JULY, AUGUST and September, 1911, represent dark days in our history; the lives of many hundreds of previously healthy and vigorous infants having been lost.

The total number of deaths from all causes for the quarter ending September 30th, 1911, in the Dublin registration area was 2,172. Diarrhoeal disease in children under two years of age accounted for 426 (18.6 per cent of all deaths) and of these 118 were registered as enteritis.

Although the total number of deaths from all causes in Ireland for the months of July, August, and September,1911,was not greater than the average for that quarter, i.e., 16,011, yet no less than 1,459 of these were due to “diarrhoeal diseases” ( against 505 for the same period of 1910) of which the appalling number of 1,287 were children under two years of age.

I see in The Medical Officer of February 3rd, 1912, that in Islington last summer the infant mortality was no less than 204 per thousand, that is, one-fifth of the children born died before reaching the age of one year. The causes, Dr A.E. Harris, the Medical Officer of Health, says are:

1. Improper feeding; 2. Uncleanliness; 3. Undue exposure.

He appealed in vain for the appointment of three health visitors to the Public Health Committee. Their plan is to circularize the mother of every notified child urging the importance of breast-feeding.

Naturally, in the face of these figures we ask ourselves if the experience gained has been such that we can face the summer of 1912 armed with weapons of precision to protect the lives of infants, either by prevention or cure of this dread disease. Or, are we bound to confess that we are as helpless to save the children as we were in 1911?

The purity of cow’s milk

As is only too well known, breast-fed babies are singularly exempt from infantile diarrhoea. It follows that our attention must be centred upon the artificial foods administered to infants, unlucky enough to be born of mothers unwilling or unable to nourish their offspring by the natural means. As cow’s milk forms a large proportion of this food, it would appear that the prophylaxis of infantile diarrhoea rests upon checking infection, in some way or other, directly connected with cow’s milk.

If the matter is to be taken up seriously, it must be taken up by the State. We must have licensing of cow keepers, of dairymen, and of milk shops. These must be inspected at irregular intervals by qualified men beyond reach of a bribe. Offenders must be severely punished by heavy fines or by suspension of license, not by the ridiculous fines of 5s, occasionally imposed at the present time for non registration.

The duty of these inspectors would be to see that milk receptacles are scalded and kept in suitable surroundings; that the hands of the milkers are clean; that the cows are kept reasonably clean, and, when necessary groomed in the open air, that their udders are washed before milking; that manure heaps and cesspools are kept at a much greater distance from milking sheds than is usual at the present time; and last, but not least, that the milk should be required to be refrigerated within ten minutes of being withdrawn and kept at a temperature of about 40° F, until delivered to the customer. Occasional specimens of this milk must be taken from the street cars and handed to well paid, and not overworked, city bacteriologists for quantitative estimation of bacteria. If found not to be up to the standard required of “certified milk,” the death-distributing vendor must be punished with the utmost rigour of the law, seeing that in his own way he costs the community more lives than any madman running amok.

Ice is not costly, and greater demand will reduce the price still further. The delivery carts will bring back fresh ice to the dairy daily, if necessary. If impracticable, chemical freezers are available. Receptacles after the fashion of those used in an ice-cream vendor’s cart must be used for delivery of the milk.

These precautions, if properly carried out, would insure a supply of safe milk at our doors. It then remains for the consumer by means of ice, or evaporation in a draught, to carry on the good work, and a purer, cleaner, safer and more digestible food will nourish the little ones.

‘Pasteurizing ... kills babies indirectly’

Pasteurizing may kill bacilli, but, I venture to say, also kills babies indirectly. If the milk on arrival at a distributing depot contains one million bacteria per c.c., then it is dirty and dangerous milk, and pasteurizing it will certainly reduce the number of organisms.

But we have seen that in “certified milk” in New York and elsewhere it has become commercially possible to sell milk containing only 30,000 or less bacteria per c.c. These are the lines we must follow. Dr. Benson, of New York, who is deeply interested in the so-called “babies dairies” started in 1908, states among these infants there has been no death from diarrhoea in 2.5 years, and that the total death rate among infants has fallen by practically 5 per cent. The milk distributed was unpasteurized and unsterilized, with from 2 to 4 per cent of fat, and a bacterial count of from 12 to 40 thousand per c.c. Their formula is roughly: top milk; barley water (dextrinized by diastase); milk sugar (this being lessened or omitted in the summer months).

I am well aware that in expressing this opinion of pasteurized milk I am opposing the views held by many able men. Park and Holt have shown by statistics the advantages of pasteurized over raw milk for infants; those fed upon pasteurized milk showing a lower percentage of mortality and morbidity during a summer test. But even this is not convincing, and my opinion will not be altered, until the comparison is made with milk drawn and delivered under such conditions as I have just laid down.

Let the milk be drawn cleanly and let it be kept cool from start to finish. Pasteurization or sterilization will then become superfluous.