466 CITY MILK SUPPLY 



milk-borne. Group 4, deaths due to accident, congenital disease, and 

 other causes bearing no relation to food. 



It was found that a large number of children died of diseases of the 

 fourth group and that many more children die of diseases of the third 

 group which are not attributable to milk, than of diseases of the second 

 group which are sometimes milk-borne. The number of deaths that 

 occur in group 2 does not convey a correct idea of its importance, for 

 many children contract non-fatal bovine tuberculosis from milk. The 

 deaths in group 1 are caused by diseases to which milk has a direct rela- 

 tion. So it is commonly used in studying the relation of market milk to 

 infant mortality because diseases of the three other groups are more 

 remotely or not at all related to it. In such studies only the deaths of 

 children under 1 year of age should be used because so many complicat- 

 ing factors enter into the lives of older children that the relation of milk 

 to illness becomes less definite. 



As the result of plotting the yearly death rate per 1,000 of population 

 in children under 1 year of age and the average yearly bacterial count of 

 the milk for each year of the period from 1910 to 1911, Dr. Williams 

 showed there was no correspondence between the two. A comparison 

 between the yearly infant mortality rates and these bacterial counts 

 would have been more illuminating. 



Because death certificates often do not give data beyond the imme- 

 diate cause of death and because they are often made out by coroners 

 and physicians that have no intimate knowledge of the case, they are 

 often misleading. So all the deaths of children under 5 years of age 

 which occurred in the period from Aug. 1, 1910, to Aug. 1, 1911, and which 

 the death certificates attributed to diseases of the first groups were 

 studied in detail. The results of these studies appear in Table 122. 



It was found that: 



~^f, 



"1. Many of the poor families moved within a year, showing that they led 

 a hand-to-mouth existence. 



"2. That many of these poor parents went to work, leaving the children with 

 neighbors or to fend for themselves. 



"3. That many poor children lacked proper medical attention and that many 

 of them were doctored by the mother or at the nearest drug store. A large num- 

 ber of children die unattended by a physician. The certificates are made out 

 by the coroner and in the table are listed under the heading ' No Records Obtain- 

 able.* There is good reason to believe that they properly belong with the cases 

 that died from bad care and neglect. 



"4. Seventy-five children died of bad care and neglect and in 87 cases there 

 was a definite history of improper feeding which often meant too frequent feeding 

 of improperly prepared food or of the breast milk. 



"5. Of 156 children that died under 1 year of age, 30 were exclusively breast- 

 fed, 27 were breast-fed and received other food besides. 28 received cow's milk 



