CONTROL OF THE PUBLIC MILK SUPPLY 469 



table and pouring cold milk into it to feed right to the baby. No attempt 

 at modifying milk. 



3. Mother taking no care of her hands; as, for instance, preparing 

 the babies' food without washing them after handling the diapers. 



4. Keeping the baby bundled up near the stove or in some other 

 unsuitable place. 



5. Bathing the baby improperly. 



This reduction of the infant mortality rate was accomplished without 

 in any case changing the milk supply of the neighborhood except that 

 an earnest effort was made to eliminate the use of condensed milk. De- 

 troit has a good milk supply and Dr. Price says distinctly that these 

 results would not have been possible had it been otherwise but the point 

 is that an excessive infant mortality is not wholly attributable to the 

 milk and that the best of milk cannot make up for the errors of bad 

 mothering. 



Flies are generally believed to be a factor in infant mortality but it 

 is difficult to determine how large a part they play. It certainly must 

 vary a great deal. They are probably more important in the warm 

 Southern cities than in the cool Northern ones and in a city or ward 

 without sewerage and without garbage collection than in places that 

 have these facilities. They are also more menacing in a dirty house 

 than in a clean one. Several studies have been made to ascertain the 

 importance of fly infection but owing to the many complicating factors 

 involved final conclusions have been drawn in few cases. Recently 

 Platt of the New York Association for Improving the Condition of the 

 Poor has outlined the chief results of an extensive cooperative investiga- 

 tion by the Association of the question of the relation of the fly to infan- 

 tile diarrhea. The findings, expressed in certain factors devised by the 

 investigators, are that the fly has an importance in causing this rate of 

 1.9, "dirt" 1.8, artificial feeding 2.4, flies and "dirt" 2.4 and artificial 

 feeding and "dirt" 3.5. By "dirt" is meant the conditions found in 

 homes presided over by easy-going mothers who are satisfied with mini- 

 mum standards of decency with the result that everything is at loose 

 ends and the house is littered with remnants of meals, dirty clothes, etc. 

 In discussing this paper Dr. Levy emphasized the importance of 

 proper excrement disposal in Southern cities and the part played by 

 flies in distributing feces. He stated that since 1911, the board of health 

 nurses of Richmond, Va., had been instructed to emphasize to mothers 

 the importance of properly caring for soiled diapers. The effect of laying 

 stress on this point was gratifying. The city had an excellent milk 

 supply for 6 years and general instructions in the care of babies had been 

 given for 2 years; still, the infant death rate from diarrhea per 100,000 

 inhabitants ranged from 122 to 152 but when the nurses added to_ their 

 other instruction, information on the care of babies' excrement this death 



