MODIFIED MILK MOVEMENT 503 



at Liverpool, St Helens, Battersea, etc. There can be little doubt that this kind of 

 milk supply may be of great service to the children of the poor, in the reduction 

 of infantile mortality due to the use of contaminated or infected milk, and in 

 special cases calling for special treatment. It is not, however, of the nature of 

 control of the milk supply, but rather, of a specialised supply, to meet special 

 needs. There is evidence to show that at Liverpool, Battersea, and other 

 places, it has had beneficial results in this special direction, and has also done 

 good service in protecting the milk from home contamination. The system has, 

 however, several limitations unless properly managed. Its object being the]saving 

 of life and prevention of infant diseases, it is necessary that the system should be 

 individualised. Each mother must be separately advised, each infant inspected 

 and weighed periodically, each home supervised, the condition of the milk 

 regularly tested, and the source of the milk kept under control, the cows and 

 cowsheds, from which the milk is derived, being supervised by a veterinary 

 surgeon and the Medical Officer of Health. And here, in any event, the 

 quality of the milk used must reach a high standard, chemically and bac- 

 teriologically. If these conditions are not fulfilled, it would appear that a 

 municipal sterilised milk supply can only be a palliative measure of transient 

 usefulness. The desideratum is a naturally pure milk supply, rather than an 

 artificially purified and humanised supply. The latter question is one certainly 

 requiring careful consideration, but of a different nature to the former. If 

 undertaken by a Local Authority, it would appear desirable to do it very 

 thoroughly, after the manner of Budin's work in Paris, each case being under 

 strict medical supervision. 



Further, at the present time it is not fully established that epidemic diarrhoea 

 is avoided by sterilisation of the milk In some places and cases it appears to be 

 so, but the subject requires more investigation. On the whole, it may be said 

 that general management of the child in the home, domestic cleanliness, clean 

 milk bottles, and a pure milk supply are the chief desiderata in contra-distinc- 

 tion to sterilised milk. On the one hand, if the cow's milk is clean, pure, and 

 unadulterated, sterilisation is not needed, though modification may be ; on the 

 other, a bad milk cannot be made good by sterilisation. Nor must it be forgotten 

 that for a municipality to furnish a sterilised milk supply, raises special difficulties 

 as to the function of a municipality, which surely should be to control the milk 

 supply and insist upon its purity rather than itself to trade in a sterilised milk. If 

 success attend such an enterprise, private dealers will take the matter up, and it 

 will be carried on in an uncontrolled manner. For these reasons, it appears to 

 the writer, {a) that the education of the public, particularly of elder girls, in the 

 practice of domestic cleanliness and infant feeding, is of more importance than 

 a supply of sterilised milk by the municipality ; {b) that municipalities should 

 use all their powers, and as far as necessary, obtain extended powers for the 

 supervision of the milk supply to large towns ; and {c) that milk laboratories, 

 sterilised milk depots, and the like, should be directed to special needs where 

 existent, and then only under the control of the medical profession, each case 

 treated being carefully observed. One of the most recent and lucid accounts of 

 the milk depot system will be found in the/<?«r. of State Medicine, Oct. 1903, 

 p. 599, written by Dr Mussen of Liverpool. 



