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Chairman STANLEY. Are there any questions you would like to ask Doctor Brown before proceeding to the next paper?

MEMBER. I would like to ask if cooked milk has the same value in a diet as the raw milk?

Chairman STANLEY. I wish you would bring that up again before we close this session.

I think, when we speak of the agricultural work done by the Department of Agriculture we immediately think of the splendid work done by Miss J. M. Hoover since being associated with us. We are going to have her tell us about“ Community milk-for-health programs as conducted by the United States Department of Agriculture.”

COMMUNITY MILK-FOR-HEALTH CAMPAIGNS AS CONDUCTED BY

THE UNITED STATES DEPARTMENT OF AGRICULTURE.

Miss JESSIE M. HOOVER, specialist in milk utilization, Dairy Division, United

States Department of Agriculture.

Milk-for-health campaigns as conducted by the Dairy Division, Bureau of Animal Industry, United States Department of Agriculture, are organized educational programs planned to convey to communities adopting them, information regarding the value of milk as a food which is exceptionally well suited for growth, maintenance, and repair of the human body, as well as a valuable health food.' This work is conducted cooperatively by the United States Department of Agriculture and the extension service of the State agricultural colleges through nutrition and dairy specialists and county agricultural and home demonstration agents. It covers both urban and rural communities, and is usually conducted on a countywide basis. County-wide campaigns are repeated until they practically become State-wide campaigns. A campaign is never undertaken unless it is desired by the community leaders after an investigation of the needs of their community has been made and it appears that there is a spirit of willingness to cooperate in improving these conditions. The campaign is divided into three parts: (1) Preliminary organization; (2) training school and practice (the intensive part of campaign) for extension workers and local leaders; (3) the follow-up, which covers a period of months or years. The local home demonstration agent or an especially appointed milk specialist is responsible for the successful conduct of the follow-up.

The ultimate object of the work is to assist in reducing malnutrition through an increased use of milk. The milk-for-health program, like many other projects related to foods, was an outgrowth of the World War. The nutritional needs of many nations received the most careful consideration during and since this period of conflict, and food as a means of sustaining life, promoting growth and health, and preserving vigor, was thoroughly studied. It was not until the World War that a comprehensive physical examination was ever given to any considerable portion of our population. But when the young men were examined for military service, it was found that 1 out of every 3 was unfit for active service at the front because of physical defects. A nation-wide program to ascertain the amount of malnutrition among school children was undertaken, and it was found that about 1 out of every 5 school children in the United States was 10 per cent or more under weight, according to the heightweight tables prepared by Dr. Thomas Ď. Wood, of Columbia University. It was also observed that poverty had little to do with this condition. The more important factors appeared to be ignorance or carelessness on the part of parents in the selection of foods for child feeding, and lack of discipline in directing the food habits of children. Obviously, the best remedy for this condition is education. Therefore, our first work was systematic educational programs for the parents. This was undertaken in the fall of 1918, but it met with only partial success, for mothers said, “We want our children to use milk, but they do not like it," and we found them constantly suggesting this idea of disliking to their children, by both precept and example. Profiting by this experience in our later work, which is described in this paper, we reach the children directly.

1 A woman agent of the Government employed to teach people living on farms or in rural communities better practices in agriculture and home economics,

Other conditions which brought about the need for educational milk work were of an economic nature. During the war an unprecedented demand for wheat and other farm products in Europe caused vast quantities to be sent from this country, and enlarged the acreage devoted to grain crops in the United States. This tended to force up the price of feed for cows, and thus increased the cost of production. Added to this difficulty was the high cost of farm labor as well as the inadequate number of laborers available; in many sections it was impossible to secure farm labor at any price. Accordingly, it became necessary to increase the price of milk, and the public, being very sensitive to such advances, especially in regard to milk, decreased the family consumption. This reacted by creating a surplus at a time when prices were necessarily being advanced in an effort to meet the cost of production. Newspapers were printing articles telling how milk was being poured into sewers and rivers, and the final result was so to aggravate the situation that organized groups of housewives started boycotts for the avowed purpose of discontinuing the use of milk in their families except for infants and small children until such time as pre-war prices should be restored.

It became necessary to point out to housewives that this plan of action would surely defeat the purpose for which it was intended, because by so doing producers would be driven out of the industry and the supply of milk reduced to the point where it would not be available at all for the poor and middle-class people; and, further, that there would be an accompanying increase in malnutrition and a reduction in growth and health standards. Herbert C. Hoover, then in charge of the work of the Food Administration of the United States, in relating his experiences in feeding millions of people in Europe, said: “Due to the denudation of cattle, milk has been unknown in many places for years. Whole populations were undernourished, but the children were suffering the most acutely from disease and malnutrition." He further said, “ The white race can not survive without dairy products.” In addition to the above causes, milk brought a higher price when sold for use in manufactured dairy products than when sold as fluid milk, and vast quantities of butter and condensed milk were shipped for use in Europe. Skimmed

milk was being fed to animals or poured into sewers; and to check this waste, programs for its conservation as human food were put on during the war.

From these conditions grew the present programs for larger use of whole milk in the family. When the war ended, the demand for export products was greatly reduced and the existing surplus was increased. The Department of Agriculture, fearing the loss of the dairy herds of the country and a general setback to improvement of dairy cattle, which would react unfavorably on the public health, launched an educational program to disseminate knowledge regarding the importance of milk in the diet. This work consisted of a systematic, organized program adopted by various communities, both rural and urban. It was started in its present form in the spring of 1919. The United States Department of Agriculture cooperates with the extension service of the agricultural colleges in demonstration campaigns. In these campaigns the extension workers of the State are trained to conduct the work, which is then repeated, county by county, throughout the State wherever malnutrition exists and where there are county agricultural or home demonstration agents. The work is planned to reach both adults and children. It is a community project, and to get a community well organized requires time, tact, and perseverance. After the condition of the milk supply is ascertained as to both sanitary condition and quantity, a survey is made in the schools, both city and rural, to ascertain the number of children seriously underweight and their daily consumption of milk as well as their other health habits. We are aware that physical defects are responsible for much malnutrition, but when all these facts are compiled it is frequently found that where milk consumption is lowest there malnutrition is highest.

The schools have cooperated vigorously in this work. In addition to conducting the surveys before the campaign and afterwards, they have welcomed the trained speakers from the agricultural colleges or other authorized sources to give milk talks so prepared as to be suitable for the various grades of the school. Copies of these talks are left with the teachers to be repeated from time to time. The children make milk posters, write milk essays, sing milk songs, and give milk plays. Milk-feeding demonstrations are conducted, and the children who are under weight but who are free from such physical defects as would make it impossible for them to gain are enrolled for the demonstrations. In many remote rural communities medical examinations must be dispensed with. The children of the demonstration group receive their milk twice daily at the middle of each school session, and a careful record of their condition is made. Their weight, height, age, scholarship, and conduct are all noted. School superintendents have reported improvement in all of these conditions.

The mid-session milk lunch is not confined wholly to the undernourished, for in most schools, following the proof furnished by the demonstration, all children may purchase a half-pint bottle of milk with a straw and a graham cracker at a nominal price. The States of Washington and Indiana, through their State legislatures, have given official status to the milk lunch, for in both these States cities of the first class have been authorized to purchase milk for school children from the public funds, a definite per cent of the taxes being

available. In the State of Washington the legislature went a step further, by authorizing the purchase of milk in school districts of the second class also. Thus have these official bodies recognized the importance of milk in the health of school children, as well as the fact that malnourished children are an economic loss to the community, and that to provide this necessity for the development of the body is as important as to provide textbooks for the development of the mind.

For adults, as well as children, the value of milk as a growth and health food is presented through talks, newspaper publicity, radio messages, motion pictures, lantern slides, bill boards, electric signs, window exhibits, menu reminders in hotels and restaurants, and in many other ways. To launch a piece of work of this kind requires careful organization. It is organized on the local committee basis, with some member of the college extension staff qualified to speak with authority on food and dairying as a member of each committee. It is the duty of the college representative to act in an advisory capacity on subject matter.

The cost of the milk campaign is small, and it is not uncommon to conduct a county-wide program lasting over a period of months for $150. The reasons for this low cost are that the permanent county home-demonstration agents and agricultural agents do this as a part of their regular work; the publications of the Department of Agriculture and State agricultural colleges have been available for distribution; and because of the method of organization and the agencies cooperating, newspaper space is given freely. In populous sections more money is, of course, required.

Statisticians tell us that in 1919 the average annual per capita consumption of milk was 42.5 gallons, but last year, 1922, it was 50 gallons per annum. Among the many factors that have contributed to this increased consumption, we believe the educational program has played a part. While the increased use of milk alone will not remedy all the health problems of childhood, it has proved to be helpful in reducing malnutrition when it is used as a part of a varied diet. In one city a survey covering 10,000 children showed that 14 out of every 100 school children were 10 per cent below the normal average weight for their age and height, and oniy 2 out of 5 were daily milk drinkers. The milk-for-health program was started, and two months later only 11.5 per cent of the children were 10 per cent or more under weight, and during that time the milk consumption in that city had increased 20 per cent. A county in one of our Middle West agricultural sections reported approximately 1 out of every 5 of the rural children to be 10 per cent or more under weight. Following the educational milk work, malnutrition was reduced more than half; during this period the use of milk was materially increased.

In one of the far Western States a number of feeding demonstrations have been conducted. In order to interest the children these are called “ Keep-growing demonstrations." Just four points are emphasized: A quart of milk a day, two vegetables, a cereal for breakfast, and 10 hours of sleep. A nutrition worker from the college made four trips to one of these communities. The nearest doctor in the community was 40 miles away. There were plenty of cows, but the children were not using milk previous to the demonstra tion. In this special group 74 children were examined, and of this number 66 completed the demonstration, which lasted over a period of nine months. Before the demonstration 35 of the 66 were in the normal zone; at the close of the demonstration it was found that 57 out of the 66 were in the normal zone. Instead of 29, only 4 were 10 per cent or more below normal, and 5, instead of 2, were over weight. The total number of children who gained in weight was 64 out of 66. The total amount gained was 431.5 pounds, an average of 6.7 pounds per child.

The cooperation of the local people in these demonstrations was excellent, through both schools and church societies. In the rural work it is not uncommon to stage such demonstrations many miles away from a doctor. I have on my desk a report of a demonstration which was conducted 70 miles from a doctor. It is obvious, therefore, that if these children, so remote from health centers, must wait until they have had a doctor's examination their condition of malnutrition will not be remedied during their lifetime. In most of these rural districts there is plently of milk, but it is being fed to livestock or sent to creameries for the manufacture of dairy products. The farmer pays high transportation charges in shipping to cities a valuable food product which is sold at wholesale rates. Less valuable food is then shipped in to these remote communities at high retail prices and large expense for transportation.

The number of children who complete the “keep-growing " demonstration is large. In one of these remote communities where 97 children were examined, 96 completed the demonstration, and the ratio of improvement compared favorably with the illustrations already given.

The effectiveness of a milk-for-health campaign varies as a rule in accordance with the interest and work contributed by the citizens themselves. The United States Department of Agriculture has only two milk campaign workers but by the plan of training State extension workers, who in turn train local leaders to conduct milk-forhealth work in their own community, results are very far-reaching, and thus the work goes on in an ever widening circle. Already the United States Department of Agriculture has launched this work. in over half the States of the Union.

The value of milk in the diet is summed up by Dr. C. F. Lang. worthy, formerly chief of the Office of Home Economics, United States Department of Agriculture, when he says: “Good health demands plenty of milk. It supplies the body with necessary materials in exceptionally healthful and economical forms. An 'abundant supply of milk is of national importance."

SUMMARY.

The outstanding points of milk-for-health programs as conducted by the United States Department of Agriculture are:

1. Through the training of leaders to convey the message of milk as a food, the work of a few is multiplied many thousand fold.

? For more complete information and illustrations, see U. S. Department of Agricul. ture Circular No. 250.

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