^{page 330 note 1} Variot, , La Goutte de Lait, La Clinique Infantile, 11. 1st, 1903.Google Scholar

^{page 330 note 2} Herrgott, , Annales de la Société Obstétricale de France, 1901.Google Scholar

^{page 330 note 3} Budin, Rapport sur les règles á suivre dans l’alimentation du premier age, Congrés d’hygiéne de Bruxelles, 1903. Des moyens de combattre la mortalité infantile, Revue Philanthropique, 1902.

^{page 331 note 1} Maygrier, , Les Consultations de Nourrissons, Paris, 1903.Google Scholar

^{page 331 note 2} Some writers draw a sharp distinction between the Consultation de Nourrissons and the Goutte de Lait. Variot, however, applies the latter term to both organizations; but he lays stress on the difference in type between the consultations at the maternity hospitals where the infants are under medical supervision from birth, and the ordinary Goutte de Lait where most of the children are in a state of ill-health when they are first brought to the institution.

^{page 332 note 1} La Goutte de Lait à Fécamp, Rouen, 1900.Google Scholar

^{page 333 note 1} Dufour, , Comment on crée une Goutte de Lait, Fécamp, 1902.Google Scholar

^{page 333 note 2} Rowland, G. Freeman, The Straus Milk Charity, New York, 1895.Google Scholar

^{page 333 note 3} Freeman, , Milk Pasteurization, New York, 1897.Google Scholar

^{page 334 note 1} Freeman, , The Reduction in the Infantile Mortality in the City of New York, Medical News, New York, 09. 5th, 1903.Google Scholar

^{page 334 note 2} The British Medical Journal of August 18th, 1900, contains an interesting article by Dr Drew Harris on the St Helens Depot.

^{page 336 note 1} The dilutions and amounts are based on the table in the leaflet, How to bring up Children, issued by the Medical Committee of the Hospital for Sick Children, Great Ormond Street.

^{page 339 note 1} Mussen, , Supply of Sterilized Humanized Milk for Infants, Journal of State Medicine, 10. 1903.Google Scholar

^{page 340 note 1} Dufour, , Comment on crée une Goutte de Lait.Google Scholar

^{page 341 note 1} Chapin, , The Theory and Practice of Infant Feeding, 1902.Google Scholar

^{page 342 note 1} Annual Report on the Health of Brighton, 1902.Google Scholar

^{page 342 note 2} This Journal, 1903.Google Scholar

^{page 343 note 1} Annual Report on the Health of Liverpool, 1902.Google Scholar

^{page 343 note 2} Park, and Holt, , Report upon the results with different kinds of pure and impure milk in infant feeding in tenement-houses and institutions of New York City, Medical News, New York, 12. 5, 1903.Google Scholar

^{page 343 note 3} Quoted by Lister, T. D, Infant Feeding and Milk Supply, 1903.Google Scholar

^{page 345 note 1} Mackenzie, , Edinburgh Journal of Medicine, 1899.Google Scholar

^{page 346 note 1} This Journal, 1903.Google Scholar

^{page 346 note 2} The importance of the home contamination of food in the causation of diarrhoea was first pointed out by Newsholme in his Presidential Address to the Incorporated Society of Medical Officers of Health, 1899. See Public Health, December 1899.

^{page 347 note 1} Newsholme, , Remarks on the Causation of Epidemic Diarrhoes, Transactions of the Epidemiological Society, Vol. XXII. N. S. p. 34. See also Annual Report on the Health of Brighton, 1902.Google Scholar

^{page 347 note 2} This Journal,1903.

^{page 347 note 3} The relation of condensed milk to diarrhoea requires further investigation. Delépine and Hope have shown that condensed milk is frequently non-sterile, and it does not follow that condensed milk which is sterile, i.e. containing no living bacteria, is necessarily non-toxic. Moreover, further information is required as to the relation of attack-rate to death-rate in infants fed on condensed milk and other foods. The case mortality in infants whose nutrition has been impaired by a condensed milk diet may be exceptionally heavy, as would appear from the enquiries of Park and Holt, see p. 344. If this be so, a comparatively small number of tins of condensed milk containing infective material may give rise to a disproportionately large number of deaths.

^{page 348 note 1} Budin, , Le Nourrisson, Paris, 1903.Google Scholar

^{page 348 note 2} Sterilization is not an essential part of the work of an Infants’ Milk Depot. In the depots at Rochester, U.S.A., it has been found possible by the employment of aseptic methods to supply the milk raw. This is of course the ideal method.

^{page 350 note 1} The difference between the two rates, however, is too great to be explained by the difference in age-periods. There can be no doubt that the children at the Clinique had a much better chance of survival than children living under average conditions in Paris, although this cannot be expressed numerically from the data given. The 712 children were all born in the institution and all were under highly skilled medical supervision.

^{page 350 note 2} Annual Report on the Health of St Helens, 1902.Google Scholar

^{page 351 note 1} “Infantile Mortality and the supply of Humanised Sterilised Milk,” a paper read before the Liverpool Medical Institution on March 17, and reported in the British Medical Journal, 03 26th, 1904.Google Scholar

^{page 351 note 2} Annual Report on the Health of Battersea, 1902.Google Scholar

^{page 352 note 1} Newsholme, , Vital Statistics..Google Scholar

^{page 353 note 1} Hope, , op. cit..Google Scholar

^{page 353 note 2} Peyroux, , Consultations de Nourrissons et Gouttes de Lait, La Semaine Médicale, Paris, 12 24th, 1902.Google Scholar

^{page 353 note 3} In considering these figures it should be borne in mind that still-births are registered in France.

^{page 354 note 1} Caron, , L’OEuvre des Gouttes de Lait, Havre, 1903.Google Scholar

^{page 355 note 1} Variot, , L’Avenir des Gouttes de Lait, Archives de Médecine des Enfants, 04 1903.Google Scholar

^{page 355 note 2} Letter to the writer, 03 1904.Google Scholar

^{page 355 note 3} Caron, , op. cit..Google Scholar

^{page 358 note 1} Freeman, , The Reduction in the Infantile Mortality in the City of New York, and the agencies which have been instrumental in bringing it about, Medical News, New York, 09. 5th, 1903.Google Scholar

^{page 358 note 2} Sterilization of milk is now so generally practised in the tenements of New York that the investigators of the Rockefeller Institute, an account of whose work is given on pp. 359, 360, discovered that, “In the summer of 1902 especially it was rare to find and infant fed on raw milk.” This perhaps has been the chief factor in the decline in the mortality.

^{page 358 note 3} Paffenholz, , Wichtige Aufgaben der öffentlichen und privaten Wohlfahrtspflege auf dem Gebiete des künstlichen Ernährung des Säuglings, Bonn, 1902.Google Scholar

^{page 359 note 1} Park, and Holt, , op. cit..Google Scholar

^{page 360 note 1} But all the children in this investigation were under some supervision by the physicians making the observations.

^{page 361 note 1} At the same time the writer warmly sympathises with the desire to encourage breastfeeding which animates those who bring this charge. There can be no doubt that the difference between breast-feeding and hand-feeding is very great and implies far more than questions of digestibility and contamination. Ehrlich’s theory of immunity has given rise to lines of research the results of which show that profound differences exist between the blood and other fluids of different species, and that these differences extend to milk. It is said that mother”s milk contains anti-bodies—a fact which explains the immunity of sucklings from infectious disease, and there are probably other fundamental biological differences. It is highly improbable that the milk of another animal can ever adequately replace human milk. It is greatly to be deplored that there has been no organized effort to encourage breast-feeding in this country. Much might be done to imitate the example of the French in this respect. A “Consulation de Nourrissons” should be established in every town as complementary to the Milk Depot. The Factory Act might with advantage be modified so as to extend the period during which a woman is excluded from work after childbirth, provision being made to secure from pecuniary loss all women who could produce satisfactory evidence that they were suckling their infants.

^{page 362 note 1} Swithinbank, and Newman, , Milk Bacteriology, p. 503, 1903.Google Scholar

^{page 362 note 2} It will be noted that the New York physicians engaged in the investigation conducted by Park and Holt came to a different conclusion as to the functions of a municipality in relation to the prevention of infantile mortality. See p. 361.

^{page 363 note 1} Swithinbank, and Newman, , op. cit..Google Scholar

^{page 363 note 2} Chapin, , The Theory and Practice of Infant Feeding, 1903.Google Scholar

^{page 364 note 1} Swithinbank, and Newman, , op. cit. See also Niven, Annual Report on the Health of Manchester, 1902.Google Scholar

^{page 364 note 2} Op. cit. Niven’s suggestions as to the methods on which a milk depot should be conducted are as follows:

1. The milk must be obtained from kept farms kept under inspection by the Corporation, and preferably managed by the Corporation.

2. When modified and sterlized it should be sold at paying prices except to persons willing to submit to certain rules.

3. These rules should include systematic weighing of the infant, inspection of the house, and supervision by officers of the Corporation.

4. A written undertaking must be given to keep up the feeding of the child for a period of not less than three months with obtained from the depot; to give the infant no other food whatever, and if it is desired to give up the method of feeding to lodge at the health office a statement of the resons why the mother desires to released from her unertaking.

5. The person assisted must also undertake to carry out the other instructions given by the visiting officer of the Corporation in the management of the infant.

6. The Corporation to provide adequate means of supervising the application of the milk supplied, and to keep a record of the condition of the children supplied with modified and sterilized milk.

7. Where the milk is supplied at a paying price no supervision should be maintained or agreement entered into.

^{page 365 note 1} Une Vacherie modèle annexée à la Goutte de lait de Rouen, La Clinique Infantile, Paris, January 15th, 1904.

^{page 366 note 1} “The Influence of the Municipal milk Supply on the Deaths of Young Childern.” Dr Golder, health officer, Rochester, N. Y., U. S. A., new York State Journal of medicine, December 1903.

^{page 366 note 2} Ashy, , British Medical Journal, 02 27th, 1904.Google Scholar

^{page 367 note 1} La Clinique Infantile, paris, November 1st, 1903.