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officer to concern himself with having these removed, by conference, discussion, and, if necessary, administrative action on the part of the city. This is just as important for him to do as it is for him to see that water of a standard purity is provided.
A definite policy and the prosecution of a vigorous program of education by the health officers of the country would go far to encourage milk consumption to such an extent that reduction in various nutritional disturbances of children and adults would ensue, and a great impetus would accrue to the dairying industry, the
prosperity of which, more than that of coal and iron, is a measure of the intelligence, thrift, and progress of a nation in physical fitness and well-being.
It will be many years before the per capita daily consumption of milk in this country reaches an altogether desirable amount, but let us, for the present, aim to teach the people so well that enough is used to allow each child under 6 years 1 quart daily and all the rest of the population a pint daily per individual.
The wealth of the Nation in human and material resources will surely be greatly enhanced when the consumer demands and is prepared to pay for a safe quality of milk and an amount which will sa feguard the nutrition of his family.
Chairman STANLEY. Are there any questions you would like to ask Doctor Emerson immediately? I think the general discussion had best be left until all the papers are read. But there may be some question that may be brought up now.
If not, we will proceed, then, to the presentation of the next paper.
Doctor Emerson has spoken of the importance of educational work. There is probably no one better fitted to discuss that subject in this country than Miss Lucy H. Gillett. We will have the next paper presented by Miss Gillett, who has charge of the nutrition bureau, Association for Improving the Condition of the Poor. Miss Gillett. [Applause.]
WELFARE AGENCIES AS A FACTOR IN EDUCATING CONSUMERS
IN THE USE OF MILK.
Miss LUCY H. GILLETT, superintendent of nutrition bureau, Association for
Improving the Condition of the Poor, New York City.
It is unfortunate that the public health officer has not always the funds at his disposal to develop as large a public health program as he likes. The welfare agencies are sometimes more fortunate in having private funds whereby they can help the public health officials to develop and put over a public health program. I think this is the attitude of most progressive welfare agencies, and this is what I have in mind in presenting this paper. We are only developing a program which can eventually be taken over by the public health agencies.
“Use a quart of milk a day.” This sign greets the mothers and children who visit almost any welfare center, health station, or clinic room, until milk and health are looked upon as almost synonymous. These stations and offices are usually in congested districts so that large numbers of people visit them. They are often among people from countries other than our own, people who do not speak our language or read our papers, who attend no public meetings, and who, therefore, do not get information through the ordinary channels of publicity, and are not swept on by the wave of enthusiasm from the outside world. Usually the people surrounding these centers must still be convinced that milk is cheap and indispensable in any health program at any price.
Yet these people form a large part of many cities and even rural districts, and their health influences our health. In raising the health standards of any community, therefore, this group must be educated. For our own sakes as well as theirs, and that of their children who will be our future citizens, they must be made to realize the importance of health, of attention to health habits, and especially to the drinking of milk. But how? They are hard to reach and slow to believe.
Such education must come more or less through direct, personal instruction. Welfare agencies, especially health centers, have a splendid opportunity of influencing these people because they come in very direct contact with them. The centers offer help in time of sickness or other trouble. Because they make the community feel that they are there to serve it, the people go for advice, whereupon a physical examination of each child
in each family is encouraged, and many ailments are discovered. This gives the doctor a chance to advise the drinking of milk. Many boys and girls are undernourished because they have not been in the habit of drinking milk. These families are visited in their homes by social workers, nurses, nutrition workers, who, one and all, urge the use of milk not only for those already suffering from malnutrition, but for the whole family. Our aim is to build up a resistance to all disease, and naturally we consider milk one of our strongest allies.
Recommendations for the use of milk begin with the pregnant women. Each of them under normal conditions is encouraged to drink a quart a day. This advice extends on through the preschool, elementary, and high school ages of the children from every family.
Mothers and children are gathered together for demonstration in the proper care and feeding of children. Always milk, milk, milk, is emphasized—not as the sole food but as a necessary part of a complete diet.
The children make posters emphasizing good food and other health habits. These posters are placed in public places where they may be seen, and because the children have made them they attract attention and bring results. One poster which had a picture of a milk bottle with the caption, “ Drink a quart a day,” was placed in the milk station in the neighborhood. In two weeks the dealer said he had increased his sales from 150 quarts a day to 300. The people would read “A quart a day” and add to keep the doctor away” and leave with an extra quart. Some of the posters are placed in the schools, others in clubrooms, and others in clinic rooms.
In one way or another, thousands of families are reached, thousands of children influenced, and a demand for milk is the result. Not only the children examined form the milk habit, but the neighbors also fall in line. They see the improvement in the health of the children drinking milk and reason: “If milk is good for my neighbors' children, if it will help to make them strong and keep them well, why not mine?" From every possible point milk is advocated until "A quart of milk a day” becomes the slogan in almost every district where a health center is located. A quart a day is our ideal and a pint the minimum.
But milk is seldom taught alone. If milk were the only food advocated the mothers would consider it an overbalanced idea which would soon vanish from their minds. It is taught as a part of a so-called well-regulated diet, and the diet is only a part of a complete health program. Rest, sleep, fresh air, and sunshine must all be given proper recognition before it can be shown what milk or any other food can do. The best advertising for any health measure is to present it in its right relation to other habits. This appeals to the majority of mothers as sane and sensible. The average human mind is open to reason. If milk is advocated as a part of a general scheme of a day's diet instead of the one and only food, the mother sees it in its proper relation and it and we are not considered fads and faddists.
We have had best results, most lasting results, where we have advocated milk together with vegetables, fruit, bread and cereals, eggs, and meat if desired.
A booklet recently published by the Association for Improving the Condition of the Poor contains suggestions for the proper feeding of babies, toddlers, school children, pregnant mothers, the preparation of luncheons, and other information that a mother should have. There are 24 pages. On each page milk is a very important, perhaps the most important, item; but it does not stand alone. For instance, on the page dealing with the food for the preschool child, the meals for the day are given with plenty of milk, a cup for breakfast with cereal, bread, and fruit; a cup for luncheon, with eggs and vegetables; and a cup for supper, with bread, cereal, or vegetables. These three cups, with the dishes made with milk, complete the quart a day.
We have probably sold more milk for the dealers through showing women how to use it in its proper relation to other foods than we would have through giving a quart per child outright for a year, with no recommendation about cereals, vegetables, and fruit.
Many mothers do not know how to use milk unless told, and even shown. Milk left at the door as a gift may be thrown away, left to spoil, or given away. Instruction should accompany it.
Some people may say, “But all this could be done through the schools." We, too, feel that it can be done equally well through schools in better-educated communities, and probably could be accomplished through the children in the foreign districts, but it would take much longer because of the slowness of these people in absorbing new ideas, and because of the indirect contact and the multiplicity of other responsibilites of schools.
It would take several years to accomplish through the schools alone what the welfare agencies are able to do in a few months. Human lives are at stake which make it seem necessary to act with speed and concentration. I believe both schools and welfare agencies working in close cooperation are necessary for best results.
A quart of milk per child per day may be questioned by some physicians. In addition to feeling responsible for the growth of the children under its care, the New York Association for Improving the Condition of the Poor also feels responsible to the financial supporters of the organization in making the best use of the funds at its disposal. We want to make the funds serve as many families as possible. Unless the children are materially benefited by a whole quart per day, we would not feel justified in advocating it. On the other hand, we do not want to take the responsibility of depriving children of the best chance for good health which food can give. Therefore the association conducted a series of experiments which it was hoped would throw some light on the quantity of milk best suited for optimum growth of children. These experiments were performed in cooperation with Prof. H. C. Sherman, of Columbia University. They were conducted under carefully controlled conditions and repeated several times at various seasons of the year, on different groups of children of different ages. The results seem quite conclusive that a child needs about a quart of milk a day to provide the calcium required for best developments. Furthermore, we were convinced that the body does not make equally good use of calcium from other foods. Therefore we do not hesitate to advocate a quart per child per day. On the strength of this experiment, made by one welfare agency, other agencies are recommending a quart of milk per child per day, and again we are helping to educate people through indirect contact.
At our fresh-air camps, where we entertain mothers and children for periods of two weeks throughout the summer, the milk consumed during these three months is in the neighborhood of 50,000 quarts, or about 600 quarts a day. These mothers and children form a habit which is bound to have its lasting effect. And it does have its effect, as is shown by the fact that the children often cry for milk after thes return home.
Through practice, through direct teaching in the homes, and through literature, then, most health and welfare agencies spread the gospel of milk. Welfare agencies are recognized as having nothing to gain in advertising any one food. The people know that such organizations have only the best interest of the community at heart. If welfare agencies and milk dealers could cooperate more closely, their combined efforts would be of tremendous advantage to both.
The following slides show how one welfare agency is putting the idea of milk before the people:
Slide 1 represents our medical clinic where the children are examined for any physical defects. This is the beginning of our teaching the use of milk. This slide shows the doctor examining a child with the mother present. What the doctor says goes a long way. Through these clinics we have a large influence for educating the people. When the child and mother leave the clinic there is a nutrition person outside the door, who talks to them, emphasizing the good health habits the child should observe. Milk is always one of the things emphasized.
Slide 2 is a picture of a worker talking to a mother in one of the homes. The mother is being shown how to use milk. There are two
or three mothers present from other tenements. The worker is show. ing them all how to make various milk dishes.
Slide 3 is a picture of one of the workers weighing the children to show the mothers how much they have gained. It shows a portable scale which the worker carries with her into the home. It interests the mother to see how much her children weigh. If their weights increase, and she has been following the health habits the worker teaches, it inspires her to continue. If the weight curve shows a downward trend, she is alarmed.
Slide 4 is a weight chart. One line represents the average weight of thousands of children of the same age. Another line shows what the child actually weighed throughout a given period. When the line begins to go up the mother is more than pleased and says, “ If the child can gain that much with milk, he is going to have a quart a day.” This weight line influences many mothers to continue the use of milk.
Slide 5 gives the general health habits given to all the children. Milk is advocated as one of the health habits in a general scheme of the day's program.
Slide 6 shows a chart made to illustrate the great value of milk. Black lines represent the growth-aiding material needed by the girl in the pictures. Beside it is a milk bottle with the black portion representing the growth-aiding material provided by it. At the extreme right of the slide you will see a column entirely blank which shows no such material in a cup of coffee. We are trying to discourage coffee and encourage milk.
Slide 7 represents milk as a part of a meal. That long column at the extreme right represents a whole meal-a milk soup with vegetables in it. In comparison, the second one represents the lesser value of a soup made with meat and vegetables, and this short line at the left is a clear soup with neither milk, meat, nor vegetables.
Slide 8: We are trying to impress upon the people that they need this calcium for bones and teeth. This chart gives them an idea of the foods which will best provide it. It also shows the amount of calcium in whole milk as compared with some of the other foods. Meat is one of the things they like best of all. This shows the comparison between milk and meat as sources of calcium.
Slide 9: These are foods which we encourage the people to eat between meals. Here you see the glass of milk represented, as always, in its proper relation to other foods.
Slide 10 shows one of our poster classes making the posters about which I spoke in my paper. One poster was put in a milk station and helped the dealer to increase his sales from 150 to 300 quarts a day. The girls are very much interested and calculate where they can put the posters so they will be of most use. We are trying to encourage a community spirit to help people develop the health habits throughout the district.
Slide 11 illustrates a poster which was made for us and is typical of posters made by the children. We try to make milk drinking a cheerful process. You see the milk bottle dancing with the boy and girl in a very joyful manner.
Slide 12 represents one of our fresh-air homes where a quart of milk is provided each day for each individual, both mother and