S. W. NEWMAYER, M. D. 235 



Modified milk stations, with set formulas Nos. 1, 2, 3, try 

 to make the baby fit the milk modifications, instead of the milk 

 to fit the baby. It would be far better for the stations to supply 

 milk for fewer infants and do it as near individually as practic- 

 able. The central branch having a chemist and a physician, and 

 each station having- a trained nurse in charge, would overcome 

 many difficulties. The modification should be made on physi- 

 sians' or dispensary order, similar to the methods employed by 

 the Walker-Gordon Laboratories, which are available to the 

 wealthier class. Such arrangements must eventually come, even 

 if it must be under municipal ownership. 



While many cities dispense milk and ice free to the poor, there 

 is often a tendency to overlook the furnishing of milk to preg- 

 nant women, which would often assure breast feeding, when 

 physical conditions without the milk would prevent it. Many a 

 mother would give less table food to the infant if milk were 

 furnished to her for this purpose. 



Infant mortality work has so closely correlated with it organi- 

 zations dispensing milk and ice, medical clinics and modified 

 milk stations, baby farms, lying-in charities, seashore and country 

 outing homes, that to attain best results, all of these agencies 

 should be under the supervision of one competent head, with a 

 central office as a clearing-house. 



The present methods of computing the mortality among in- 

 fants are incorrect and misleading. The relation should not be 

 shown to the total population, but to the population of infants 

 of corresponding ages. 



Comparison with the total death rate is of some value. An- 

 other feature of vital statistics which has important bearing in 

 a. study of infant mortality, but for which there seems no remedy, 

 is the inaccuracy of the diagnosis placed on death certificates 

 by the attending physician. I venture to say that over 50 per 

 cent, of the causes stated on these certificates are incorrect. 

 Anyone in charge of a bureau of vital statistics, even without 

 a knowledge of medicine, could pick out many a certificate which 

 he could positively state was mere guess work. This is not 

 entirely the fault of the physician, as in many cases he has made 

 but one or two visits and must give some cause of death. 



A comparison of the deaths in different wards based on sup- 

 posed social conditions is misleading. Every ward, even the 

 most aristocratic, has its byways and small streets containing 

 the poorer element. The foreigner no longer confines himself to 

 one section of the city, but makes small settlements in a number 

 of wards. 



When we state that the death rate among the poor, tenement 

 or foreign population is greater than among the rich we are 



