3 i2 MILK AND ITS HYGIENIC RELATIONS 



general knowledge obtained during a residence in these parts. This 

 information, although interesting, is of little value for the present 

 purpose. 



The present arrangements in this country for the medical inspec- 

 tion of school-children will no doubt facilitate the making of such 

 observations, but the school medical officer is hampered in the first 

 place by lack of time for original work, and further by the difficulty 

 of ascertaining the home conditions and general surroundings of the 

 child between its birth and the time it comes under medical inspection 

 at school. Attempts at such investigation have doubtless been made 

 by a number of these medical officers, but it would appear that only in 

 one case has the investigation been recorded. 



The observations referred to have been made by Dr. Norman of the 

 London County Council. A reference to this work is made in the report 

 by the medical officer of the London County Council for 1913, but the 

 reference is somewhat brief, and I am indebted to Dr. Norman for 

 kindly allowing me to use his MS. copy, which gives a considerably 

 more detailed account than that in the report referred to. The con- 

 ditions of the home life were not available to Dr. Norman, although 

 he made an effort to obtain such information but found it to be 

 impossible. 



The investigation was made among infants of non-selected schools 

 in St. Pancras and Holborn during the summer of 1913. Children 

 were reckoned as having been breast-fed when this method of feeding 

 alone was used for at least six months after birth. The ages of the 

 children investigated ranged from three to eight years, most of them 

 being from four to six years of age. The method of feeding during 

 infancy of 355 children was investigated, of whom 176 were boys and 

 179 girls. Dr. Norman points out the great preponderance numerically 

 of the breast-fed over the bottle-fed babies, the numbers being 70.7 

 per cent, and 29.3 per cent, respectively. It was noticed that the 

 poorer type of children were those who had most usually been breast- 

 fed. It is a matter of common knowledge that artificial feeding prevails 

 among the better-to-do to a greater degree than among the very poor. 

 Hence the artificially-fed child will usually have better surroundings 

 than many breast-fed children. The table on p. 315 has been pre- 

 pared from Dr. Norman's figures and shows fairly fully the condition 

 of all the children investigated. It may be noted that without an 

 exception the range both of height and weight in the groups o^: breast- 

 fed children is greater than that among the bottle-fed children. This 

 may indicate that the poorer specimens among the breast-fed children 

 survived while those in a corresponding condition among the bottle- 

 fed ones did not do so. This inference, however, cannot be pressed too 

 far. The weeding out of the sickly bottle-fed babies is referred to by 

 Dr. Norman in his conclusions, which are as follows : 



' The superiority of breast-fed children as compared with bottle- 

 fed ones is not so well marked at school age as one would be led to 

 expect. It is during the early years of life, prior to school age, that 

 the great advantage of breast- feeding over bottle-feeding is so apparent. 

 The bottle-fed children of the poor that survive, appear to overtake 

 their disadvantages, and by the time we find them in school, show no 

 inferiority physically to their breast-fed fellows.' 



The investigation is of interest as being the only one of which 



