2 DECEMBER 1911, Page 33


TO THE EDITOR OF THE "SPECTATOR."' Sin,—In reading Miss Loane's article in your issue of November 11th I was surprised to find that she made no reference to the schools for mothers which have been in- creasing with remarkable rapidity during the last five years. She will find that all her suggestions on the preservation of child life and the endeavour "to raise the national standard of health and efficiency" have already become an accom- plished fact. The movement has made such rapid strides lately that it has been found necessary to form a central office at the National League for Physical Improvement, where information, both medical and social, on the work of these institutions will be forthcoming. The subject is, of course, in its infancy at present, so that we are most anxious to hear any criticism of the methods already in vogue.

Miss Loane says, "When nursing is really impossible, or for some valid reason undesirable, careful and repeated in- struction must be given as to the nature of the artificial food, its preparation, the hours when it should be given, and the quantity needed. Teachers must be extremely careful to make these methods practicable." Miss Loane does not sug- gest who, in her opinion, should be the teachers. Now this is of fundamental importance. In all well-organized schools for mothers the infant consultation must form an important part of the work, and this must always be conducted by a qualified medical practitioner. This point cannot be too much emphasized. A tradition has grown up amongst all classes of the community, the rich as well as the poor, that it is the duty of the nurse, parent, or guardian of a child to prescribe the quantity and quality of food which should be given. Now until this view is eradicated I feel perfectly certain that we cannot hope to raise the national standard of health and efficiency.

In my own personal experience for close on five years at an infant consultation I have seen the result of the good inten- tions of nurse, parent, and guardian, and I can only say that they have utterly failed in the great majority of cases. I certainly believe that rules of hygiene can be taught by nurses and others, but when it comes to the question of feeding I find that each case has to be treated differently ; it is impos- sible to lay down hard-and-fast rules as to how much food a child of a certain age is to receive, and as to how that food should be prepared. Printed leaflets on this matter are quite useless ; they are really worse than useless, because they give a feeling of false security to the parent.

Later on Miss Loane says, " One can be fairly well satisfied if the child is fed solely on fresh milk served in an absolutely clean bottle and raised to blood heat by the addition of a little boiling water." This sounds delightfully simple and presumably satisfies Miss Loane, but unfortunately it does not satisfy the infant in a great many cases.

A paper appeared in the Lancet for September 2nd, 1911, showing the average amount of milk obtained from the breast in a large number of infants at various ages. The observations were made by weighing the infant before and after feeding on accurate scales. The results showed that the average child amongst the poor receives very small amounts of breast milk and thrives on it. The authors of this paper say that "infants are often given supplementary feeds of cow's milk in amounts of 4 or 5 oz. (we have known as much as 9 oz.) when the 'test-feed' proves that the

amount they obtain from the breast is about 1 oz., sometimes less ; under such conditions it is hardly surprising that cow's milk is found to disagree." This sudden change in the quan- tity of the food is sufficient in itself to account for the inability to digest cow's milk. I have only mentioned one point amongst several which appear to me open to criticism in Miss Loane's article. It is surprising that a writer of Miss Loane's experience should not have taken more pains to acquaint herself with the work connected with the saving of

child life which is already in progress, not only in London, but in all the great cities of the kingdom.—I am, Sir, &c., Kensington. RONALD CARTER, M.D.