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The annual reports show generally, increase of organised effort to reduce the mortality of infants.
This includes the tendering of advice to mothers as to the feeding and care of their infants, the visitation
of their homes by women inspectors who for this purpose must have training and knowledge different
from, or beyond that, which is required for the purposes of sanitary inspectors, and the establishment
in two districts of a depot for the supply of milk. In Battersea, milk is taken with due precautions
from cows on farms which are open to the inspection of the medical officer of health, is modified
at the depot of the borough council and supplied in bottles at prices which do not entirely cover the
total cost incurred. Commenting on the incidence of infantile mortality in the four sub-districts of
the borough, Dr. McCleary states: "There has been a great and progressive reduction in infantile
mortality in North-west Battersea since 1901. The Council's Infants' Milk Depot is situated in that
sub-district, and most of the babies fed on the milk live there. This has been probably an important
factor in the reduction." In Finsbury a milk depot has been established by a voluntary society under
the control of a small medical committee, of which Dr. Newman, the medical officer of health, is a
member. The milk is received from a farm at Theydon Bois, Essex. The cows are milked with
precautions to ensure cleanliness, and the milk is modified, sterilized and bottled on the farm. To begin
with, it is not intended to supply more than fifty infants with this milk.
Enquiry by Dr. Newman as to the method of feeding of a number of cliildren of the
poorer classes of Finsbury enabled him to compare the mortality among children differently
fed at four age-periods, viz., 0-3 months, 3.6 months, 6-9 months, and 9-12 months, and showed
that the deaths from diarrhoea in artificially-fed children under three months of age "were
nearly four times the number that ought to have occurred on the supposition of an average
distribution of deaths from diarrhoea among infants fed in different ways. The same excessive mortality
in the hand-fed continues up to the ninth month of life. In the last three months of the first year of life
the diarrhoea mortality approximates to the average." This diminution in the deathsjfrom diarrhoea
among children artificially fed after the ninth month of life appears, Dr. Newman states, to be due to the
fact that many of these children had in the antecedent period been breast-fed and had thus acquired powers
of resistance. The mortality of breast fed children after the ninth month is, however, comparatively
high for the reason that "many of them obtain insufficient nourishment from the milk of mothers who
are not equal to the strain of nine months' lactation." Referring to the mortality from diarrhoea among
children fed on condensed milk, he found that in the first six months of life this is nearly three times
the average mortality, while the mortality amongst those fed on cows' milk is less than twice the
average. "Between the sixth and ninth months condensed milk still gives a high mortality but the
discrepancy is less marked. The difference in the two mortalities admits of both the following explanations;
one that fermentative changes in the condensed milk are more deadly than similar changes in
cow's milk, and the other that children fed on condensed milk are virtually starved and are ready victims
of diarrhoea.". Again: "Further evidence of the unfavourable influence of condensed milk is shown
by the deaths from 'other causes.' Between the third and ninth months the deaths from 'other causes'
among those fed on condensed milk is twice the average number, whilst the deaths among those fed on
cow's milk are, in the first age period, equal to the average, in the second period only slightly above, and in
the third age period actually below. The enfeebled constitution resulting from the use of condensed
milk is the direct cause of this high mortality in the case of wasting diseases, and the indirect cause of
the fatal termination of other ailments less intimately connected with feeding." He concludes : " It
would thus appear that condensed milk is the worst food for infants, that cow's milk greatly increases
their liability to death, and that all artificial feeding is attended by a high rate of mortality."
In a paper read before the Derby Medical Society, Dr. Howarth, the medical officer of health of
Derby, gives an account of the method of feeding and the mortality during the first year
of life among over 8,000 children born during three years in that town, with the
result that the mortality among the breast-fed children was 69.8 per 1,000, among the hand-fed
1975 per 1,000, and among children reared partly naturally and partly by hand 98.7 per 1,000.
Of the hand-fed children, those fed on milk and water only, had a mortality of 177 per 1,000, those fed
on condensed milk only, had a mortality of 255 per 1,000, and those fed on patent foods a mortality
of 202 per 1,000. The increased incidence of mortality among the hand-fed infants as compared with
breast-fed was manifested under various causes of mortality, including bronchitis, pneumonia, and
convulsions, as well as gastric and intestinal maladies. Comparing the mortality of infants born in
the different quarters of the year, he found that hand-fed children born in the second quarter show the
highest mortality, that there is a progressive decrease amongst those born in the third, fourth and
first quarters, and that "the high mortality among hand-fed children born in the second quarter is due
to zymotic enteritis and diarrhoea," the result probably of less care being taken in preparing the food
after the first month, and "as the resisting power of a child to attacks of zymotic enteritis is an increasing
one, children of the age of two or three months at the time of greatest prevalence of this disease
will show greater mortality than those who are older."
How far it will be possible to increase the practice of the breast feeding of infants, or when this
cannot be done, to ensure the provision of the best substitute for the mother's milk is the problem
which has to be considered in the first instance, but obviously efforts in this direction give the largest
promise of success.
Deaths at " all Ages " from certain Diseases and Groups of Diseases.
The following table from the Annual Summary of the Registrar-General shows the diminution
or excess in the year 1904 under certain of the more important heading, in the list of causes of death, as
compared with the corrected annual average of the preceding 10 years—
C
6108]