METHODS AND REGULATIONS FOR THE MEDICAL EXAMINATION OF EMPLOYEES. THEIR HEALTH AND PERSONAL HYGIENE

89. A medical officer, known as the attending dairy physician, shall be selected by the commission, who should reside near the dairy producing certified milk. He shall be a physician in good standing and authorized by law to practice medicine; he shall be responsible to the commission and subject to its direction. In case more than one dairy is under the control of the commission and they are in different localities, a separate physician should be designated for employment for the supervision of each dairy.

90. Before any person shall come on the premises to live and remain as an employee, such person, before being engaged in milking or the handling of milk, shall be subjected to a complete physical examination by the attending physician. No person shall be employed who has not been vaccinated recently or who upon examination is found to have a sore throat, or to be suffering from any form of tuberculosis, venereal disease, conjunctivitis, diarrhea, dysentery, or who has recently had typhoid fever or is proved to be a typhoid carrier, or who has any inflammatory disease of the respiratory tract, or any suppurative process or infectious skin eruption, or any disease of an infectious or contagious nature, or who has recently been associated with children sick with contagious disease.

91. In addition to ordinary habits of personal cleanliness all milkers shall have well-trimmed hair, wear close-fitting caps, and have clean-shaven faces.

92. When the milkers live upon the premises their domitories shall be constructed and operated according to plans approved by the commission. A separate bed shall be provided for each milker and each bed shall be kept supplied with clean bedclothes. Proper bathing facilities shall be provided for all employees on the dairy premises, preferably a shower bath, and frequent bathing shall be enjoined.

93. In case the employees live on the dairy premises a suitable building shall be provided to be used for the isolation and quarantine of persons under suspicion of having a contagious disease.

The following plan of construction is recommended:

The quarantine building and hospital should be one story high and contain at least two rooms, each with a capacity of about 6,000 cubic feet and containing not more than three beds each, the rooms to be separated by a closed partition. The doors opening into the rooms should be on opposite sides of the building and provided with locks. The windows should be barred and the sash should be at least 5 feet from the ground and constructed for proper ventilation. The walls should be of a material which will allow proper disinfection. The floor should be of painted or washable wood, preferably of concrete, and so constructed that the floor may be flushed and properly dis

infected. Proper heating, lighting, and ventilating facilities should be provided.

94. In the event of any illness of a suspicious nature the attending physician shall immediately quarantine the suspect, notify the health authorities and the secretary of the commission, and examine each member of the dairy force, and in every inflammatory affection of the nose or throat occurring among the employees of the dairy, in addition to carrying out the abovementioned program, the attending physician shall take a culture and have it examined at once by a competent bacteriologist approved by the commission. Pending such examination, the affected employee or employees shall be quarantined.

95. It shall be the duty of the secretary, on receiving notice of any suspicious or contagious disease at the dairy, at once to notify the committee having in charge the medical supervision of employees of the dairy farm upon which such disease has developed. On receipt of the notice this committee shall assume charge of the matter, and shall have power to act for the commission as its judgment dictates. As soon as possible thereafter, the committee shall notify the commission, through its secretary, that a special meeting may be called for ultimate consideration and action.

96. When a case of contagious disease is found among the employees of a dairy producing certified milk under the control of a medical milk commission, such employee shall be at once quarantined and as soon as possible removed from the plant, and the premises fumigated.

When a case of contagion is found on a certified dairy it is advised that a printed notice of the facts shall be sent to every householder using the milk, giving in detail the precautions taken by the dairyman under the direction of the commission, and it is further advised that all milk produced at such dairy shall be heated at 145° F. for 40 minutes, or 155° F. for 30 minutes, or 167° F. for 20 minutes, and immediately cooled to 50° F. These facts should also be part of the notice, and such heating of the milk should be continued during the accepted period of incubation for such contagious disease.

The following method of fumigation is recommended:

After all windows and doors are closed and the cracks sealed by strips of paper applied with flour paste, and the various articles in the room so hung or placed as to be exposed on all sides, preparations should be made to generate formaldehyde gas by the use of 20 ounces of formaldehyde and 10 ounces of permanganate of potash for every 1,000 cubic feet of space to be disinfected.

For mixing the formaldehyde and potassium permanganate a large galvanized-iron pail or cylinder holding at least 20 quarts and having a flared top should be used for mixing therein 20 ounces of formaldehyde and 10 ounces of permanganate. A cylinder at least 5 feet high is suggested. The containers should be placed about in the rooms and the necessary quantity of

permanganate weighed and placed in them. The formaldehyde solution for each pail should then be measured into a wide-mouthed cup and placed by the pail in which it is to be used.

Although the reaction takes place quickly, by making preparations as advised all of the pails can be "set off" promptly by one person, since there is nothing to do but pour the formaldehyde solution over the permanganate. The rooms should be kept closed for four hours. As there is a slight danger of fire, the reaction should be watched through a window or the pails placed on a noninflammable surface.

97. Following a weekly medical inspection of the employees, a monthly report shall be submitted to the secretary of the medical milk commission, on the same recurring date by the examining visiting physician.

The following schedule, filled out in writing and signed by himself, is recommended as a suitable form for the attending physician's report:

This is to certify that, on the dates below indicated, official visits were made to the dairy, owned and conducted by of (indicating town and State), where careful inspections of the dairy employees were made. (a) Number and dates of visits since last report.

(b) Number of men employed on the plant.

(c) Has a recent epidemic of contagion occurred near the dairy, and what was its nature and extent?

(d) Have any cases of contagious or infectious disease occurred among the men since the last report?

(e) Disposition of such cases.

(f) What individual sickness has occurred among the men since the last report?

(g) Disposition of such cases.

(h) Number of employees now quarantined for sickness.

(i) Describe the personal hygiene of the men employed for milking when prepared for and during the process of milking.

1) What facilities are provided for sickness in employees?

(k) General hygienic condition of the dormitories or houses of the employees.

(1) Suggestions for improvement.

(m) What is the hygienic condition of the employees and their surroundings?

(n) How many employees were examined at each of the foregoing visits?

(0) Remarks.

Date,

Attending Physician.

TABLE OF 100-CALORIE PORTIONS OF FOODS

EXPLANATION OF TABLE. The first column of figures in the table gives the number of 100-Calorie portions in one pound of the food as purchased. The next four columns show the weight of food which yields 100 Calories, i.e. the weight of the 100Calorie portion, both in ounces and in grams, and both for the material as purchased and for the edible portion. Next follow columns showing the amount of protein first in Calories and then in grams, which the 100-Calorie portion of food contains. The protein content as thus expressed often gives a truer impression of the food as a source of protein than does the percentage by weight of protein which the food material contains.

HUNDRED-CALORIE PORTIONS OF FOOD