IRA S. WIIvE, M. S., M. D. 221 



breast as long as possible. How often are students told how to 

 improve the milk supply of the mother ? Rarely. Even a lying-in 

 hospital of the reputation of Sloane Hospital, of New York, 

 evinces as poor judgment in matters relating to feeding children 

 during the first two weeks as can be found in institutions that 

 are supposed to stand for the highest teachings in medicine. 

 Repeatedly mothers come directly from Sloane to the Vander- 

 bilt clinic with children already on partial artificial feeding when 

 there is no excuse for it, as may be judged from the fact that 

 the babies are promptly placed upon the breast and no other 

 food, and continue to gain on that milk alone for months. Yet 

 this is part of the teaching equipment of the College of Phy- 

 sicians and Surgeons, though, unfortunately, having no super- 

 vision by the Department of Pediatrics. 



Students are not made to appreciate the full value of breast 

 milk, nor are they advised fully as to the conditions demanding 

 that the child be taken off the breast, nor the best way to wean, 

 nor when to wean. The teaching in these phases of infant feed- 

 ing is intimately bound up in the question of the prevention of 

 infant mortality. If the students fail to receive adequate instruc- 

 tion along these lines, how can they be prepared to take a part 

 in the educational work that has been deemed so essential to the 

 work for which this association was organized. Physicians must 

 be social teachers and all the stress should not be placed on 

 nurses and health officers. At the present time the educational 

 institutions are not supplying them with the training to enable 

 them to take their place. 



Over 40 per cent, of the present infant mortality has been 

 adjudged to be preventable. As a general average, there are 28 

 cases of sickness to each death. The amount of preventable 

 illness is thus seen to be enormous. 



From the figures presented by Dr. Holt, 25.9 per cent of the 

 infantile deaths are due to tuberculosis ; acute respiratory diseases, 

 as influenza; contagious diseases, as pertussis, measles and diph- 

 theria. These different causes of death are "capable of consid- 

 erable reduction, chiefly through proper housing, isolation and 

 medical treatment." This is very true, but medical students have 

 no training in the very important subjects mentioned as the means 

 of securing the reduction of deaths. 



From the same source we learn that 52.5 per cent, of the 

 infantile deaths are due to acute gastro-intestinal diseases, maras- 

 mus and inanition, and prematurity after the seventh month. 

 This type of mortal cause is regarded as "capable of very great 

 reduction through proper care and feeding." But no teaching is 

 given regarding boarding out babies or securing breast milk from 

 a wet nurse or a willing mother. 



