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and 1005-6, lend support to the hypothesis of improved registration, such hypothesis being apparently
the most probable that can be advanced to account for the relatively high mortality in the period 1005-6
among children in the first month of life.

In numerous districts in London efforts are being made to limit infant mortality by visits to
the mothers of new-born infants, and by endeavours to improve the conditions affecting infant life.
In the majority of districts this work devolves upon a woman sanitary inspector ; but in a few districts
voluntary workers undertake this duty. In the absence of a system of notification of births, the County
Council supplies to medical officers of health the addresses of women who have been attended by midwives.
For this purpose a large majority of the midwives in London communicate weekly to the Council's
Public Health Department a list of all the cases which have been attended by them, and in this way medical
officers of health were in 1006 put in possession of addresses of 30,749 women who had been confined,
the information reaching them within less than a fortnight of the confinement.
The annual reports of medical officers of health supply interesting accounts of the work which
is being done in this connection in the several districts. Value is undoubtedly attached by the medical
officers of health to the services performed by the health visitors in visiting the homes of newly-born infants.
The result of these efforts may be expected to manifest itself later in the London statistics of infant mortality,
but the experience of some years will be required before sound inferences can be drawn.
In four districts, viz., Battersea, Finsbury, Holborn and Woolwich, these efforts are supplemented
by the supply of modified milk in suitable cases. In Battersea and Woolwich the milk is
supplied from depots owned by the Borough Councils ; the Battersea depot has been established more
than five years, while the Woolwich depot was opened in November, 1906. The milk depot in Finsbury
has been established by a voluntary society, which is advised by the medical officer of health of the
borough, and the milk is pasteurized and modified at the farm from which it is received. In Holborn
arrangements have been made for supplying, on the order of the medical officer of health, modified milk
provided by a large dairy company.
The effect of the supply of milk from the Finsbury depot is discussed by Dr. Newman in an
excellent chapter on infant mortality. He states that the children supplied with milk came as a rule
from poor houses, that 60 per cent. of them "were ill at the time of admission, many of them were very
seriously ill and some of them dying." Nevertheless the mortality of the infants supplied by the depot,
ill and frail though they were, was less than half the infant mortality of all the children born in Finsbury
at the same time." And again, "taken as a whole, however, it is abundantly evident that the depotfed
children suffered much less from epidemic diarrhoea, and all other diseases, than other artificiallyfed
children in the borough, and even when they were attacked had a much lower mortality. And
yet nearly all the depot children were of the very poorest classes; all of them were artificially fed; all
were living at home and subject to precisely the same external conditions of life as other infants in the
borough, and together they formed a selected class of the weakest and most frail an " unfit residuum,"
so to speak, of the children born in Finsbury. But they received pure milk and proper supervision, and
so they survived."
The value of the milk depot does not depend only upon the quality of the milk supplied therefrom.
"Each child fed on depot milk," Dr. Newman states, "is visited in its own home. In this
way a direct personal influence is brought to bear on the mother, and homely advice is given and precautions
taken as to the management of the infant. Sanitary conditions and their effect on the health
of the child are noted. . . . I attribute much of the success of the depot to these personal visits and
assistance." Dr. McCleary, the medical officer of health of Hampstead, who, in a similar office in
Battersea, had experience of the milk depot in that borough writes strongly in favour of the provision of an
establishment of this kind in the Kilburn ward of Hampstead, and he, too, insists upon the value of
the personal visits and the advice which is given in association with its administration.
Dr. Sykes compares the position which the Borough of St. Pancras occupied in respect of infant
mortality in the third quarter of the year in relation to the seventy-six large towns of England and
the London sanitary areas in 1904, 1905 and 1006. A system of visitation to the homes of newly-born
children was instituted in 1904, extended in 1905, and accompanied by the institution of the voluntary
notification of births in the third quarter of 1906. The work of visiting was undertaken by women
inspectors, assisted by ladies who volunteered for this purpose, their efforts in the main being directed