Woman's work in municipalities. Mary Ritter Beard
associated with every effort to reduce infant mortality and make children strong. The problem of milk is twofold: to supply the best possible grade for bottle-fed babies, on the one hand, and on the other to provide the mother of the breast-fed baby with necessary conditions for nursing her infant properly. There is no dispute as to the greater importance of the latter phase of the problem.
The milk station to supply pure milk to the poor at low cost is an outgrowth of the knowledge that the greater part of infant mortality comes in summer months from the feeding of babies upon unsatisfactory milk. The risk of death among such babies is far greater than it is among breast-fed babies so that emphasis has perhaps naturally been placed there to an undue degree. Knowing that bottle babies were subject to such danger, the first thought was to minimize the peril for such babies. As Miss Lathrop points out, however, in harmony with the best scientific teaching: “There may be and in some places there have been certain attending dangers where the furnishing of milk has been the only thing attempted. On this account in many, if not most, milk stations, positive proof is required that the mother either cannot or ought not to nurse her baby before she can get the pure milk, and this precaution has been found necessary in order to prevent an increase in bottle feeding in the community as a result of the feeling of greater safety which the pure milk station gives to mothers who, while perfectly able to nurse their children, would prefer, for insufficient reasons, not to do so. It is never intended that there should be less insistence upon the duty of breast feeding because of the milk station, for while the death rate among the bottle-fed is reduced by pure milk, the death rate among the bottle-fed from the purest milk possible is still much higher than the death rate among the breast-fed, and if there is any perceptible increase in bottle feeding as against breast feeding because of the milk station the latter might thus become an agency to increase rather than decrease infant mortality.”[9]
Dr. S. Josephine Baker of the Bureau of Child Hygiene of the New York Health Department also has a large perspective in dealing with this problem. She says: “The evolution of the infants’ milk station is essential. Pure milk, however desirable, will never alone solve the infant mortality problem. Under our system of home visiting to instruct mothers in the care of babies we have demonstrated that babies may be kept under continuous supervision at the cost of 60 cents per month per baby, and the death rate among babies so cared for by us has been 1.4 per cent. The death rate among babies under the care of milk stations has been 2.5 per cent., and the cost $2 per month per baby. Without overlooking the value of pure milk, I believe this problem must primarily be solved by educational measures. In other words, the solution of the problem of infant mortality is 20 per cent. pure milk and 80 per cent. training of the mothers. The infants’ milk stations will serve their wider usefulness when they become educational centers for prenatal instruction and the encouragement of breast feeding and teaching better hygiene, with the mother instructed to buy the proper grade of milk at a place most convenient to her home.”
Here, as in medical prescriptions, it is futile to insist that a mother who is physically able shall nurse her baby if she is so poor that she must work under conditions that weaken her and thus reduce the grade and quality of her milk or that preclude leisure in which to nourish the infant. The question of poverty, that skeleton in every social closet, looms up here with an insistency that nothing will banish. No kind of philanthropy will solve the requirements of infant welfare when poverty or labor conditions are the root of the problem.
Babies’ milk thus becomes essentially a social-economic problem. It is so recognized by many women and is becoming more and more recognized as such by those who work along baby-saving lines. No one sees this fact more clearly perhaps than Miss Lathrop who joins in the ever-growing cry for a “war on poverty.” Mothers’ pensions, and every attempt to increase the wage of the husband or of the wife before the child-bearing experience has entered into her life, that she may lay by a sum for that function, reaches infant mortality more fundamentally and directly than do milk stations. In spite of this truth, milk stations are a useful supplementary social service and the value of pure milk where mothers cannot nurse their offspring or secure a competent wet-nurse must not be underestimated. The milk station, too, for one thing, affords an acceptable avenue through which to reach mothers and instruct them in the care of infants, to assist them with a nurse in times of trouble or crisis, and to prepare them for the hour when milk from the stations becomes a necessity.
In most cases women now recognize the milk station not as a private but as a public responsibility. They first demonstrated the wisdom and practicability of the enterprise as direct health activity, then urged the municipalities to incorporate the plans into their regular health department program. Cities have accepted the lesson readily, although there are still places like our national capital, where the death rate among infants is disgracefully high and where no provision is made by the commissioners, during even the hot summer months, to care for babies in this way.
The superiority of breast feeding is so well-known that the provision of wet-nurses is recognized as a social advantage. The examination, registration, pay and care of wet-nurses are matters of increasing interest to women health workers and the Women’s Municipal League of Boston is attempting to deal seriously with this social mother.
No more interesting story of women’s help on the problem of general milk supply is to be found than comes from the Oranges, although it is fairly typical of the way women have viewed their responsibility elsewhere. In the spring of 1913, the Civic Committee of the Woman’s Club of Orange, New Jersey, offered, for the summer, the services of its secretary to the Orange Board of Health in order that a more thorough study of the milk supply might be made than was possible with the limited official staff alone. “Through the courtesy of the Board, Miss Hall was made a temporary special milk inspector in June, 1913, and has enjoyed the use of the department’s laboratory in assisting in the test of over 600 samples on which conclusions are based as to the quality of the milk furnished in the Oranges.” Those conclusions are published in a report by the aforesaid club in order to give the consumer a better knowledge of the production and supply of milk “in the hope of arousing citizen interest in a union of effort among the four municipalities, toward a more efficient control.”
The joint effort of the Woman’s Club and of the Department of Health led to their common support of certain proposals dealing with the milk situation in the four Oranges. In this case, after a careful and detailed study of all the elements that enter into the provision of milk for these communities, the women determined upon a citizen support of the health officers that, among other proposals, they might obtain better appropriations for the work of inspection. Their publications and general agitation have been marked by exact information.
From New York on the eastern seaboard to Portland on the western come countless reports of the activities of organized groups of women in behalf of pure milk. The “Portland Pure Milk War” was graphically described by Stella Walker Durham in a recent number of Good Housekeeping. The struggle to secure the kind of milk they wanted meant a year’s fight for the women who knew and proved that they knew the true conditions of their city’s milk supply.
Dr. Harriet Belcher, formerly bacteriologist in the Rockefeller Institute in New York, in her campaign for clean milk, made a close study of dealers, delivery, refrigeration, balanced rations for cows, care of cows, process of milking, soils in relation to cost of production, and many other phases of the problem. She did field work as well as laboratory work, and is justly entitled to the name of expert.
While the advisability of mothers learning to care properly for milk and other food in their own homes instead of relying solely upon public care, is evident and is urged even at the milk stations in their educational capacities, such right care in the home necessitates the ability to secure ice easily and cheaply.
Ice
A tragic story of the scarcity and cost of ice in summer has come from more than one large city and the machinations of ice trusts have been among the most scandalous of business revelations. Here and there in the United States sporadic attempts have been made to establish municipal ice plants. Women have been prominent in