SPECIALISED MILK 239 



intelligent, cleanly, and simple mode of rearing infants. Infants should be breast-fed, 

 and anything which relieves the healthy mother from this duty should not be looked 

 upon favourably until it has absolutely justified its worth. (3) The cost is at present 

 in many places prohibitive. (4) The evidence of benefit is not yet of a conclusive 

 or sufficient nature to form an opinion as to how far the use of depot milk reduces the 

 infant death-rate. But there can be no doubt that, indirectly, benefit is derived. 



Infantile mortality has a definite relationship to (a) the feeding of infants ; (b) 

 personal care of infants by parents ; (c) housing accommodation ; and (d) certain 

 meteorological conditions affecting temperature and the dissemination of dust. Other 

 elements enter into the problem, but, so far as municipal action is concerned, those 

 are the four main elements. If we can succeed in raising the quality, as regards 

 purity, of the milk on which infants are fed, we shall at the same time educate and 

 improve the sense of duty towards their infants on the part of parents. The mischief 

 lies in polluted milk. The sources of the pollution are not only in unsatisfactory 

 methods of milking, and in storing and conveying the milk supplied, but also in 

 dirty domestic conditions, and particularly in carelessness in the use of feeding- 

 bottles. Successfully to attack, by municipal administration, all the sources of 

 pollution, is at present impossible, but the ideal of public health administration in 

 respect of infant feeding is a pure milk supply which needs no sterilisation ; and 

 towards that end all our efforts should be directed. Modification of such cow's milk 

 for infant use will still be necessary. Meanwhile we must do the best possible 

 under existing conditions, and that involves sterilisation, modification, and protection 

 from home contamination. It is also essential that such a milk supply should be 

 under medical supervision, and adopted only in suitable cases. Without entering 

 into unnecessary details, it would appear that there are five possible means of 

 supplying such a suitable and pure milk for infants : (1) By means of municipal milk 

 depots (vide supra) ; (2) by one or more milk-vendors or dairymen undertaking, by 

 private enterprise, to furnish such modified milk (certified) under medical super- 

 vision ; (3) by obtaining such a supply from some central institution, company, or 

 society, such, for example, as the Walker-Gordon Laboratory ; (4) by means of 

 medical milk commissions, as is done, in part, by the milk commissions established 

 in the United States of America ; and (5) by means of a voluntary health society 

 supplying such milk under necessary supervision and control of sources and usage, 

 as is done, in part, by the York Health and Housing Association. 



The essential points requiring attention are such modification of the cow's milk 

 as will make it, like human milk, suitable for infant consumption, absolute control 

 of its source and handling prior to its modification, and prevention of home contami- 

 nation by delivery in sealed bottles. At present it would also be necessary to 

 pasteurise or sterilise such milk. 



(ii. ) The Rotch system was introduced by Dr Thomas Morgan Rotch of Harvard 

 University, and is now in operation in some eighteen or twenty cities in the United 

 States and Canada, and has also a centre in London. The system, which has for 

 its object the betterment of infant feeding, consists in controlling the milk supply by 

 controlling the farms, and establishing a chain of protection from the time the milk 

 leaves the cow until it arrives at the mouth of the infant. But in addition to this 

 scheme of protection, there is also combined with it a scheme of modification of the 

 milk to make it meet more exactly the requirements of infant feeding. The two- 

 fold function of the Rotch system may be briefly referred to : (a) Protection of the 

 Milk. With this object in view Rotch made a number of recommendations similar 

 to those laid down by various Milk Commissions, which latter indeed took many of 

 Rotch's proposals for their model. At the farms supplying milk under this system, 

 the breed of the cow and its food are matters which receive primary attention. In 

 America the Holstein has been found to be the best for its adaptability for infant 

 feeding. The cow itself must be regularly and wisely fed on the basis to which 

 reference has been made. There is regular grooming and good housing. The cow- 

 house has cemented walls, ceilings, and floors, and is properly drained and 

 frequently cleansed. A most careful supervision of the cow's health is maintained, 

 and if in any way abnormal, the cow is isolated until in normal health. Careful 

 tuberculin testing is made of each cow used, and the milk of each cow also under- 

 goes microscopical examination for the purposes of detecting pus cells, colostrum 



