MUNICIPAL HYGIENE. 137 



recognize the existence of diphtlieria and to be in a position to employ 

 without delay the specific remedy. In this respect the city physician 

 is at a distinct advantage in treating diphtheria as compared with his 

 brother in the country districts, although the latter may be often his 

 equal, perhaps his superior in individual ability. Both as regards the 

 early diagnosis of diphtheria and the speedy procuring of reliable anti- 

 toxin the city practitioner occupies a position of vantage. Whether 

 the city physician always avails himself of his superior opportunities 

 is another matter. The opportunities certainly exist, and with the de- 

 velopment sure to take place in the efficiency of municipal lal^oratories, 

 the perfection of telephone and messenger service and the establish- 

 ment of stations for the delivery of antitoxin, the balance is likely to 

 turn even more in his favor. Individual ability and special training 

 in the use of the microscope will sometimes enable a country physician 

 to obtain the necessary information for himself, but in accordance with 

 the laws of specialization, such tasks in the larger towns will devolve 

 more and more upon the expert who devotes his whole time to the work. 



The same tendency is at work in other directions. The scope of 

 municipal laboratory work is evidently broadening with the advance 

 of scientific medicine, and. new fields of activity are continually opening 

 before it. In the diagnosis of malarial fever and typhoid fever and 

 in the early recognition of consumption it is already rendering valu- 

 able aid to the busy city practitioner. The actual degree of usefulness 

 of the municipal laboratory to the community is still made the shuttle- 

 cock of local political conditions, but this stage can last only so long 

 as the city dweller continues to close his eyes to the part that might ]ye 

 played by the laboratory in securing and safeguarding the public health. 



There are at least two particulars in wliich the city is still at a con- 

 spicuous disadvantage as compared with the country. These are, first, 

 the high infant mortality, and second, the greater prevalence of various 

 infectious diseases. 



As regards the first of these, it is well known that there is a clearly 

 established relation between infant mortality and city milk supply. 

 The richness of milk in those very substances that render it valuable 

 as a food is a source of danger. Not only children but microbes find 

 milk an exceptionally nutritious food. It is not surprising that milk 

 that is at the start carelessly collected and carelessly handled and then 

 carried a long distance should often swarm with countless microorgan- 

 isms by the time it is delivered to the consumer. In hot weather the 

 growth of bacteria in milk is especially rapid, and much of the milk 

 that is distributed in cities during the summer season is far advanced 

 in the process of decomposition. The high death rate among bottle-fed 

 infants during the summer months, and the traditional popular dread 

 of the 'second summer' as a critical period in infant development are 

 directly traceable to the use of stale milk. The evil is by no means 



