HE problem of the poor mother and her infant is by no means new. For years it has been the object of serious concern to governments and municipalities, and has won the attention of physicians, philanthropists, milk dealers, sanitarian and social workers, not only in this country, but in France, Germany, England, and other nations of Europe. It is only within recent years, however, that the great mass of people has awakened to the

fact that hundreds of thousands of infants are dying needlessly each year, and has begun to take active steps to save their lives.

Numerically to picture the problem of infant mortality is, at the best, unsatisfactory. To the expert, as well as layman, statistics convey little real impression of the suffering and pathos involved in these needless deaths. Reduced to comparative terms, however, the situation changes. Even figures now cause one to shudder; for other dread diseases shrink into insignificance when the resulting loss of life for any given year is contrasted with deaths among babies from the first to the twelfth month of their existence.

Last year, it is estimated, 150,000 deaths resulted from tuberculosis in the United States. These deaths covered the whole span of life from infancy to old age, and occurred in spite of long efforts and the expenditure of large sums of money.

Although we have no accurate figures as to the number of babies born annually in

*The Survey.

other two-thirds by casualties and those ordinary ills of infancy which may almost wholly be prevented by the exercise of reasonable intelligence and care.

The importance of pure milk in reducing infant mortality, although worthy of grave consideration, has, up to the present time, been over emphasized; in fact, it has withdrawn attention from other factors equally important, probably on account of the grim manner in which the hand of death flays down the children of the tenements in the congested portions of all American cities during the hot months.

The tragedy is well pictured in the French chart, familiar to every child specialist, called the Eifel Tower. Here we have a contrast in morbidity between children suckled and those fed upon artificial food. Among the former the ratio of deaths remains comparatively constant until we approach July and August when it rises to a considerable but not startling degree, falling shortly afterwards and remaining, as at first, until the closing of the year. With the artificially fed infant, however, it is always subject to leaps and bounds. When July is reached, the leap is frightful, spouting up like a geyser of human blood. Fifteen bottle-fed babies die

the percentage to be even as high as twenty to one. Recently Dr. Joseph L. Winters of New York, pictured the situation truthfully when he said: "No matter how dark the tenement, how foulsome the street, how unsanitary the home or how sickening the conditions in which the child is raised, an infant, fed at the breast of a healthy woman, runs little risk of death. No medicine. no care or treatment, no proprietary food, will guarantee the life of a sick infant in the summer time. There is one remedy and one alone. That is, that the infant should be fed as God intended it to be."

But although many of us realize, and others are coming to realize, that the breast-fed baby is comparatively immune from death, the fact nevertheless remains that thousands upon thousands of infants all over the world, are unable to obtain maternal nourishment.

The New York Milk Committee in Manhattan Island, is feeding in the neighborhood of 750 infants. A careful statistical estimate, based upon the ratio of infants fed in its depots to the total number of infants in the areas included by them, extended to all the varyingly congested districts of the island, shows that in Manhattan, 12,500 mothers of the poorer classes (and no one knows how many of the middle classes) are forced to rely upon artificial feeding for their infants. The two main reasons for this maternal impotency, are physical disability, due to improper nourishment and disease, and industrial employment, due principally to abject poverty. Added knowledge and intelligence, not only on the part of the corporation and the man at its head and the careless spendthrift; but also for the tenement house mother, for whom much is being done, but who, through sheer ignorance, nullifies the efficacy of material relief and kindly effort -added knowledge and intelligence, I say, must be created before the problem of infant mortality can be satisfactorily solved.

The beginning of this work already has been made. Seventeen years ago, Nathan Straus, in New York city, began his memorable campaign against impure milk. Splendid have been the results achieved, but, as concerns the decrease of infant mortality, Mr. Straus attacks only one phase of the problem. Pure milk is only one factor. More important than to supply a substitute

for breast milk is to encourage breast feeding and render it possible-to remove the conditions of undernourishment and employment, which prevent women from nursing, and to educate mothers to realize, not only the importance of maternal nursing, but also the value of sanitation, infant feeding, infant hygiene, and the proper care of their infants and of themselves.

It was with this idea in mind that the New York Milk Committee in June, 1908, opened seven milk depots in New York city from which is sold certified milk from what probably is one of the best dairy herds in the United States-the Tully Farms herd.

Each depot is in the charge of a group of volunteer physicians under a senior physician elected by them. These physicians examine the babies at weekly classes, weigh them, prescribe their exact feedings and educate the mothers by talks on infant feeding and infant hygiene patterned after the well known consultations of nourishment of France. Trained nurses, employed by the committee, supervise the distribution of milk, assist the doctors at the classes, and, by visiting the homes see that the mothers actually carry out what they are told to do. At the close of each day,

these nurses telephone their exact milk orders for the day following to the central laboratory, which is generously provided by the Sheffield Farms-Slawson Decker Milk Company-and the next morning before eight o'clock, the milk, properly prepared and refrigerated, is delivered at each

station.

The results have been wonderful. Sickly, emaciated children, hardly human in appearance, have become in a few months fat and rosy. Overworked mothers, who scarcely had had a night's sleep since the birth of the child, have become rested and refreshed. In the Henry Street Depot alone more than one-third of the babies who are now alive and in healthful condition were on the point of death, when they were first brought in. In Cannon street, the committee is feeding nearly 200 babies, most of whom were in bad condition when found. At the last consultation only one with a severe cold was failing to improve.

In one of the consultations at Bloomingdale Guild thirty-two babies are enrolled. The average age at which they were brought was twenty-five weeks and two days. The average weight was thirteen pounds six and four-tenths ounces, whereas the regularly accepted estimate for a nor

mal child of that age is fifteen pounds eight ounces. Thus the average weight of these thirty-two babies was two pounds two ounces below the normal. At the end of fifteen weeks and three days, their average weight was eighteen pounds one and ninetenths ounces, whereas the normal weight for infants at this age is seventeen pounds eight ounces. Thus the thirty-two babies fed at this one consultation at the Bloomingdale Guild Depot, were nine and ninetenths ounces over weight.

At St. Cyprian's Chapel, Mrs. J. W. Johnson, wife of the rector of the church, told me that before the committee's work began in that neighborhood, her husband had buried, on an average, one colored baby every other day throughout the year. Since June 15, 1908, she said, he had buried only six children.

GAINED TEN OUNCES IN ONE WEEK

Given a whole year in which the 750 infants now being fed at the committee's depots would have been exposed without them to the dangers of ignorance, impure milk and the other concomitants of poverty, I think it is safe to say that the saving of lives among them amounted to fifty per cent. Extending this estimate to the 12,500 babies needing similar care and assist

ance in New York city, and considering that last year the deaths under one year in Manhattan was 9,000, it can readily be seen that a saving of life equal to fifty per cent of the 12,500 would be an enormous reduction of infant mortality for the island as a whole.

What is true for New York city, is of course true for the entire country. The saving of lives, important as that is, is only one of the many results accomplished. Equally important are the prevention of suffering and misery, the raising of the standard of intelligence of whole families and communities and the starting of young lives on a sound physical basis.

Reviewing the situation as it is naturally one is led to inquire, "How shall we face this problem?" To such an inquiry there is a definite answer. In the first place clean. milk must be provided. This preventive of infant mortality is the most easily supplied, and therefore must be considered first. Where money is not obtainable for certified milk, the milk must be pasteurized. Similarly where money is lacking to prepare individual prescriptions, suited to the exact needs of each baby, wholesale modifications, prepared on a commercial basis, must be secured. Under all circumstances the most urgent problems must be undertaken. first. This, of course, means continually compromising with ideals. But ideals need not be lost sight of, even when temporary expedients seem extreme.

Together with the distribution of milk, instruction is imperative. No mother should be allowed to get the milk until it is definitely determined that she is unable to suckle the child herself. Many and many a mother could nurse her baby if she received an extra quart of milk daily, or even if an extra cun of cocoa were given her with each meal.

The case of Barry O'Shea suggests itself in this connection. At the age of three months Barry came to the committee's depot in Bloomingdale Guild weighing six pounds and fourteen ounces as opposed to eleven and three-quarters pounds, the normal weight of an infant at that age. Three physicians had given the little fellow up to die and the mother, who had tried everything on the calendar except her own milk, brought him to the depot as a last resort. The doctor in charge, realizing that breast milk alone could save him, insisted that