V
The importance of impure milk as a contributing cause of infant mortality is now pretty generally recognized. The splendid work of Mr. Nathan Straus has done much more, perhaps, than anything else, to emphasize this fact. In view of some rather caustic criticisms of charity in the preceding pages, it may be well if I embrace this opportunity to explain my position somewhat more fully. No one, I think, recognizes more fully than I do the important experimental work which has been done by philanthropic enterprise. Such work, of which that of Mr. Straus is a conspicuous example, has blazed the path for much municipal and state enterprise. It would be impossible to overestimate the value of the work done by social settlements and such bodies. For the charity which denies justice and seeks to fill its place, I have no sympathy, but for the charity which adopts as its motto the fine phrase adopted by the ablest journal of philanthropy in America,[[H]]—“Charity to-day may be Justice to-morrow,”—I have nothing but praise.
A “CLEAN MILK” DISTRIBUTING CENTRE IN A BAKER’S SHOP, ROCHESTER, N.Y.
I have long held the opinion that the milk supply of every city should be made a matter of municipal responsibility. Some ten years ago, while residing in England, where the subject was then beginning to be discussed and agitated, I devoted a good deal of time to the propaganda of the movement for the municipalization of the milk supply. In view of the splendid achievement of the gouttes de lait in France, it was natural that we should have attached much importance to the sterilization of the milk, and I remember with what enthusiasm some of us hailed the introduction of the system into St. Helen’s, Lancashire, the first English city to adopt it. I am convinced now that sterilization is unnecessary and a grave mistake. Undoubtedly it is well that dirty or impure milk should be sterilized, but it would be still better to have clean, pure milk which needed no sterilization. The testimony of Dr. Ralph M. Vincent before the British Interdepartmental Committee[[163]] and, more emphatically still, the splendid results of the Rochester experiment under the leadership of Dr. Goler[[164]] show that this can be attained. Every municipality in America could adopt, and should adopt, the plan. “Now that the way has been shown, upon ‘city fathers’ indifferent to the childhood of their cities, upon health officers and departments warped into unbudgeable routine, upon near-sighted charity workers and unknowing givers who care for the suffering, but do not get at causes, will rest the responsibility for the continuance of a part of that fearful tally of dead babies which each summer’s week jots down on a town’s death-roll—your town and ours.” In these direct, unequivocal words Charities sums up the whole question of responsibility.
The purely experimental work of such philanthropic efforts as that of Mr. Straus has been done. The practicability and value of municipal control of the milk supply has been abundantly proven, and there is no longer need of private charitable effort and experiment. There lurks a danger in leaving this important public service to philanthropy, a danger well-nigh as great as in leaving it to private commercial enterprise. The dangers arising from the amateurish meddling of “near-sighted charity workers and unknowing givers” is much greater than is generally recognized. Many of these charitable societies drag out a precarious existence, their usefulness and success depending upon the measure of success attending the efforts of the “begging committees.” Generally speaking, they are less economical, and, what is more important, less effective, than municipal enterprises, besides being based upon a fatally unsound and demoralizing principle. I know of one large city in which a number of public-spirited citizens have for some years interested themselves in the supply of sterilized milk for infants. Notwithstanding that they receive each year in subscriptions a much larger amount of money, in proportion to the milk supplied, than Rochester’s deficit, they charge the parents more than twice as much as the latter city for the milk.
Nor is this all; there are other, weightier objections than this. There are no regular depots for the distribution of the milk, under the direct supervision of the Committee, but it is handled by drug-store keepers and others. No sort of control is exercised over the sale. Any child can go into the store and buy a bottle of milk. This is what happens: small children, sometimes not more than four or five years old, are sent by their parents to buy the milk. These little children are, naturally, ignorant of the importance which the medical advisers of the charity attach to the subject of modifications of the milk to suit the age of the child to whom it is to be given, with the result that babies less than three months old are given milk intended for babies eighteen months old, while the latter are half starved upon the modified milk intended for the former. Another evil, not, I am told, peculiar to this particular charitable society, is the selling of milk irregularly and in single bottles. When the mothers have the money, or when they are not too busy to go for the Pasteurized milk, they buy a single bottle, but at other times they send out to the grocery store for cheaper milk, or else feed the babies upon ordinary table foods. Of course, there should be a system of registration adopted; every child’s name should be enrolled, together with the date of its birth, and no less than a full day’s supply should be sold. That is the custom where the matter has been taken up by the municipal authorities. The result is that the children can be weighed and examined more or less regularly; facilities are offered for the periodical visiting of the homes of the infants and their inspection; mothers can be taught how to care for their little ones; and, instead of leaving it to chance, or depending upon the word of an ignorant mother, or a child, the attendants in charge are able to regulate the supply so that at the proper time each child gets milk of the proper strength and richness. How far the abuses I have named are prevalent in philanthropic experiments of this kind, I do not know, but I am convinced that there should be no room for such well-intentioned but disastrous muddling. The whole milk supply of every city should be the subject of municipal management and control, and special arrangements should be made for dealing with the milk intended for infant consumption. Personally, I should like to see the principles of the Rochester system extended to cover the entire milk supply of the city, and, in some one of our great cities, the further experiment of a municipal farm dairy for the supply of all milk necessary for hospitals and similar institutions upon the most hygienic principles possible. This has been done to some extent in Europe with success.