194 MILK AND ITS HYGIENIC RELATIONS 



children are kept at regular intervals under medical supervision, 

 accompanied by home visitation by trained women visitors, has 

 afforded opportunity for observations upon healthy children which 

 had hitherto not existed. 



The largest infant consultations existing at that time were to 

 be found in Berlin. These consultations, which are maintained 

 by the municipality, had been established for a number of years, 

 and the amount of material accumulated in their archives was 

 immense. So far, however, no results of the medical supervision 

 had been published. The infants attending these consultations 

 were for the most part breast-fed, this form of feeding being 

 naturally encouraged as much as possible by the medical officers 

 to the consultation. Children for whom artificial feeding was 

 required were fed upon boiled cows' milk supplied in connection 

 with the consultation. The milk was produced on the Berlin 

 municipal farm with adequate precautions to ensure the clean- 

 liness of the milk, and was delivered cooled at a number of centres 

 in the city. Mothers attending the infant consultations were 

 entitled to obtain the milk from these centres at a reduced rate, 

 if this was necessary. They were instructed to bring the milk just 

 up to the boil in their own houses, to set it aside in a cool place, 

 and to prepare it for the infant as directed by the doctor of 

 the consultation. In order to ensure that this method of pro- 

 cedure was carried out, a sufficient staff of trained health visitors 

 was available from the centre, the homes being visited at least 

 every ten days. 



The drawback for this investigation was the absence of children 

 fed upon raw cows' milk. Enquiry in a number of quarters 

 showed that there was no infant consultation of sufficient size to 

 afford the necessary material available from which to draw for 

 data, in connection with the nutritive value of raw cows' milk. 1 



Material used for the Investigation. For the purpose of com- 

 paring the progress made by infants when breast-fed or when fed 

 upon cows' milk, it was determined to secure at least two hundred 

 infants for each series, utilising as far as possible similar numbers 

 of infants in the same year in order to eliminate as far as possible 

 climatic influences. The mortality among the infants at the 

 consultation was extremely low in the years from which the material 

 was taken, and careful calculation showed that the mortality 

 factor could be neglected altogether in the material investigated. 



Children specifically stated in the notes to be suffering from some 

 congenital defect or disease were not admitted into the series. No 

 child who was older than four months at the time of its first attend- 

 ance was considered, and the very great majority of cases in both 



1 Raw cows' milk is used for the feeding of artificially fed infants in 

 Belfast, but the material has not been worked up, and at the time the in- 

 vestigation here being considered was made, the material was not sufficient 

 for the purpose. 



