7.2
7.2

KaO

28.3
24.9

Cl

16.5
13.6

Fe

0.00015
0.00007

1 Adapted from “ A chemical study of woman’s milk, especiallyitsinorganicconstituents,” by L . Em m ett
Holt, M . D ., Angelia M . Courtney, and Helen L. Fales, in the American Journal of Diseases of Children,
Vol. X (October, 1915), pp. 246-247.

The fat content and the size o f the fat droplet vary greatly in milk
from different breeds of cows, but ordinarily there is not much d if­
ference in average amount o f fat between cow’s milk and human
milk. The percentage o f sugar (lactose) is about twice as high in
human milk as in cow’s milk.
The relative average difference in the vitamin content of the two
forms o f milk is not yet Imown. There is no reason, however, to
doubt that the vitamin content o f a woman’s milk, as o f a cow’s,
depends primarily on her diet, and probably also on her exposure
to the direct rays of the sun. (See p. 4.) The occurrence of
deficiency diseases—beriberi (88), scurvy (89), and rickets (90)
(91)—in breast-fed infants during the first months after birth, as
well as later, gives startling evidence o f the effect of inadequate
feeding and hygiene of mothers.
Digestive disturbances in infants fed on cow’s milk have usually
been attributed to its difference from human milk in the percentage
o f casein (see Table 2) or to the chemical differences in the fat (84).
It seems probable now that many of these disturbances are due to
the fact that cow’s milk has a higher “ buffer value” than breast
m ilk; that is, cow’s milk is able to neutralize or bind more acid than
breast milk. The digestion o f cow’s milk therefore requires more
acid secretion in the stomach than the digestion of breast milk.
Individual instances of deficient gastric secretion may occasionally
be the result of congenital defect or disease. However, breast milk
is intrinsically more acid than cow’s milk. Acidification is the
method generally employed to reduce the buffer content o f cow’s
milk and render it more digestible by the infant. Dilution also
slightly increases the acidity o f the milk, and so helps to reduce the
buffer content. (92) (93) (94) (95) (96)
Cow’s milk to be a safe food for anyone must be clean and free from
the germs o f disease. This is even more important in regard to milk
for infants than for older children or adults. Not only should cow’s
milk be pure, but the fresher it is and the fewer manipulations it has
been subjected to, the less probability there is of its having been
altered in any o f its essential properties as a complete food. Knowl­
edge of the fundamental nutritive qualities of milk is still incom­
plete, so that it can not be affirmed absolutely that heat, chemicals,
or mechanical manipulations do not alter its nature as a food in
some essential way.
The modification of cow’s milk to adapt it to the needs and diges­
tive ability of the average child is studied in another bulletin of


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M IL K THE INDISPENSABLE FOOD FOB CHILDREN

the Children’s Bureau, “ Infant Care ” (Publication No. 8), and will
not be discussed here.
I f cow’s milk is to be used the questions next to be taken up are
which form o f cow’s milk is the safest and the best adapted to the
nourishment o f infants, which is best suited to transportation, and
which is available in all localities.
THE PURCHASING AND PREPARATION OF MILK FOR
INFANTS
L IQ U ID M IL K
GRADES OF R A W

M IL K

The United States Department o f Agriculture takes as the stand­
ard for milk (9=7) “ the whole, clean lacteal secretion obtained by the
complete milking of one or more healthy cows, properly fed and
kept, excluding that obtained within 15 days before and 5 days
after calving, or such longer period as may be necessary to render the
milk practically colostrum free.’’
It is left to the State (98) or the city to set up further standards
to protect consumers o f milk against fraud and disease and to insure
that proper methods are used in the production, handling, and trans­
portation o f milk. The regulation o f milk and milk supplies, with
other public-health protection, is part of the police power of the
State, as the United States Supreme Court has decided on several
occasions (99).
Many cities, both large and small, have strict regulations in regard
to such requirements, employing inspectors to detect insanitary prac­
tices in dairies and milk plants and to encourage the best methods
o f dairying. For proper control and study o f a milk supply it is
also necessary to maintain laboratories to find out its quality—
whether it has been adulterated by skimming or watering— and its
richness in fat and other solids, its freedom from dirt, and its bac­
terial content (100). There is no reason why, if funds are available,
small cities can not have at least as good a milk supply as larger
cities. It is, however, a fact that because milk control has not been
developed smaller cities, villages, and rural communities are in more
danger from poor milk than large cities, where increasing effort
is being made to safeguard the public in the use o f all dairy prod­
ucts. It has been estimated that in eities the annual per capita cost
of controlling the quality of the milk offered for sale is only about
5 cents (101).
In city or country the quality o f milk, whether raw, Pasteurized,
or canned, as it reaches the consumer, depends largely on the quality
o f the original milk (102). Therefore supervision and control o f
the source o f supply are of the utmost importance. The production:
o f clean, pure cow’s milk o f good quality and low bacterial content
depends on the feeding and the health or the cow ; the cleanliness o f
the cow, the milker, and the utensils ; the use o f the small-mouthed
milk p ail; prompt, efficient cooling o f the milk and constant refrig­
eration until the milk is used (102) (103).


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M IL K THE INDISPENSABLE FOOD FOR CHILDREN

17

Grading o f milk, based on dairy scores and bacterial count, which
has become universal in cities having the best milk ordinances, is
one of the first steps necessary in the protection o f the public food
supply. The United States Department o f Agriculture recommends
that in framing a milk ordinance city authorities divide milk into
three grades.6 The requirements for these grades as to both com­
position and bacterial content are different in different localities.
The commission on milk standards appointed by the New York Milk
Committee requires Pasteurization for all grade B milk and recom­
mends it for grade A milk (105).
In 1920 information was obtained about the milk supply o f 83
cities, including 25 cities having a population of more than 250,000
and 58 cities having a population o f less than 250,000 (106). O f
these cities only 31 reported a graded milk supply, and 45 reported
the sale o f certified milk for which the bacterial count must not
exceed 10,000 per cubic centimeter. In the cities_where grade A raw
milk was sold the maximum bacterial count allowed varied from
40,0007 to 100,000 per cubic centimeter, and this milk when Pasteur­
ized was allowed a bacterial count of 5,000 to 30,000 per cubic centi­
meter. Only a few of the cities had a grade B milk (with a bacterial
count up to 200,000 per cubic centimeter in raw milk and from 50,000
to 100,000 in Pasteurized milk), and practically none allowed milk o f
a lower grade than this to be offered for sale.
A grading ordinance recommended by the United States Public
Health Service (107) has been adopted as standard since 1922 by the
State boards o f health o f Alabama, Texas, Virginia, Kentucky, Ten­
nessee, South Carolina, Missouri, and North Carolina, and by July 1,
1925, had been enacted into law by 53 cities. This number, added to
the 31 cities reporting in 1920, makes a total o f 84 cities in the United
States which had adopted grading ordinances up to July 1, 1925.
A ll market milk should reach the consumer within 48 hours after
it is produced, for changes.affecting its nutritive value and its purity
are likely to occur as time elapses (108). Surprisingly little em­
phasis is usually put on the differences between stale milk and fresh
milk, though it is obvious that milk dried or canned within a few
hours after it is drawn is in a sense fresher than so-called fresh milk
which may actually be three or more days old. Certified milk is
supposed to reach the consumer before it is 24 hours old (104).
6 T h e U . S. D ep artm en t o f A g ric u ltu re h a s d ra fted the fram ew ork o f an ord in ance
upon w hich cities an d tow n s m ay build a law adapted to local con ditions.
P a r t o f th is
form is as fo llo w s :
“ Certified milk is m ilk produced and handled in conformtity w ith th e m ethod s a n d
stan d ard s fo r the production and distrib u tion o f certified m ilk adopted by th e A m erican
A sso cia tio n o f M edical M ilk C om m ission s M a y 1, 1 9 1 2 , and am en dm ents thereto ( 1 0 4 )
in effect a t th e tim e o f production , an d certified to by a m ilk com m ission con stitu ted in
com plian ce therew ith.
Grade A nUlk is m ilk produced fro m h e a lth y cow s, a s determ ined
by the tuberculin te s t an d p h ysical exa m in ation w ith in n o t exceeding one yea r previously
by a qualified v eterin arian , from dairies th a t score n o t less th a n ------------- on the d a iry fa rm score card in cu rrent use a t the tim e by the U . S. D ep artm en t o f A g ric u ltu re, w hich
m ilk sh a ll n o t, a t an y tim e, con tain m ore th a n ------------- bacteria per cubic cen tim eter. A ll
persons com ing in co n ta ct w ith the m ilk or m ilk u ten sils m u st be m edically inspected,
and such inspection m u st h a ve th e ap proval o f th e board o f h e a lth .
Grade B milk is
m ilk produced from h e a lth y cow s, a s determ ined by p h ysical exa m in ation w ith in n o t
exceeding one year p reviou sly by a qualified veterin arian , from dairies th a t score not
less th a n ------------- on the d a iry -fa rm score card in cu rrent use a t th e tim e by th e U . S.
D ep a rtm en t o f A g ric u ltu fe , w h ich m ilk sh a ll n o t, a t an y tim e, con tain m ore th an ------------bacteria per cubic cen tim eter ” ( 1 0 0 ) .
7 T w o cities had special grad es o f m ilk w ith m axim um bacteria l cou nts o f 1 5 ,0 0 0 and
2 5 ,0 0 0 resp ectively.


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IS

m il s : th e

mrasFJSNSABos

food fob children

In large cities, or wherever else it can be obtained, certified raw
milk or milk of grade A quality that has been Pasteurized should be
purchased for infants,. In small cities, if the milk is not graded,
information regarding dairies may be obtained from the local board
o f health. In towns and small communities a visit to the dairy
should be made by the householder personally. Bottled milk should
always be used, as “ dipped ” milk, dispensed from a large container,
is an unsafe food for young children. When milk is used on the
premises where it is produced it should be kept in sterilized bottles
or jars. The essentials of the care of milk both in the dairy and in
the home are to keep it clean, cool, and covered (109).
In general only the milk o f a tuberculin-tested, healthy, well-caredfor herd or single cow should be used. Herd milk tends to vary
less in its character than the milk o f a single cow, and is preferable
for infants if other conditions are equal. Milk relatively low in
butterfat is generally better for infants, and the removal o f 1 or 2
ounces o f cream from the top o f a quart by means o f a cream dipper
easily adapts milk o f high butterfat content for their use.
It is very difficult to obtain a constant supply o f raw milk in a
state suitable to be fed to an infant (110), for even under the best
conditions any milk may become contaminated accidentally. Milk
fit to be used raw must be produced under conditions which insure
rigid scientific inspection of the dairy, the cow, the milkers, and the
utensils and supervision o f the care given to the milk (102) (103)
and which allow the milk to be used in a relatively short time after
it is produced. Certified raw milk can be obtained .in large cities,
but only at a price prohibitive except to families with incomes far
above the average. In large cities-—where milk has to be furnished
to thousands o f infants, where it has to be supplied from a large
number o f dairies of all sizes so that adequate inspection is difficult,
and where it has to be transported long distances and kept for a long
time—ordinary raw milk is not a safe food for infants.
P A S T E U R IZ E D

M IL K

Pasteurization of most of the milk for infants and children which
is supplied to cities and towns therefore becomes a necessity. Such
general Pasteurization o f milk does not eliminate the need for great
care in the production and handling o f milk, but it provides an
additional safeguard for mills which must be transported long dis­
tances. Pasteurization of milk does not justify the use of filthy
milk; neither does it take the place of heating milk again before its
use by infants. But in some small cities and towns the conditions
o f production are so insanitary that Pasteurization is doubly neces­
sary if the milk is to be used for children. Pasteurization should be
regarded as an additional factor of safety in caring for clean milk
and not as a cloak to cover dirty milk. Pasteurization is the best
method at present available for obtaining safe milk on a large com­
mercial scale (108) (111) (112) (113). Most public-health authori­
ties consider Pasteurization necessary in order to prevent milk-borne
epidemics o f disease (114).
When milk is Pasteurized it is generally heated to 145° F. (about
63,° C.) and held at this temperature 30 minutes (111). This process


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M IL K THE INDISPENSABLE FOOD FOR CHILDREN

19

when done by the best commercial methods (112) destroys a large
percentage of the bacteria in milk and considerably delays its sour­
ing. Vitamin C and the calcium salts of milk are thought to be
affected adversely by Pasteurization. The important result of
Pasteurization is that if properly done it kills any disease germs
present, such as the germs o f tuberculosis, diphtheria, typhoid
fever, septic sore throat, or scarlet fever. For this reason to render
milk a safe food Pasteurization is carried out to some extent in the
majority of United States cities of 10,000 inhabitants or more, and
90 per cent or more of the milk that is used in the 12 largest cities
is Pasteurized (113). The average cost o f Pasteurizing milk was
'estimated in 1913-14 to be 0.313 cent a gallon (115). Pasteurized
milk is not sterile, and it will not, keep unless quickly chilled and
kept chilled until used; and for children it should be used within
36 hours after being Pasteurized. More general supervision by State
and municipal authorities of Pasteurization o f milk would tend
further to eliminate defects in the apparatus and methods employed
(116) and to give the public a good and uniform milk supply (117).
Even when milk is produced under apparently perfect conditions
the possibility of bacterial contamination can not be eliminated.
Epidemics are frequently reported in which the infection has been
traced to a single dairy, even to a dairy which came up to the highest
requirements for milk production, and occasionally to a dairy where
the milk was Pasteurized, though “ no epidemic of disease has ever
been traced to properly Pasteurized milk ” (118). Furthermore,
transporting and keeping milk increase the danger of bacteria’s
multiplying to a dangerous extent before it is used.
For these reasons the heating of milk sufficiently to insure the
killing of bacteria ordinarily present is now generally considered
a wise precaution to be taken in the home before young children are
fed milk either raw or Pasteurized, even of grade A quality.
P R E P A R A T IO N O F M IL K

The necessity of heating milk to make it a safe food before giving
it to infants presents several problems, as the temperatures and
methods used to destroy bacteria have other effects also on the milk.
A t one time heating milk was held to change its food value in no
way (119). Recent work on the effect of high temperatures on the
accessory food factors in milk has necessitated some change in this
opinion (120). Vitamins A and B seem to suffer little, if any, in
the heating of milk. There is considerable evidence now that the
antiscorbutic vitamin (vitamin C) is the least stable of the accessory
food factors and that it is injured in general by heat, oxidation, and
alkalization. The degree of heat and the length o f time it is applied
both affect the amount of injury. These conditions also cause
changes in the physical and chemical properties of milk that may
definitely influence its physiological value for an infant.
Sterilization of milk requires more heat than any other process.
Milk boiled (heated to 212° F.) is often spoken of as sterilized milk.
However, milk is not sterilized—that is, freed from all forms o f
living organisms^—unless it is subjected to this high temperature


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20

milk; the ihdispef &abee food fob children

for an hour or more on several. successive days. Boiling for five
minutes does kill all ordinary bacteria and does render milk for all
intents and purposes a sterile food. I f there is any question whether
milk is contaminated, this method should be used.
A ll methods of heating milk probably influence the destruction
of vitamin C, although holding milk at a high temperature while ex­
posed to air seems to be more destructive than bringing it to a degree
o f heat even higher but not holding it at that temperature. Milk
heated to just below the boiling point, and even allowed to cool in
the air, a process which submits it to a temperature o f 212° F. to
158° F. for 5% minutes was found by certain English investigators
to suffer little reduction in its antiscorbutic value (124). Aging of
milk also tends to destroy vitamin C (125). Since the vitamin C
content o f milk may vary from poor to good (see p. 4) it is univer­
sally accepted that the antiscorbutic vitamin should be provided in
the form o f orange juice or tomato juice for all infanta rm matter
how their milk is prepared.
In addition to heating milk to insure the killing o f pathogenic
bacteria many authorities recommend cooking it to increase its
digestibility. The heating of milk causes definite physical or
chemical changes in its protein, fat, mineral, and gas content (126),
Slight changes occur in milk heated to temperatures lower than the
boiling point, but the most distinct changes result from boiling it,
As a result of these changes the milk becomes more digestible but
also more constipating. The curd o f milk which has been sub­
jected to a high temperature forms a fine, easily broken down clot
in the stomach (127), The longer milk is cooked the finer and the
more digestible the curd (128). Pasteurized milk is no more
digestible than raw milk. Scalded milk may be slightly more so,
whereas boiled milk is definitely more digestible than raw m ilk
Evaporated milk (which has been cooked an hour) and dried miffr
are the most digestible of all. (See p p . — .) This modification o f
the casein or curd of cow’s milk to render it more like the curd o f
human milk and therefore more digestible can be brought about in
other ways than by heat, such as acidification.
In heating milk in the home for an infant the points to be con­
sidered in the selection o f a method of preparation are, first,
whether the milk is made safe; second, whether it retains as nearly
as possible its original character; and, third, whether greater
digestibility o f the curd is necessary for the infant.
Scalding is an easy and quick way o f rendering milk safe. It
carries the process o f sterilization one step further than Pasteuriza­
tion but not so far as boiling. It takes only a few minutes, but the
milk must be watched in order that the scalding point may be
recognized. The scalding or simmering of milk consists in heating
it over a fire in an open pan, preferably tin or enamelware, until it
purls or bubbles around the edge and steams in. the middle. At
this stage and before it boils it reaches a temperature of 167° F.
to 185° F. A t these temperatures the germs of disease ordinarily
found in milk are destroyed, (The temperature varies with the
size of the pan and the amount of milk being treated and the
altitude.) The reduction o f baeteria has been found to be some-


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M IL K THE INDISPENSABLE FOOD FOB CHILDBEN

21

what greater by scalding than by Pasteurization (129), Because
o f the low temperature and the short time of heating, scalding
probably brings about less destruction of vitamin C than any other
method o f heating. There is said to be less loss o f soluble protein,
fat, and salts in scalding milk than in boiling it (130) (131). There
is no change in taste in scalded milk, and it has no constipating
effect. The curd of scalded milk is more digestible than that of
raw milk.
Cooking in a double boiler brings milk to a temperature just a
little below boiling. It takes more time than scalding or boiling,
but the milk does not need to be watched during the whole period.
The milk is placed in the top o f a double boiler over cold water
and is tightly covered. The water is heated, and after it begins
to boil.the milk is allowed to cook from 6 to 10 minutes or longer
if greater modification o f the curd is desired. The germs o f disease
are destroyed, and the casein curd becomes more digestible than
that of raw milk though less so than that of milk boiled in an open
saucepan. Vitamin C is partly destroyed, the amount of destruc­
tion varying with the length or the cooking.
Cooking milk at a boiling temperature (212° F. or lower in high
altitudes) is a simple and quick method o f preparation. The milk
is placed in an open saucepan, and it must be watched closely until
it boils. At this point it may be taken off the fire, or it may be
allowed to boil for 2 to 10 minutes. Care must be taken that it does
not burn. By this method the germs o f disease ordinarily found
in milk are destroyed, and the casein curds when formed in the
infant’s stomach become soft and fine and much more digestible
than those o f raw cow’s milk, which are often large, thick, or tough.
The antiscorbutic vitamin is partly destroyed, the degree o f destruc­
tion depending on the length o f the cooking. To supply this vitamin
to the infant orange juice or tomato juice should be given.
C A N N E D M IL K

In large areas o f this country there are still no milch cows. In
these and other large areas, including some big cities, it is becoming
increasingly difficult to obtain a good grade o f bottled milk, raw
or Pasteurized, at a price that can be paid bv the average parent.
The dangers and delays in transportation, the difficulties o f dis­
tributing milk rapidly and keeping it iced, and the expense o f rapid
transportation, distribution, and refrigeration are such that the
question of canned milk for infant feeding is forced on the atten­
tion of the public. Milk in a condition allowing safe transportation
for long distances is a necessity if the children o f even continental
United States are to be furnished their needed allowance. Hawaii
(132), Porto Rico (133), the Philippines (134), and even Alaska
(135) depend very largely on importation o f canned milk to nourish
their child population. In the food crisis precipitated by the World
W ar the United States was forced to consider the varieties and rela­
tive merits o f different forms o f canned milk in order to meet the
emergency of helping to feed a large part o f Europe as well as its
own people.


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22

M IL K TH E INDISPENSABLE FOOD FOR CHILDREN

For infant feeding four kinds o f canned milk are now available:
Proprietary or patent foods, condensed milk (sweetened), evapo­
rated milk (unsweetened condensed), dry milk or milk powder. The
relative merits of these forms will be discussed briefly.
P R O P R IE T A R Y

O R P A T E N T FO O D S

Proprietary or patent foods are of two types, which may be called
class A and class B. Class A includes foods having milk as one of
their ingredients, usually in the form of dry milk, and class B those
having no milk in their composition.
Class A foods may or may not afford a completely balanced food
for an infant, but they all have the disadvantage of being consider:
ably more expensive than is necessary for an adequate infant food.
The foodstuffs in any proprietary food can be purchased more
cheaply uncombined. These foodstuffs can be combined to meet
individual needs more judiciously than is possible by using proprie­
tary foods offered under trade names for general use in infant feed­
ing. Some infants have been reared successfully on patent foods,
but many have been unnecessarily sacrified to the hit-or-miss method
of prescribing one arbitrary combination of foodstuffs to meet the
needs o f all infants.
Class B foods consist largely o f combinations of sugar and starch,
which are of no greater efficiency in the diet than certain flours,
cereals, and sugars purchasable in bulk at a much lower price in any
grocery store. Patent foods of this type should be used only in com­
bination with cow’s milk; they are not complete foods without it.
As modifiers o f milk or additional foods to be used with milk, they
are unnecessarily expensive.
C ON DE N SED M IL K

(S W E E T E N E D )

(1 3 6 )

What is comonly known as “ condensed milk ” is sweetened con­
densed milk. Evaporated milk is unsweetened condensed milk.
Condensed milk is usually made by heating fresh milk to a tempera­
ture of 180° to 200° F., which destroys most of the bacteria, yeast,
molds, and other organized and unorganized ferments, and facilitates
further processing. Cane sugar is then added in the proportion of
about 18 or 20 pounds to every 100 pounds of milk. When the sugar
is dissolved the mixture is run into vacuum pans and evaporated at
a temperature of 130° to 150° F. until the desired concentration is
reached. It is then cooled and run into cans. It is not sterilized,
but it is preserved by the high sugar content, about 42 to 46 per cent.
The specific gravity o f condensed milk is about 1.3. This specific
gravity is reached when the ratio o f concentration is about 2.33
to 1, or when about 2y3 pounds o f fresh milk are reduced to 1 pound
o f condensed milk (137). The proportions o f milk fat and total
milk solids are carefully stipulated for every form o f canned milk
by Federal standards, and variations in composition are much less
common than formerly (138).
Sweetened condensed, sweetened evaporated, or sweetened concen­
trated milk under Federal food and drug regulations must be “ the


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M IL K TH E IH M SPEXSABLE FOOD FOB CHHJDREH

23

product resulting from the evaporation o f a considerable portion o f
the water from the whole, fresh, clean, lacteal secretion obtained by
the complete milking of one or more healthy cows, properly fed and
kept, excluding that obtained within 15 days before and 10 days
after calving, to which sugar (sucrose) has been added. It contains,
all tolerances being allowed, for, not less than 28 per cent of total
milk solids and not less than 8 per cent o f milk fat ” (13fl).
Since the heat used in the entire process is below the boiling point
and since it is applied for a relatively brief time, the more resistant
forms o f organisms may persist, though they do not grow or multiply
in milk properly selected and properly canned.
There is experimental evidence that the vitamin value of condensed
milk has suffered little injury if any during the process o f evapora­
tion. Some antiscorbutic value (due to vitamin C) has been found
to be retained in condensed milk. Its presence depends (140) (141)
partly on the antiscorbutic value o f the raw milk used for canning.
The antiscorbutic value o f the raw milk depends in turn upon the
feeding o f the cow (Table 1).
Condensed milk is a semifluid substance, very sweet, and it is put
on the market in cans o f varying sizes and prices. Its high sugar
content practically prevents its freezing in transportation. I f made
properly, it will keep well until opened, but it is best when fresh.
Once opened it tends to spoil, and it should be kept iced and used
in a very few days after opening.
Sweetened condensed milk was the first form o f canned milk put
on the market. The early French inventions along this line, more
than 100 years ago, are said to have been called forth by Napoleon’s
efforts to obtain a milk that could be transported for the use o f his
armies. It is interesting to note here that canning milk first became
a successful business in the United States because o f the problem of
the proper nourishment of the soldiers o f the North during the
Civil War. Milk was demanded that would be small enough in bulk
for transportation and that would keep during transportation. The
condensed-milk business received a tremendous impetus at that time.
During the W orld War the demand for canned milk again became
insistent; and its production, especially for export, was greatly
stimulated, Enormous exportation o f condensed milk took place in
•I f 48 and I f I f , and exportation is still far above pre-war figures.
Sweetened condensed milk has been used in the feeding of infants
for several generations and has been also o f considerable use in the
eneral nourishment o f the family. As an infant food it has the
rawback of. an enormously high sugar content. With a 42 to 46
per cent proportion o f sugar (sucrose), condensed milk must be so
diluted for the average infant that the percentage of the other ingre­
dients o f the original milk is brought below the proportions best
adapted to growth and development, if human milk is taken as the
standard.
A comparison o f the distribution o f calories in different forms o f
milk commonly used for children can best be appreciated when 10@caterie portions are compared, rather than portions o f equal volume
or weight.

f


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24

M IL K THE INDISPENSABLE FOOD FOR CHILDREN

The following table shows the percentage distribution o f calories in
the protein, the fat, and the carbohydrates o f a 100-calorie portion of
each of certain forms o f m ilk:
T able 4.— Percentage distribution of calories in 100-calorie portions of certain
forms of m ilk 1

100-calorie portion

Percentage distribution of
calories

Form of milk
Measure

Cow’s milk:
Condensed (sweetened)_______________
Evaporated (unsweetened condensed)
Liquid, skim _____________ ____________
Liquid, whole_________________________
D ry, whole____________________________
D ry, skim___________ _____ ____________
Human m ilk_______________________________

VA tbsp........
3% tbsp.........
VA cup..........
 cup______
VA tbsp____
tbsp.........
ir cup............

Weight
in
ounces

h

2.1
9.6
5.1
. .7
1.0
5.7

Protein

11
23
37
1920
39
10

Carbo­
hydrates

Fat

23
51
7
52
52
5
48

65
26
56
29
28
56
42

1 Adapted from Feeding the Fam ily, b y M ary Swartz Rose, pp. 368-369 (The M acmillan Co , New York,
1924); A Laboratory Handbook for Dietetics, by M ary Swartz Rose, p. 129 (The Macmillan Co., New
/
1
and unpublished analyses by the Bureau of Chemistry, U. S. Department of Agriculture
(1925).

As usually 2 tablespoonfuls o f condensed milk is diluted with twothirds of a cup of water to give the equivalent o f a glass o f milk,
it is obvious that as far as growth food is concerned there can be no
comparison between the value of an equal number of calories in fresh
milk and in condensed milk. Cane sugar is not equivalent to either
protein or fat, and when it replaces these substances in milk the con­
tent o f calcium and other minerals is also lowered.
I f the sugar content is left high by diluting condensed milk less, bad
results from the intake o f too "much sugar may occur. Children who
apparently thrive on condensed milk—that is, who can stand a great
deal o f sugar— are not found, as a rule, to have good muscular de­
velopment. Though some o f them are fat, owing partly to excessive
water retention, they are flabby and pale and do not have the average
resistance to disease. For babies, “ condensed milk is a safe food
for a very short time on ly ” (142). Experiments with animals also
tend to prove the relative inadequacy or condensed milk as the solefood for the young (143). Condensed milk is not sterile; it may
spoil if left open to the air or if not kept iced, and it should be used
soon after being opened. These are additional reasons why con­
densed milk is not a safe food for infants in the hands o f the average
mother without medical supervision. Condensed milk may some­
times be given to infants—in certain emergencies, or by direction o f
a physician, or as an occasional food, if cod-liver oil and orange juice
are also given. A physician should be consulted as to its use.
Condensed milk is not the form o f canned milk to choose for the
adequate nourishment o f children or adults where fresh milk can
not be obtained and food must be transported from great distances.
It has the disadvantage of a high water content even after evaporar
tion and is unnecessarily bulky for shipping.


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M IL K TH E INDISPEKS ABLE FOOD FOR CHILDREN
EVAPORATED

M IL K

(U N S W E E T E N E D

CON DEN SED )

25

(1 3 6 )

Evaporated milk is made by taking fresh milk with nothing added
to it, heating it to a temperature near the boiling point, and evaporat­
ing it in a vacuum until the ratio is reached of about 2 to 2 y2 parts
o f fresh milk to 1 part o f the finished product. It is then placed in
cans and sterilized by subjecting the cans to steam under pressure.
The temperature must be high enough and maintained long enough
to insure practical sterility and to give the evaporated milk suffi­
cient body to prevent separation o f the butterfat in subsequent trans­
portation and storage. Temperatures o f 226° to 240® F. for 30 to
50 minutes are said to be commonly used.
Evaporated milk has the consistency and appearance of thin cream.
I f properly made, it is practically sterile, and it will keep unopened
indefinitely, but it is said to be best when fresh.
Under the food-inspection decision o f January, 1923, evaporated
milk (unsweetened condensed or concentrated) must be “ the product
resulting from the evaporation o f a considerable portion of the water
from milk, or from milk with adjustment, if necessary, o f the ratio
o f fat to nonfat solids by the addition or by the abstraction of
cream. It contains, all tolerances being allowed for, not less than 7.8
per cent o f milk fat, nor less than 25.5 per cent of total milk solids;
provided, however, that the sum of the percentages of milk fat and
total milk solids be not less than 33.7 ” (144).
The relative proportions o f the original ingredients o f milk—the
so-called “ milk solids ”— are about the same in sweetened condensed
as in evaporated (unsweetened condensed) milk. Sweetened con­
densed milk as a rule has each of the milk solids in a slightly
higher proportion than evaporated milk, probably on account o f a
greater degree o f condensation in the sweetened (136). Evaporated
milk has no solids except those originally in the milk, whereas
sweetened condensed milk has had large amounts of cane sugar
added.
The following table shows the average composition o f different
forms o f canned cow’s m ilk:
T able 5,— The average composition and calorie value o f different forms of
canned m ilk 1

I tem s

C on d en sed E v a p o ra te d
m ilk (u n ­ D r y w h ole
m ilk
m ilk
(sw eetened) sw eetened
con den sed) ;

D r y sk im
m ilk

COMPOSITION
T o t a l -------------- -------------------------- -------------- p er c e n t ..
W a t e r . . —.......................... ...............................
do
M ilk s o lid s . — ........... .......... ...................... .I ____. . . da
F a t ------------------------------------------------------------------- d o . ___
P rotein . . . . . . . . . . _____. . . . . . _____ . . .
do
M ilk s u g a r .......... ........... ......................
do .
A s h ................................................................................. d o ____i
C a a « su gar_______ . . . . . . . . . . . . . .
- ...........
do,.

100.00
28.00
30.00
9.00
7.80
11.50
1.70
42.00

100.00
73; 00
27,00
& oo
7.00
10.50
1.5

332

145

100.00
4.00
96.00
29.00
25. 50
36.00
6.50

100.00
3.00
97,00
2.00
35.50
51.50
8,00

CALORIE VALUE
C alories per 100 gram s——______ . . . . . . . .
100-calorie portion :
B y w eight, o u n ce s . .............................. .
B y m easure, tablespoon fu ls___ . . . .

‘ 1.1
IK

2.1
3M

, 512
0.7
4K

361
1.0
3K

i Adapted from unpublished analyses b y the Bureau of Chemistry, U . S. Department of Agriculture,
and from Feeding the Family, by M ary Swartz Rose, pp. 368-369 (The Macmillan Co., N ew Y o rk. 1924),


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26

M IL K TH E INDISPENSABLE FOOD FOR CHILDREN

Evaporated milk, if used when the can is first opened, is practi­
cally free of all germ life. In this it resembles boiled milk, and, like
it, is superior to Pasteurized and to raw milk in sterility and in
digestibility. .The digestibility of both the fat and the casein is
probably increased by the exposure of the milk to as high a tem­
perature as is used in this process (145).
The butterfat, milk-sugar, and mineral contents are not appreci­
ably altered by condensation, but the minerals are rendered less
soluble by the process of sterilization (146). Recent investigation
(147) shows that the only calcium salts affected by heat are the
colloidal calcium salts, which are rendered much less stable and which
pass in part at least into a crystalloid form. The precipitation of the
phosphates is in general proportional to the amount of heat used
and its duration. The change made in the form -of the minerals
through heating has not been found to cause any appreciable disad­
vantage to the child, though some recent experiments in feeding in­
fants suggest that the longer heating of milk may result in a de­
crease in the availability of the phosphorus and calcium (148).
Feeding experiments on animals tend to show that vitamins A and
B (and probably vitamin D ) are not appreciably injured by evap­
orating or heating the milk (10). Vitamin C, however, appears to be
injured by the great heat (240° F.) necessary for the sterilization of
condensed milk not preserved by the addition of sugar (11). As an
antiscorbutic, such as fruit juice, should be given to all infants arti­
ficially fed, this lack, if it exists, does not necessarily imply a serious
lowering in the nutritive value, of evaporated milk.
By diluting it with an equal volume of sterile water, evaporated
milk can easily be reconstituted approximately as ordinary milk. It
has been o f great use in the general nutrition of the household, and it
has a more tenable place in the feeding of infants and older chil­
dren, when fresh milk can not be obtained, than condensed milk.
However, it freezes and is therefore not suitable for transportation in
the coldest weather even to the northern parts of the United States,
because freezing apparently alters the chemical nature o f milk as well
as its digestibility (151) (152). It must be carefully handled and
kept cold after opening if it is to remain sterile and fit to give an
infant; and even though it is condensed to less than half its original
bulk, its transportation still entails the carrying of a considerable
amount of water, more than 70 per cent of the weight of the evap­
orated milk. (See Table 5.)
Sweetened condensed milk is retailed in 123/2-ounce, 14-ounce, and
15-ounce cans; evaporated milk in 6-ounce and 16-ounce cans. The
15-ounce can of condensed milk, in April, 1926, could be bought for
19 cents, and the 16-ounce can of evaporated milk, for 12 cents. Since
both forms o f condensed milk are reduced half or more in bulk these
prices represent about the cost of 1 quart of reconstituted milk. A t
present evaporated milk is the cheapest canned whole milk on the
market, but there is no apparent reason why a good quality of wholemilk powder could not be retailed at as low a price if the demand for
the powder should increase so as to-equal that of either sweetened or
unsweetened condensed milk.


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Skimmed milk is condensed in both the sweetened and the un­
sweetened form. However, it is used mostly for commercial purposes
and has no place in the feeding o f the normal healthy infant.
Goat’s milk is available in condensed form and can be used as a
substitute for canned cow’s milk. (See p. 14.)
D R Y M IL K

O R M IL K P O W D E R

Drying milk on an extensive scale began as a means o f saving
skim milk, a by-product in the manufacture o f butter and cream.
On many farms great quantities o f skim milk are still wasted or
uneconomically used in the feeding of animals. The movement to
utilize this product by making more condensed or powdered skim
milk or by making skim-milk cheese is an enterprise that should
meet with the cooperation and assistance o f all interested in the
proper nourishment of the human family.
Apparently the first commercially usable patent for any process
o f drying milk was taken out by Grimwade from the British Gov­
ernment in 1855, Although certain processes have been patented
in the United States for more than 50 years, the dry-milk industry
can not be said to have become a large business in this country until
after 1900 ; indeed, it has reached large proportions only in the last
10 years.
Milk powder is now made in this country by numerous methods,
most o f which are based upon two essentially different processes;
namely, the drum, roller, or film-drying process, and the spraydrying process.8 In both processes the milk may or may not be
condensed before drying.
Skim-milk powder is still the principal form o f dried milk on
the^ market in this country. There is a wide wholesale demand for
it for use in bakeries and in the manufacture of ice cream and milk
chocolate. There has never been a great retail sale of milk powder,
but it is now rapidly becoming better known, and skim-milk powder
for family cooking is beginning to receive the attention it deserves
as a valuable form o f protein food.
Milk is also dried as cream, as whole milk, as partly skimmed
milk, and as buttermilk, and the different constituents o f the milk
itself-—the casein, whey, and milk sugar— are separated by certain
dry-milk concerns and put on the market as powders.
J n , i b e , dry m > roller, or fita -d r y in g pro cess the m ilk i s dried by com ing in to .contact
m t h the h ot su rfa c e s o f one or m ore m eta l cylind ers or dru m s, charged w ith steam
under p ressure.
T h e m ilk, w ith or w ith o u t condensing, is spread upon the su rface o f
th e dru m or dru m s in a thin film , and w hen dry it is a u to m a tica lly rem oved bv a
scrap er. T h e m ach in ery used in th e J u st-H a tm a k er process, a w idely used variety J f 'fh e
dru m process, h a a tw o drum s, about one s ix ty -fo u rth o f an inch ap art, revo lv in g in on nosite direction s. T h ese drum s, w hich are som e 6 0 inches lo n g and 24 inches in diam eter
are charged w iUi ste a m under about five a tm osp h eres o f p ressure, and their h e a tin g s u r’
fa ce s a tta in a tem peratu re estim ated a t 2 4 6 ° to 2 8 0 ° F .
T h e dried m ilk com es off each
revo lv in g cylind er as a sheet, w hich is ea sily crushed in to a fine pow der.
In a m ore
Jiio+U !’7 ffiS fP t& l
Gf
Process the dru m is in closed in a vacuum
so
th a t the m ilk dries fa s te r and a t a low er tem perature th a n it w ould in the a ir
P rovi­
sion is m ade fo r rem ov in g th e pow der w ith o u t breaking th e vacuum .
In th e sp ra y-d ryin g process th e m ilk is dried by reducing it to a sp ra y in th e presence
a51;.fv, Usua]1f } }
first P asteurized an d th en condensed in a vacuum .
A spray is
form ed , either c en trifu g a lly or b y fo rcin g th e m ilk under high pressure in to a hot-air
cham ber th rou gh m inute op enings in m eta l disks.
T h e atom ized liquid, surrounded by
^
r^ T ° M ot air, in s ta n tly dries an d ta ils to the bottom o f the cham ber a s a sn o w y


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M IL K .T H E INDISPENSABLE FOOD FOR CHILDREN

Under the Federal food and drug regulations dried milk must
be “ the product resulting from the removal o f water from milk,”
and must contain “ all tolerances being allowed for, not less than
26 per cent of milk fat and not more than 5 per cent o f mois­
ture.” (153)
The essential point in this, as in every kind o f canned milk, is that
the original milk should be of high quality. No good canned milk
can be produced from milk that is stale or impure or that comes
from improperly fed cows.
Next to the quality o f the original milk, the most important things
apparently in all processes used in preparing milk powder are the
degree o f heat, the period through which it is applied, and the pre­
vention, as far as possible, o f oxidation, which causes changes in
the fat and the vitamins (154) (155).
The processes differ materially in these points, and they are con­
stantly being modified, so that it is difficult to tell by which process
the properties o f the original milk are more likely to be changed.
The drum process submits the milk (for a brief time) to a higher
temperature than the spray process. Theoretically milk would be
expected to suffer greater change if submitted to a higher tempera­
ture ; but recent investigations seem to show that, at least as far
as the antiscorbutic vitamin is concerned (155), the prevention of
oxidation (by use of a vacuum for condensing or drying and by
immediate removal o f the powder from the heat o f the drying
chamber) is as important in preventing change as keeping the
temperature low. A tangible advantage o f milk powder made by
the spray-drying processes, especially those in which the fluid milk
is heated to not more than 150° F., is that it may be reconstituted
completely, even in cold water, forming a solution and emulsion
similar to the original fluid milk (136).- Some forms o f dry milk
leave an insoluble residue, even when mixed with warm water (156).
In the early days of manufacturing milk powder 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 also was frequently added. Through the
perfecting of the steps used in the process, and especially by the con­
trolling o f the temperature employed and the duration o f exposure,
a powder which may be reconstituted completely in water can now be
made of milk, or any of its constituents other than fat, without the
addition of any foreign substance.
In the best preparations of dry whole or dry half-skim milk the
constituents are little if any altered from their state in fresh milk.
The butterfat retains the globular form and readily emulsifies when
mixed with water, the actual size of the fat globules is apparently re­
duced, the albumin is not coagulated, and the casein is not toughened
and is still soluble in water.
There is also no doubt that milk can be dried iii such a way as to
conserve the vitamins of the original milk (155) (157) (158) (159)
(160) (161) (162). (See Table 1; also p. 28.)
From recent experimentation on animals it seems probable that the
presence of vitamins in milk powder depends primarily on the quality
o f the milk that has been dried. The effect of change o f seasons on


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the vitamin content o f fresh milk, largely due to green food eaten by
the cows (160) (163) (164) (165) and possibly their exposure to
sunshine (166) (167) (168) is undoubtedly greater on vitamin C
and vitamin D than on either vitamin A or vitamin B (169). Either
age or heat in the presence of oxygen may injure the relatively
unstable vitamin C, and the injury is greater when an alkali has
been added to the milk (170) (150) (171) (172). The necessity for
an additional supply of vitamin D in cod-liver oil or sunlight when­
ever fresh cow’s milk is used in infant feeding is even greater when
canned cow’s milk is used, whether dried, evaporated, or condensed.
Dry milk, like whole milk, if produced under the right conditions,
may be a complete fo o d ; and ordinarily when it has been tried as an
infant food in France (156), England (156), Germany (173), and
the United States (174) (174a), its use has not been followed by
scurvy In fact, it may be effective as the sole antiscorbutic in the
cure of this disease (175) (176). There is no doubt, however, that
some infants whose food consists of cow’s milk Pasteurized, boiled,
condensed, evaporated, or powdered— and sugar and water, without
the addition of fruit juice or vegetable water, will finally cease to
grow and may also show more or less definite symptoms of scurvy.
The same disaster may occur on a diet o f human milk.
_
The danger o f bacterial decomposition in milk powder is reduced
to a minimum by the low moisture content. Bacteria and other
microorganisms require moisture for growth and for decomposition
o f the substances in which and on which they live. The removal
of the water from milk makes the resulting powder a poor culture
medium and largely does away with the perishable qualities of the
liquid milk (176) (177). There is good evidence that pathogenic
organisms in milk are greatly reduced in virulence by drying, if
not completely done away with (156) (178) . I f milk powder made
from ordinary milk is protected from recontammatioy during pow­
dering and packing its bacterial content becomes as low as that o f
certified milk (176). Even this low bacterial content is gradually
reduced, for if dry milk is tightly covered it becomes more nearly
sterile the longer it is kept.
.
‘ .* *
A ll products containing milk fat keep better when placed in the
cold and not exposed to light and air. One great drawback to the
production o f dry whole or dry half-skim milk has been the fact
that the powder made by the early methods quickly became rancid
or acquired a t£tallow y’’ odor or taste. Milk powders containing
fat, even if made by modern processes, tend after prolonged storage
to become either rancid or tallowy. These changes, though un­
pleasant, are not injurious. The heat treatment a milk receives in
drying, the quality o f the original milk, the moisture content of the
milk powder, the kind of container in which it is packed (it should
be air-tight and moisture p roof), and the temperature during its
storage all influence its keeping quality (179) (180). The manu­
facture o f dry milk has been so improved that even dry whole milk
is now put up (by the best processes) in a form that will keep for
many months without any rancid or tallowy taste, which is the first
sign o f deterioration. Nevertheless, the production o f dry milk
should be carefully regulated to meet the demand, and the containers
should be dated.

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MILK THE INDISPENSABLE FOOD EÔR CHILDREN

The following table shows the average composition o f milk pow­
ders—whole-milk powder and skim-milk powder :
T able 6

— The average composition of milk p ow der1
Whole-milk Skim-milk
powder
powder

Per cent
29.0
25.5
36.0
5.5
4.0

Per cent
2.0
35.5
51.5
8.0
3.0

i Unpublished analyses b y Bureau of Chemistry, U . S. Department of Agriculture, 1925.

Dry milk is put up in tin receptacles of different sizes, sometimes
parchment lined, the price per pound varying with the process of
manufacture and the character o f the milk dried. At wholesale
dry skim milk in bulk sells as low as 10 cents a pound and at retail
in small cans as low as 23 cents a pound. Dry whole milk in
2impound cans sells, at 76 cents a pound, wdiich gives a whole milk,
when it is properly reconstituted, at about 19 cents a quart. (These
prices are as o f March, 1925.) The best preparations o f milk powder
made specially for infants retail at a price which makes the price
o f the reconstituted milk about 20 cents a quart.
The composition o f whole dried milk has been specially studied by
a number of authorities, and all agree that the milk solids are in­
creased to about eight times those o f the original milk. Therefore,
to reconstitute an average milk with a fat content of between 8 and
4 per cent, one part o f milk powder should be diluted with 8 or 8y2
parts o f water (by weight).
„ \
The use o f dry milk in the Tropics, in the Canal Zone, and m the
islands under United States protection is increasing because dry milk
keeps without ice (181) (182). Dry milk was used extensively m
the British hospitals and ambulances during the W orld War, and
for military purposes it was found in some ways superior to con­
densed or evaporated milk (181). In explanation o f this it was
said that the “ advantages of this (dried milk) are, o f course, the
great saving in weight and the fact that the dried milk is even less
subject to contamination or deterioration than evaporated or con­
densed m ilk ” (188). Its desirability for use in traveling or for
transportation to places where fresh milk is not available is selfevident. The French picturesquely characterize dry milk as “ la
vache en placard,” “ the cow in the cupboard.”
In cooking, the equivalent o f a glass of milk or even a pint can
be added to a food without greatly increasing its bulk or changing
its taste or texture (184).
For dispensaries, hospitals, and day nurseries or nursery schools
milk powder is distinctly more economical than any other form of
cow’s m ilk; the cost of much equipment, including kitchen outfit, ice
or refrigerating plant, and the large number o f bottles, is.eliminated,
as well as much of the service needed to prepare and dispense other
milk preparations. The use o f dry milk as directed by a physician
needs only the equipment and intelligence necessary to boil water
and measure in a tablespoon.

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There are also certain occasions where for the sake o f economy,
even when fresh milk is available, dry milk seems to have a legiti­
mate use. Such a situation might occur in a poor family, when per­
haps only one bottle feeding or one glass o f milk a day is given to an
infant.
. .
The first medical reports on the use o f dry milk m infant feeding
were made for the years 1905 and 1906 in England (185) (186) and
in France (187). O f late years dry milk has been widely used by
physicians in Belgium, France, Germany, England, India, Japan,
and the United States (188a-188n), apparently with great success,
~as far as can be judged by reported normal gains in weight and
other indications o f good nutrition in infants fed exclusively on it.
There seems every evidence that for infants milk powder as a food
is equal, if not superior, to any other form o f milk except fresh milk
produced under strictly hygienic conditions. It is superior in digesti­
bility to i;aw milk because the curd o f all heat-processed milk is
finer and more flocculent than that o f raw milk (156).
.
Apparently, according to experience abroad, dry milk from which
approximately half the cream has been removed before drying (socalled half-skim dry milk) has distinct advantages in the feeding
o f very young infants. Possibly these are due to the fact that in
the dilution o f 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 nutritive value suffi­
ciently high to produce normal growth. For older infants—those
over» 6 months— dry whole-milk mixtures are advocated and would
seem theoretically advantageous, since at this age a child needs and
can digest more fat, and the relatively small amount of sugar in
whole milk can be supplemented by cereals or by granulated sugar,
as is usually done with cow’s milk for older infants.
. Milk powder has the great advantage over other forms of milk,
even Pasteurized, of having had most of the bacteria originally pres­
ent in the milk destroyed and o f being practically free o f the danger
o f transmitting the milk-borne infections (189). Milk powder, a
o-ood food for well infants, seems to have a “ distinct therapeutic
value” for sick (174a) or premature infants partly because of the
digestibility o f its protein and partly because, being a solid, it may
be made into strong solutions, doing away with the necessity of
taking large amounts of fluid.
A well-known German pediatrist sums up the experience of many
hospitals in the following report on the use of milk powder in
Berlin:
W ithin the last two years we have been able to feed very successfully the
sick children admitted for treatment to the Children’s Hospital of Berlin,
thanks to the powdered milk obtained from the United States.
The good
results so obtained are a sufficient proof that children may be fed on powdered
milk. This has been made possible by the progress in the methods of manu­
facturing powdered milk.
! . _*
.
,,
* * * Thus powdered milk makes available for the children of even the
large cities and industrial centers a food containing fewer bacteria than the
liquid commercial milk. This is a very important factor in the feeding of
infants. I myself am of the opinion that many cases of illness could be pre­
vented if the infants were fed on milk containing few bacteria, and our expe­
rience with the use of powdered milk substantiates the correctness of this
viewpoint.


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MILK THE INDISPENSABLE FOOD FOB CHILDREN

Even during liot weather we observed among infants fed on powdered milk
none of the disorders which we have seen in the cases of infants fed on cow’s
milk abounding in bacteria; in cases of diseases it was found easier to obtain
recovery when powdered milk was used instead of liquid commercial milk.
Ill saying tliis I realize tliat I shall not find universal agreement.
* * * Doubts may also arise whether the danger of scurvy among infants
could be prevented by the use of powdered milk. So far it has not been ob­
served that an infant fed on this kind of milk develops scurvy, but theoreti­
cally such a thing is possible. In the children’s clinic of Berlin the children
were always given a little fresh-fruit juice as a matter of precaution, although
there was no indication of the need of such measure. Oh the other hand in
the children s clinics of both Vienna and Berlin attempts were made to feed
° ? 1p?Y,tlere« milk chlldren sick with scurvy ; and it can be proved that, pro­
vided the other usual precautions are taken, it is possible to cure the disease
with powdered milk.
According to recent investigations it seems more important for the preven­
tion of scurvy to feed the milch cows in such a way as to assure a great
amount of vitamins in the milk. I f this is accomplished, the drying of the
milk brings about no harm (1 73 ).
J S '

Up to this time in the United States too little attention has been
paid ^by dry-milk manufacturers to preparing a product suitable
lor the use o f infants and at the same time cheap enough to attract
general notice. As yet relatively little milk o f the best quality pro­
duced under the most hygienic circumstances is dried. The price o f
the best dry milk on the market is considerably higher than the
P.rice a-sked for fresh grade A milk or even evaporated milk.
Whole-milk powder and half-skim-milk powder made o f grade A
milk to which no foreign substance has been added, dried while still
fresh, under proper inspection, and in the immediate locality where
it is produced^ should be available on the retail market at a price
equal to the cost o f production plus a reasonable percentage of profit
to the manufacturer and the retailer. At the present wholesale prices
of milk a grade A milk powder could probably be sold, if the retail­
ing could be controlled, at a price allowing it to be reconstituted at
12 cents a quart. A good demand for dry milk would help to reduce
the retail price.
Dry skim milk, dry casein, and dry whey are forms o f dry milk
especially adapted for the use o f the sick child, and these are well
known to the medical profession under special trade names. They
are, o f course, high priced. The separate constituents o f milk dried
are cheaper than dry whole milk, and they would be used in hospitals
the case of skim milk, for household cooking if their properties
and legitimate retail prices were known to the public.
To summarize briefly; Against dry milk it may be said that it has
been subjected to high temperatures in the process o f manufacture
and that there is no absolute guaranty o f the freshness and purity
of the original milk (189) . Like any other milk product, if it is
niade from ^inferior milk it may be unfit for human consumption
Also there is some danger that a mother unaccustomed to this con­
centrated form o f food may give too much milk to a child either at
one feeding or in the entire day’s food. The good points about dry
milk are: (a) Increased digestibility, (b) greater freedom from bac­
teria, (c) decreased danger o f .contamination, (d) better keeping
qualities—no ice needed, (e) convenience—always ready, (f ) palatability, (g) cheapness—no "waste, (h) ease o f transportation—small
bulkj small weight, freedom from danger o f freezing, (i) retention 6f
vitamin C in approximately the amount present in the original milk.

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The development o f the use of milk powder seems to be the next
logical step in the modern health movement to foster the production
d f milk under sanitary conditions (190) and at the same time to
increase its use as a food.
* MILK FOR THE OLDER CHILD
Concerning the nourishment of children over 2 years o f age two
things can bo stated absolutely i First, milk is an essential food for
their proper growth and development; and, second, the milk should
be clean, fresh whole milk. Every growing child is better and more
cheaply nourished if he is given clean, fresh, whole milk either as
a drink or in the cooked food in his daily diet. The value o f milk
for children lies in its richness in calcium and in vitamin A and m
the superior quality o f its proteins.
,,
A quart o f whole milk every day is now considered the optimal
amount for the best development of bones and teeth in the average
normal child (68). A pint and a half of whole milk eveiy day is
the least amount thought necessary for adequate nourishment of a
child from 18 months to 12 years of age when the rest of the diet
is balanced.
“ The dietary rule o f a quart of milk each day for every child is
much more than a precept based on individual opinions or drawn
by analogy from the results of feeding experiments with lower ani­
mals; it now rests on scientific evidence obtained by extensive and
intensive experiments directly on the children themselves” (191).
I f good raw milk or Pasteurized milk from a reliable dairy can
not be obtained, canned milk—either dried or evaporated (unsweet­
ened condensed)—should be used. I f canned milk is used it should
be used relatively soon after canning, and the original milk should
be fresh, clean, and of good quality. This can best be insured by
purchasing it from a reliable firm. There is some danger that
mothers unaccustomed to the use of canned milk may not properly
apportion the amount of milk to be given to the child and for this
reason allow either not enough or more than is necessary or judicious
for daily use. (See Table 5.) I f skim-milk powder is used instead
of whole-milk powder, milk fat, which contains one of the accessory
factors necessary to produce normal growth in children (vitamin
A ), should be added to the diet in the form of butter or cream.
There is a difference between the property o f butter due to its
vitamin A content (13) and its property, common to all fats, of
furnishing energy when consumed in the body. As body fuel any
edible animal or vegetable oil is the equivalent of butter. In vitamin
A content milk fat or butter is probably superior to all other animal
fats except fish fats and possibly the fat o f egg yolk (192). Pork
fat and vegetable oils have, as far as is now known, little or none
of the growth-producing vitamin A (193). Beef fat, however, does
contain i t ; and margarin made from beef fat, especially margarin
in the manufacture of which skim milk is used, has apparently con­
siderable o f this growth-producing power (194). I f sufficient whole
milk (1 quart) is included in the well child’s daily food, most author.# g ee “ T h “ N ew er K n ow ledge o f N u tritio n ,” th ird ed ition, by E . Vv.-M cCollum an d N in a
Sim m ond s, p . 2 2 9 (T h e M acm illa n C o., N ew Y o rk , 1 9 2 5 ) .


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ities consider that margarin may safely be given instead o f butter
to furnish the percentage o f fat needed in the diet (195), especially
if other sources of vitamin A such as leafy vegetables are included
in the diet. For economy this may be a wise procedure.
Lard, vegetable oil, and nut margarin are not nutritively equal
to butter or to beef-fat margarin, as they are only fntel fats and not
fats plus the substance that stimulates body growth (193). Milk, but­
ter, eggs, beef drippings, and body organs such as liver are the chief
animal fats that are sources of vitamin A. Fish fats such as cod-liver
oil furnish considerably more vitamin A than an equivalent amount
of milk fat, besides some of the antirachitic factor, vitamin D (196)
(197). All these foods are high in price; and there is great danger
that in families of the poor where formerly butter or beef drippings
or suet was the chief fat used vegetable oil and nut margarins—which
are not equivalent either to beef fat or to butter—may be substituted
as the only faf in the diet o f the growing child.
Startling evidence of the result o f adding milk fat to the diet was
given in a recent experience in Denmark. During the W orld War
the prevalence o f eye diseases among Danish children was gradually
increasing, from lack o f the fat-soluble vitamin A, due to the export­
ing of butter and the feeding of children on separated skim-miIk
by-products. When the German blockade went into effect in 1918
butterfat was increased in the diet o f the children (14) (15), and
the prevalence o f eye diseases was suddenly checked.10
Fallure to gain in weight, lethargy, and even marked susceptibility
to infectious diseases, especially those of respiratory origin, may
precede the more serious manifestations of deficiency diseases (such
as xerophthalmia, beriberi, scurvy, rickets, or even pellagra). Fre­
quently these latent symptoms o f lack o f vitamins in the food are the
only evidence o f dietary insufficiency. This vague ill health is much
more common than the more noticeable symptoms of disease, and
its prevention is therefore more important.
Skim milk has a legitimate use in the nutrition of children if it is
looked upon simply as a form of protein; that is, a food similar to
lean meat. It does not take the place of whole milk for the child,
because it lacks more or less o f the essential fat, according to whether
it is hand skimmed or mechanically separated. No more valuable or
cheaper form of adequate protein—tissue-building food—exists than
skim milk, and to a large extent skim milk can be substituted for
meat in the child’s dietary.
In household cooking skim milk can take the place of whole milk
and can safely be substituted for it in preparing certain dishes (199),
if the amount o f animal fat, other than lard, used in the dietary is
carefully watched and not allowed to decrease below the percentage
found necessary to help furnish vitamin A , to increase the fuel value
o f the diet, and to promote mineral metabolism (195).
Ordinary cheese is a whole-milk product containing both fat and
protein and is o f great value in the dietary of older children and
adults. Little children can not be given much whole-milk cheese, as

10Experience with wounded men during the World War has pointed out another im­
portant attribute of milk. The presence of milk fat in the diet apparently promotes not
only body growth but body repair, as seen in the healing of wounds. The necessity of
a supply of milk and butter for hospital use and for convalescence from wasting disease
is apparent.

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it is somewhat difficult to digest. Skim-milk cheese, o f course, con­
tains no fat. It has the same food value as skim milk and is not
indigestible.
SUMMARY
Milk is the indispensable food for children. Whole milk in some
form must be furnished them if nutrition is to be adequately main­
tained and if normal growth in height and weight and normal bone
and tooth formation are to be assured.
The proper nourishment o f children is the first duty of the Nation.
Every child from 1 year to 16 years of age is better for having a
quart of milk in his daily diet. . The minimum allowance for any
growing child is l !/2 pints daily; an adult needs 1 pint daily. Milk
can be used in the cooking of food and so disguised for those who
do not like it as a drink.
Since milk and milk products are a vital necessity for growing
children, for pregnant and nursing mothers, and for the sick, a
supply of good-quality clean milk should be available in every local­
ity under strict sanitary supervision.
Clean, fresh cow’s milk is the best available form o f milk for
infants after they are weaned, but it may have to be treated or modi­
fied to adapt it to the digestion o f some infants. Pasteurized milk
lias become more and more generally used in this country because
safe raw milk is difficult to obtain. Milk powder or evaporated milk
(unsweetened condensed) may safely be substituted when good raw
or Pasteurized milk can not be had.
Goat’s milk is Equally digestible and nourishing.
Milk has no adequate substitute in the diet o f the. child. Milk is
the chief calcium (lime) food. Milk is the cheapest source of highgrade protein. Milk is rich in the growth-promoting vitamin—vita­
min A. Milk is the chief o f the “ protective ” foods that compensate
for the inadequacies of the American diet and keep the people well.
There is a real relation between milk and health and growth.
Impaired nutrition means decreased vitality and lowered resistance
to disease. The future of the Nation depends upon the, stamina of
the children. The Nation can not afford to permit any ¡child to be
deprived of his daily allowance o f milk.
LIST OF REFERENCES
1. M cCollum , E. V ., and N in a Sipnuonds: The Newer Knowledge of Nu­
trition. Third edition. The Macmillan Co., NeW York, 1925. 675 pp.
2. A gricu ltu re, TJ. S. Departm ent o f : Educational Milk-for-Health Campa igns, by Jessie M. Hoover. Department Circular 250. Washington,
1923. 35 pp.
3. Sherman, Henry C.: Food Products, pp. 30-32. The Macmillan Co., New
York, 1924.
4. A gricu ltu re, TJ. S. Departm ent o f: Milk and Its Uses in the Home, p. 4.
Farmers’ Bulletin No. 1359. Washington, 1924.
5. M itch ell, H . H . : “ The biological value of proteins at different levels of
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6. S e e No. 1, p. 160. ;
7. Sherm an, H . C . : Chemistry of Food and Nutrition (second edition), pp.
268-269, 421-431. The Macmillan Co., New York, 1918;


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8. Peterson, W . H ., and C. A . H op p ert: “ The loss of mineral and other
constituents from vegetables by various methods of cooking.’’ Journal
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9. Brennem ann, Joseph: “Artificial feeding of in fan ts” Abt’s Pediatrics,
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Women and Children. Oxford Medical Publications. Henry Frowde
and Hodder & Stoughton, London, 1921.
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15. -----------: “ Blindness and other diseases in children arising from deficient
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17. Shipley, P. G., E th el M a y K in n ey, and E. V . M cC ollu m : “A study o f
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IS. Casparis, H orton, P. G. Shipley, and B en jam in K ra m er: “ The anti­
rachitic influence of egg yolk.” Journal of the American Medical A s­
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19. H ess, A lfre d E . : “ The therapeutic value of egg yolk in rickets.”
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20. See No. 3, pp. 168-170.
21. Park, E. A . : “ The etiology o f rickets.” Physiological Review s, [Balti­
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22. See No. 1, p. 421.
23. M edical Research C ouncil: Report on the Present State of Knowledge
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24. -----------: Studies of Rickets in Vienna 1919-22, pp. 140, 150-152. Special
Report Series No. 77. London. 1923.
25. Luce, E. M . : “ The influence of diet and sunlight upon the growth-pro­
moting and antirachitic properties of the milk afforded by a cow.”
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26. -----------•: “ Further observations on the influence of sunlight upon the
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c a l J o u r n a l [Cambridge, England], vol. 18 (1924), pp. 1279-1288.
27. See No. 23, pp. 53, 80.
28. See No. 12, p. 203.
29. C ow gill, G. R . : “ Vitamin B as a factor in nutrition.” N a t i o n ' s H e a l t h
[Chicago], vol. 5 (1923), pp. 509-510, 561.
30. See No. 23, pp. 44, 69.
31. H ess, A lfre d F . : Scurvy Past and Present, pp. 143-175. J. B. Lippincott Co., Philadelphia, 1920.
32. Steenbock, H ., and E. B. H a r t : Milk the Best Food, p. 5. Agricultural
Experiment Station. University of Wisconsin, Bulletin 342. Madison,
W is., 1922.
33. See No. 1, pp. 106-119.
34. Ibid., p, 539.
35. M cC ollum , E. V . : “ W h y we have a problem o f nutrition in a land of
plenty.” H y g c i a [Chicago], vol. 1 (1923), pp. 175-178.
36. M endel, L. B . : “ Milk as a food.” Proceedings of the W orld’s Dairy Con­
gress, 1923. vol. 1, pp. 438-444. Government Printing Office, Washing­
ton, 1924.


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37. “ Mineral elements in nutrition with special reference to calcium and
phosphorus.”
Report of Committee on Nutritional Problems, Ameri­
can Public Health Association, Food and ©rugs Section. American
Journal of Public Health [New York], vol. 14 (1924), p. 515.
38. See No. 1, p. 470.
39. Lusk, G rah am : “ Diet and disease.” American Journal of Public Health
[New York], vol. 14 (1924), p. 300.
40. D ay, H ilb ert F. : “ Diet during pregnancy.” Boston Medical and Surgical
Journal, vol. 188 (1923) , pp. 904-911.
41. M endenhall, D orothy Reed : “ Preventive feeding for mothers and
infants.” Journal of H om e Economics [Baltimore], vol. 16 (October,
1924), pp. 570-578.
42. See No. 3, p. 89.
43. W illia m s , E. C. P .: “ Investigation of the constancy of the chemical com­
position of the blood during pregnancy.” Journal of Obstetrics and
Gynaecology of the British Empire [London], vol. 30 (1923), pp. 18 9196.
44. Bar, P a u l: Leçons de pathologie .obstétricale, pp. 445-483.
Asselin &
Houzeau, Paris, 1907.
45. Schm itz, Ernst : “ Investigations on the calcium content of the growing
fetus.” Archiv für Gynäkologie [Berlin], vol. 121 (1923-24), pp. 1-7.
46. H o lt, L. E m m ett, A n g elia M . Courtney, and H elen L. Eales : “ Calcium
metabolism of infants and young children, and the relation of calcium
to fat excretion in the stools.” American Journal of Diseases of
Children [Chicago], vol. 19 (1920), p. 101.
47. W id d ow s, S. T . : “ Calcium content of the blood during pregnancy.”
Biochemical Journal [Cambridge, England], vol. 17 (1923), pp. 34-40.
48. Plass, E. D ., and L. Jean B og ert: “ The calcium and magnesium content
of the blood serum during pregnancy, labor, and the puerperium.”
American Journal of Obstetrics and Gynecology [St. Louis], vol. 6,
(1923), pp. 427-443.
49. Toverud, G u ttorm : “ The influence of diet on teeth and bones.” Journal
of Biological Chemistry [Baltimore], vol. 58 (192 3-24), pp. 583-600.
50. Thom a, K u rt H . : Teeth, Diet, and Health, p. 179. The Century Co.,
New York, 1923.
51. Grieves, Clarence J. : “ The relation of nutrition to teeth.”
Transac­
tions of thé American Child Hygiene Association, Washington, 1922
[Albany], vol. 13 (1923), pp. 225-232.
52. See No. 4, pp. 15-18.
53. M cClanahan, H . M . : “ The relative morbidity of breast and bottle fed
infants.” Archives of Pediatrics [New York ], vol. 35 (1918), pp. 6 5 3 660.
54. Children’s Bureau, TJ. S. Departm ent of L abor: Causal Factors in In­
fant M ortality; a statistical study based on investigations in eight
cities, by Robert Morse Woodbury, p. 5. Publication No. 142. W ash­
ington, 1925.
55. H uenekens, E. J. : “ Breast feeding from a public-health standpoint.”
American Journal of Public Health [New York], vol. 14 (1924), pp.
391-394.
56. Children’s Bureau, TJ. S. D epartm ent o f L a bo r: Breast Feeding, by
Ella Oppenheimer. Publication No. 83. Washington, 1921. 13 pp.
57. H art, E. E ., and G. C. H u m p h re y: “ The relation of the quality of pro­
teins to milk production.” Journal o f Biological Chemistry [Baltimore],
vol. 21 (1915), pp. 239-253.
58. M eigs, T. B. : “ Milk secretion as related to diet.”
Physiological R e­
views [Baltimore], vol. 2 (1922), pp. 204-237.
\ 59. See No. 1, pp. 468-470..
V 60. Rose, M a ry S w a rtz: Feeding the Family (R evised), pp. 103-108. The
Macmillan Co., New York, 1924.
61. A gricu ltu re, IJ. S. Departm ent o f: The Influence of Calcium and Phos­
phorus in the Feed on the Milk Yield of Dairy Cows. Bulletin No. 945.
Washington, 1922. 28 pp.
62. Brow n, A la n , et a l.: “A critical study of two cases o f rickets developing
in breast-fed infants.” Archives of Pediatrics [Newr York], vol. 39
(1922), pp. 559-566.


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MILK THE INDISPENSABLE FOOD FOR CHILDREN

63. D eBuys, L. R ., and L. von M e y se n b u g : “ The calcium content of breast
milk in relation to rickets.” American Journal o f Diseases of Children
[Chicago], vol. 27 (£924), pp. 438-443.
64. S e e No. 12, p. 228.
65. Ibid., p. 226.
66. See No. 23, p. 137.
67. Ibid., pp. 30, 53, 80.
68. Sherman, H . C., and E dith H a w le y : “ Calcium and phosphorus meta­
bolism in childhood.”
Journal of Biological Chemistry [Baltimore],
vol. 53 (1922), pp. 375-309.
69. M edical Besearch C ouncil: The Aetiology and Pathology of Rickets, by
V. Korenchevsky, p. 49. Special Report Series No. 71. London, 1922.
70. Sherm an, H . C., and F. L. M a cL eo d : “ The calcium content of the body
in relation to age, growth, and food.” Journal of Biological Chemistry
[Baltimore], vol. 64 (1925), pp. 429-459.
71. Shipley, P. G., E. A . Park, E. V . M cCollum , and N in a Sim m onds: “ Is
there more than one kind of rick ets?” American Journal of Diseases
of Children [Chicago], vol. 23 (1922), pp. 91-106.
72. S e e No. 21, pp. 106-163.
73. See No. 35, p. 175.
74. A gricu ltu re, TJ. S. Departm ent o f : Food for Young Children, by Caro­
line L. Hunt. Farmers’ Bulletin No. 717. Washington, 1920. 21 pp.
75. Children’s Bureau, IT. S. D epartm ent of L a bo r: Child Management, by
D. A. Thom, pp. 6-9. Publication No. 143. Washington, 1925.
76. Jordan, W . H ., and G. A . S m ith : Goat’s Milk for Infant Feeding, pp.
3—4. New York Agricultural Experiment Station [Geneva, N. Y .]. Bul­
letin No. 429. 1917.
77. A gricu ltu re, U . S. Departm ent o f: Milk Goats, by Edward L. Shaw.
Farmers’ Bulletin 920. Washington, 1924. 36 pp.
78. Voorhies, E. C .: The Milch Goat in California, pp. 85-114. Agricultural
Experiment Station Bulletin No. 285. University of California Publi­
cations, University of California Press, 1917.
79. A gricu ltu re, U . S. Departm ent o f : The Dairy Industry, by C. W . Lar­
son et al., p. 35. Separate No. 879 from Yearbook 1922. Washington,
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80. Schultz, E. W ., and L. R . C handler: “ The size of fat globules in goat’s
milk.” Journal of Biological Chemistry [Baltimore], vol. 46 (1921), pp.
133-134.
81. McLean, Stafford: “ The iron content o f goat’s milk.” Zcitschrift fur
Kinderheilkunde [Berlin], vol. 4 (1912), pp. 168-170.
82. Bosw orth, A lfr e d W ., and Lucius L. V a n S ly k e : The Casein and
Salts of Goat’s Milk, p. 3. New Yoi’k Agricultural Experiment Station
[Geneva, N. Y .] Technical Bulletin No. 46. 1915.
83. Park, Edwards A . : “A case o f hypersensitiveness to cow’s milk.” Am eri­
can Journal of Diseases of Children [Chicago], vol. 19 (1920), pp.
46-54.
'
84. H ess, Julius H . : Feeding and the Nutritional Disorders in Infancy and
Childhood, p. 209. F. A. Davis Co., Philadelphia, 1925.
85. See No. 3, pp. 77-86.
86. H einem an, P au l G .: “ Chemistry and biology of milk.” Abt’s Pediatrics,
vol. 2 (W . B. Saunders Co., Philadelphia, 1923), pp. 524-582.
87. See No. 60, p. 121.
88. Andrew s, Vernon L .: “ Infantile beriberi.” Philippine Journal of Science
[M anila], vol. 7, sec. B (1912), pp. 67-89.
89. “ The American Pediatric Society’s Collective Investigation on Infantile
Scurvy in North America.”
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Society [New York], vol. 10 (1898), pp. 6-7.
90. D unham , E th el C .: “ Rickets in an infant of thirty-four days.” Ameri­
can Journal of Diseases o f Children [Chicago], vol. 26 (1923), pp.
155-163.
91. See No. 69, pp. 49, 159.
92. M arriott, W . M c K ., and L. T. D avid son : “ The acidity of the gastric
contents of infants.” American Journal of Diseases of Children [Chi­
cago], vol. 26 (1923), pp. 542-553.
93. ---------- ■: “Acidified whole milk as a routine infant food.” Journal of the
A m e r i c a n M e d i c a l A s s o c i a t i o n [Chicago], vol. 81 (1923), pp. 2007-2009.


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94.

39

Faber, H arold K . : “ Hydrochloric-acid mills in infant feeding.” Ameri­
can Journal of Diseases of Children [Chicago], v o l.'26 (1923), pp. 4 0 1 410.
; 95. H ess, A . F ., and M . J. M a tzn er: “ The value o f milk acidified with
lemon juice.” Journal of the American Medical Association [Chicago],
vol. 82 (1924), pp. 1604-1606.
96. Rice, Fran k E ., and A lto n L. M a r k le y : “ The relation of natural acidity
in milk to composition and physical properties.”
Journal of Dairy
Science [Baltimore], vol. 7 (1924), pp. 468-A83.
97. A gricu ltu re, IJ. S. Departm ent o f : Standards of Purity for Food Prod­
ucts, p. 4. Department Circular 136. Washington, 1919.
98. -----------: Legal Standards for Dairy Products in Effect July 1, 1924.
( Mimeographed. )
99. TJ. S. Public H ea lth Service, TJ. S. Treasury D epartm ent: The Legal
Aspects of Milk Control, by James A. Tobey. Reprint No. 939. W ash­
ington, 1924. 8 pp.
100. A gricu ltu re, U . S. D epartm ent of : Inspection of Milk Supplies, by
Ernest Kelly and C. S. Leete. Department Circular 276. Washington,
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101. TJ. S. Public H ea lth Service, U . S. Treasury D epartm en t: Milk In­
spection, by Ira Y. Hiscock, p. 169. ' Public Health Bulletin No. 136.
Washington, 1923.
102. A gricu ltu re, TT. S. Departm ent o f: Production of Clean Milk. Farmers’
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103. --------— : The Four Essential Factors in the Production of Milk of Low
Bacterial Content, by S. Henry Ayers, Lee B. Cook, and Paul W . Clemmer. Bulletin No. 642. Washington, 1918. 63 pp.
104. Methods and Standards for the Production of Certified Milk, adopted by
the American Association of Medical Milk Commissions, June, 1923.
4175 Irving Park Boulevard, Chicago, 111.
105. TL S. Public H ea lth Service, TJ. S. tre a su r y D epartm en t: Commission
on Milk Standards. Reprint No. 634. Washington, 1921. 35 pp.
106. See No. 101, pp. 168-181.
1 0 7 . -------- : A State-Wide Milk-Sanitation Program, by Leslie C. Frank, pp.
12-21. Reprint No. 971. Washington, 1925.
108. -----------: Safe Milk an Important Food Problem, by Ernest A. Sweet.
Supplement No. 31 to the Public Health Reports, Washington, 1917.
24 pp.
.
109. A gricu ltu re, TJ. S. Departm ent o f: Clean Milk Is- Easily Produced by
Following a Few Simple Rules. Dairy Division Leaflet 624. W ashing­
ton, 1922.
110. See No. 107, pp. 1-2. •
111. “ Pasteurization of milk.” R eport.of Committee on Milk Supply, Ameri­
can Public Health Association, Sanitary Engineering Section. American
Public Health Association, Boston, 1920. 32 pp.
112. A y ers, S. H e n r y : “ What, constitutes efficiency in pasteurization.” Pro­
ceedings of the World's Dairy Congress, 1923, vol. 1, pp. 541-555. Gov­
ernment Printing Office, Washington, 1924.
113. A gricu ltu re, TL S. Departm ent o f: The Present Status of the Pasteuriza­
tion of . Milk. Bulletin No. 342. Washington, 1922. 27 pp.
114. See No, 107, p. 4.
115. K e lly , Ernest, and Clarence E. C lem en t: Market Milk, pp. 289-290.
John W iley & Sons (In c .), New York, 1923.
116. See No. 101, pp. 177-178.
117. W h itta k e r, H . A . : “ The supervision of the pasteurization of milk by
State authorities.” Proceedings of the World's D airy Congress, 1923,
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118. H iscock, Ir a V . : Report of Committee on Food Value o f Milk and Milk
Products, p. 6. Thirteenth Annual Report o f the International Associa­
tion of Dairy and Milk Inspectors. Washington, 1924.
119. Lane-Claypon, J an et: Milk and Its Hygienic Relations, pp. 225-241.
. Longmans, Green & Co., London, 1916.
120.. Duteher, R . A . : “ Factors influencing the, vitamin content of cow’s milk.”
Proceedings of the World's D airy Congress, 1923, vol. 2, pp. 1060-1067.
Government Printing Office, .Washington,. 1924.
,a
121. K lein , Louis A . : Principles and Practice-of. M ilk Hygiene, pp. 203-214.
J. B. Lippincott Co., Philadelphia, 1917.

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122. Brow n, F. W . C .: “A critical investigation into the thermal death-point
of the tubercle bacillus in milk.” Lancet [London], vol. 2 o f 1923, pp.
317—321.
123. See No. 105, p. 30.
124. Barnes, It. E ., and E. M . H u m e : “ Relative antiscorbutic value of fresh,
dried, and heated cow’s milk.” Biochemical Journal [Cambridge, Eng­
land], vol. 13 (1919), pp. 316-317.
125. See mo. 12, pp. 153-156.
126. See No. 86, pp. 524-582.
127. B rennem ann, J oseph: “ The use of boiled milk in infant feeding and
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vol. 67 (1916), pp. 1413-1419.
128. See No. 9, p. 653.
129. E llis, M abel E . : A Comparison of Pasteurized and Simmered Milk as
Determined by the Plate Counts. Thesis, University of Wisconsin, 1924.
130. D aniels, A . L., and Lou gh lin , I t . : “A deficiency in heat-treated milks.”
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131. See No. 86, p. 537.
132. Trotter, F. E ., President of. the Board of Health of H a w a ii: Personal
communication, April 3, 1924.
133. Children’s Bureau, U . S. Departm ent of L a bo r: Child W elfare in the
Insular Possessions of the United States. Part I, Porto Rico, by Helen
V. Bary, pp. 19-20. Publication No. 127. Washington, 1923.
134. H ernandez, A d n ., Director of Agriculture, Department of Agriculture and
National Resources, Government of the Philippine Isla n d s: Personal
communication, July 14, 1924.
135. Alaska Agricultural Experiment Station Report for 1923, p. 1 9 ; also per­
sonal Communication.
136. H u nziker, Otto F . : Condensed Milk and Milk Powder. Fourth edition.
Published by tlie author, La Grange, 111., 1926.
137. -----------: Personal communication, February, 1926.
138. Street, J. P .: Condensed or Evaporated Milks, Malted Milks and Milk
Powders: Connecticut Agricultural Experiment Station Bulletin 213.
New Haven, July, 1919. 9 pp.
139. See No. 97, p. 4.
140. H ess, A . F . : “ The antiscorbutic vitamin.” Journal of Industrial and
Engineering Chemistry [Easton, p a .], vol. 13 (1921), p. 1115.
<141. H um e, E. M . : “ Investigation o f the antiscorbutic value of full cream
sweetened condensed milk by experiments with monkeys.” Biochemical
Journal [Cambridge, England], vol. 15 (1921), pp. 163-166.
142. See No. 9, p. 746.
143. W a sh bu rn , E . M ., and C. H . Jones: Studies of the Values of Different
Grades of Milk in Infant Feeding, pp. 79-80. Vermont Agricultural
Experiment Station Bulletin No, 195. Burlington, 1916.
144. A gricu ltu re, U . S. Departm ent o f: Food Inspection Decision 189. W ash­
ington, 1923.
145. See No. 9, p. 653.
146. See No. 1, p. 157.
147. Palm er, Leroy S . : “ The effect of heat on the calcium salts and rennet
coagulability o f cow’s m ilk /’ Proceedings of the Society for Experi­
mental Biology and Medicine [New York], vol. 19 (1922), pp. 137-142.
148. D aniels, A m y L ., and Genevieve Stearn s: “ The effect of heat treat­
ment o f milk feedings on the mineral metabolism of infants.” Journal
of Biological Chemistry [Baltim ore], vol. 61 (1924), pp. 225-240.
149. See No. 12, pp. 93, 183.
150. H a rt, E. B ., H . Steenbock, and D. W . S m ith : “ Effect o f heat on the
antiscorbutic properties of some milk products.” Journal of Biological
Chemistry [Baltimore], vol. 38 (1919), pp. 305-314.
151. See No. 84, p. 109.
152. Pennington, M . E ., et a l .: “ Bacterial and enzymic changes in milk and
cream at 0° G.” Journal of Biological Chemistry [Baltimore], vol. 16
(1 913-14), pp. 331-368.
153. See No. 97, p. 5.
154. See No. 11, pp. 455-458.


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155. Kennedy, C ornelia: “ Vitamins in preserved milk.” Proceedings of the
Woi'ld’s Dairy Congress, 1923, vol. 1, pp. 198-206. Government Printing
Office; Washington, 1924.
156. Coutts, F. J. H . : Reports to the Local Government Board on Public
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157. See No. 23, p. 140.
158. Supplee, G. C., and Odessa D. D o w : “ Variations in the antiscorbutic
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[Chicago], vol. 31 (1926), pp. 41-50.
159. H art, E. B ., H . Steenbock, and N . R . E llis : “Antiscorbutic potency of
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160. Barnes, R E ., and E. M . H u m e : “A comparison between the antiscor­
butic properties of fresh, heated, and dried cow’s milk.”
Lancet
[London], vol. 2 of 1919, pp. 323-325.
161. C avanaugh, G. W ., R . A . D utcher, and J. S. H a r t : “ The effect of the
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162. U . S. Public H ea lth Service, U . S. Treasury D epartm en t: The Comparative Antiscorbutic Values of Milk, by J. M. Johnson and C. W .
Hooper. Reprint No, 743. Washington, 1922. 33 pp.
163. H art, E B ., H . Steenbock, and N . R . E llis : “ influence of diet on the
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more], vol. 42 (1920), pp. 383-396.
164. Dutcher, R . A ., et a l .: “ The influence of diet of the cow upon the nutri­
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165. H ess, A . E ., L. J. U nger, and G. C. Su p plee: “ Relation of fodder to the
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166. S e e No. 24, pp. 150-152.
167. S e e No. 25, pp. 716-735.
168. S e e No. 26, pp. 1279-1288.
169. See No. 12, pp. 136, 137, 238.
170. Ibid., pp. 152-156.
171. H ess, A . E ., and U nger, L. J . : “ Factors affecting the antiscorbutic values
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17 (1919), pp. 221-240.
172. Jephcott, H arry, and A , L. B ach arach : “ The antiscorbutic value of dried
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129-139.
173. Czerny, A . : “ Powdered milk as a food for children.” Fortschritte der
Medizin [Berlin), vol. 39 (1921), pp. 957-958.
174. U . S. Public H ea lth Service, U . S. Treasury D epartm en t: “ Dried milk
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174a. -----------: Dried Milk Powder in Infant Feeding, by Taliaferro Clark and
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175. H ess, A lfre d E , : Scurvy Past and Present, pp. 46-48
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Co., Philadelphia, 1920.
176. Leary, T im o th y : “ Dried milk.” Boston Medical and Surgical Journal.
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177. Supplee, G. C., and V , J. A sh b a u g h : “ Bacterial content of milk pow­
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178. Hunwicke, R. E., and H. Jephcott: “ Destruction o f bacteria in milk
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179. Supplee, G. C .: “ Th^ keeping quality ; o f'd ry milk.” Proceedings of the
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ing Office, Washington, 1924.
180. H o lm , George E . : “ The keeping quality of butterfat, with special refer-’
ence to milk powder.” Proceedings of the W orld’S' Dairy Congi'ess,
1923, vol. 2, pp. 1253-1265. Government Printing Office; Washington,
1924.
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181. B lackham , Robert Jam es: “ Milk in the Tropics.” Proceedings of the
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183. See No. 3, pp. 137-138.
184. Jones, N ellie K ed zie: Milk Powder in Cookery. Extension Service of
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185. Som m erville, D avid : “ Laboratory experiments on the digéstibility of
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der Medizin [Berlin], vol. 39 (1921), pp. 957-958.
h. D ennett, R . H . : “ Dry milk in infant feeding.” New York State
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i. M éry, A v ira gn e t, Lesné, Lereboullet, W e ill-H a llé , Dorlencourt,
and Schreiber: “ Report on the use of powdered milk in infant
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( 1922 ), pp. 157-181.
j. N euland, W ., and A . Peiper: “ Value of powdered milk for feed­
ing infants. M e d i z i n i s c h e K l i n i k [Berlin and Vienna], vol. 16
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k. Schreiber, G .: “ Powdered milk.”
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l. Schoedel, J. : “ Dessicated milk for infants.” Jahrbuch für Kinder­
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m. IT. S. Public H ea lth Service, U . S. Treasury Departm ent : The
Basal Metabolism of Infants Fed on Dry-Milk Powder, by Fritz
B. Talbot and Margaret E. Moriarity. Reprint No. 724. W ash­
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n. W eber, A . D. : “ Dried milks for infant feeding— a résumé.”
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189. U . S. Public H ea lth Service, U . S. Treasury D epartm ent: Report of
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Public Health [New York], vol. 16 (1922), pp. 113-116.
190. W in slo w , C. E. A . : “ Science and politics in relation to the problem of
milk supply.” Modern Medicine [Chicago], vol. 2 (1920), p. 806.
191. Editorial, Journal of the American Medical Association [Chicago], vol
79 (1922), p. 968.
192. “ Present status of our knowledge of the vitamins and its application to
the dietary.” Report of Committee on Nutritional Problems, American
Public Health Association, Food and Drugs Section. American Journal
of Public Health [New York], vol. 12 (1922), pp. 908-915.
193. See No. 12, pp. 175, 209, 210.


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““*194. H allibu rton , W . D ., and J. C. D ru m m on d: “ The nutritive value of
margarines and butter substitutes with reference to their content of the
fat-soluble accessory growth substance.” Journal of Physiology [London and
Cambridge], vol. 51 (1917), pp. 235-251.
195. H o lt, Ii. E . : Food, Health, and Growth, pp. 107-120. The Macmillan
Co., New York, 1922.
196. M cC ollum , E. V ., N in a Simmonds, P. G. Shipley, and E. A . P a rk : “ Is
there a substance other than fat-soluble A associated with certain fats which
plays an important rOle in bone development?”
Journal of Biological
Chemistry [Baltimore], vol. 50 (1922), p. 6.
197. H olm es, A rth u r D . : “ Medicinal cod-liver oils.” Journal of Industrial
'and Engineering Chemistry [Easton, P a.]„. vol. 16 (1924), pp. 1181-1184.
>198. A gricu ltu re, IT. S. D epartm ent o f: Making and Using Cottage Cheese
in the Home, by Kenneth J. Matheson and Jessie M. Hoover. Farmers’
Bulletin No. 1451. Washington, 1925. 14 pp.

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