CONTROL OF THE PUBLIC MILK SUPPLY 471 



Houses with good air circulation cool off more quickly than those that 

 lack it. The number of infant deaths is greatest in houses and districts 

 of the city having poor air circulation. It has been observed that the 

 infant mortality is less for children living in cellars and basements than 

 for breast-fed children living in warmer rooms. The mortality is greatest 

 under the roof where it is hottest. 



The observations in regard to the effect of humidity are meager and 

 contrary to what would be expected, for they indicate that infant mor- 

 tality is highest on hot dry days. In overcrowded tenements the 

 humidity is excessive owing to emanations from the lungs and skin. 



Heat produces many effects on the child. It increases metabolism 

 and favors heat retention. The regulation of heat by the body is efficient 

 within narrower limits in babies than adults so that high temperatures 

 are apt to raise the body temperature of children above normal. In 

 hot weather babies and adults both have reduced tolerance for food. 

 This in part accounts for the better results obtained by breast feeding 

 in hot spells than by bottle feeding. The baby takes the first mother's 

 milk and is satisfied, leaving the rich after milk behind whereas in bottle 

 feeding the composition of the milk is fixed and if the baby eats at all, 

 it is likely to overeat. In hot weather the quantity, acidity and activity 

 of the gastric juice is reduced. Certain experiments on laboratory 

 animals lead to the belief that the resistance to bacteria is reduced by 

 heat. 



Typical cholera infantum is believed by many to be a direct heat 

 effect and heat is supposed to have a predisposing effect toward subacute 

 diarrheas because it induces reduced tolerance of food, reduced activity 

 of the digestive secretions and reduced normal resistance of the intestines 

 to bacterial invasion. Besides these diarrheas there are the infectious 

 diarrheas due to specific organisms. Flexner, Kendall and Walker and 

 others have proved certain cases of diarrhea of infants to be due to B. 

 dysenterice, and the last two investigators found certain other cases to 

 be caused by B. welchii infections. Other bacteriologists have attributed 

 certain outbreaks of diarrhea to other germs. 



In general, infant mortality is class mortality ; it is begotten by poverty, 

 ignorance and crime. The poor live in overcrowded insanitary condi- 

 tions. The expectant poor mother has to work till she is confined and 

 has to leave her offspring soon after, thereby depriving it of nature's 

 food and entrusting its care to some " little mother." The baby suffers 

 from bad food, injudicious feeding and other forms of ignorance. 

 Criminal parents are apt to be alcoholics, the sufferers from venereal 

 disease and often to be mentally weak. Illegitimacy means that the 

 newborn is likely to receive gonorrhea and syphilis from its parents and 

 to be neglected by them. In England and Wales in 1909 the death rate 

 of illegitimate children was 211.1 and of legitimate children 104. 



