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Health Lederle spoke.

On May 31st the last 2 of the 23 stations were opened; with the original 4
stations, this made 27.

Realizing that the problem was a large one, and that every energy of all who
were interested was needed to do the necessary work, a scheme of cooperation
was devised to prevent unnecessary duplication of work. The Association of
Infants' Milk Stations was organized in May. Its objects were briefly:

1. To prevent duplication of work by districting the city, and giving

each milk station a distinct area for its activities.

2. To establish some uniform system of record keeping, so that the work

of the various agencies could be put together at the end of the
season.

3. To render the information in the possession of one group available

to all.

4. To conduct a publicity campaign in the interests of the reduction of

infant mortality.
At the invitation of Commissioner Lederle a meeting was held, and such an
association was formed May 24 1911. Eight organizations, maintaining 79 milk
stations, comprised the Association, and an Executive Committee, composed of a
representative of each, was organized, as follows:

S. Josephine Baker, M.D., Chief Division of

Child Hygiene Department of Health.

Reuel a. Benson, M.D Babies' Dairies Assn.

Maria L. Daniels, R.N N. Y. Diet Kitchen Assn.

Arthur R. Green, M.D Nathan Strauss Pasteurized Milk Labora-
tories.

Jane E. Hitchcock, R.N Nurses' Settlement.

G. N. McCurdy Morningside Milk Dispensary.

Paul E. Taylor, Director N. Y. Milk Committee.

Arthur E. Wakeman Brooklyn Children's Aid Society.

Through the courtesy of Dr. Baker office room, with use of a stenographer
and clerk, was provided at the headquarters of the Division of Child Hygiene.
Dr. H. H. Hart, of the Child-Helping Department of the Russell Sage Foundation,
provided funds for the salary of a secretary. Mr. Charles J. Storey was appointed
to fill this position.

By a committee of the Association the city was districted, thus preventing
two nurses from visiting the same family and wasting time and effort. Whenever
possible, a baby applying at a station living outside the district was referred to
the station located in that district, but, owing to the price of the milk varying in
different sets of stations, this was not always possible to bring about. No can-
vassing was done, however, outside the district assigned to each particular station.

Each station sent in a weekly report in detail showing its enrolment and



EDUCATION THROUGH PRINTED MATTER




Exhibit 10
Distributed to Thousands of Homes by Public and Private Agencies



THE CAMPAIGN IN NEW YORK CITY IN 1911 29

all details of importance, which were tabulated and made accessible to the
other organizations.

The 27 stations founded by the Milk Committee were situated in the most
congested parts of the city. The object of the Committee's campaign was to make
a demonstration of the value of milk stations in reducing infant mortality; to
show that these stations should be situated in the most densely populated dis-
tricts of the city; and that the ordinary store was suited for a milk station.

Many of the situations selected were far from ideal ; vacant stores had to be
utilized, and they were sometimes not situated just where desired, and, as was
afterward proved, were often too small. The Union Settlement in East One
Hundred and Fourth St., the Vanderbilt Clinic, the Wilson Industrial School,
and the Alfred Corning Clark House gave room rent free for the stations.

The plan of campaign was as follows: Each station was in charge of a
graduate nurse specially chosen for her knowledge of infant hygiene, for her
interest in the problem, and her willingness to give herself, as well as her time, to
the work. She was assisted by a matron. In certain districts where the popu-
lation was almost entirely foreign, and where English was spoken and understood
as rarely as in Italy or Russia, a matron was selected, when possible, who was
able to talk the language of the district. Where two or more languages must be
spoken, an interpreter was provided in addition.

Each nurse canvassed her district from house to house, looking for babies,
leaving the folder of the station with the mother, and offering to help her keep
her baby well. That was the great thing the stations tried to teach — to prevent
sickness. The windows of each station were adorned with placards in various
languages inviting mothers to make use of it. The outside of each station was
painted a light, bright blue, and the "Blue Fronts" became a regular expression
of the district, being incorporated into many foreign tongues.

The Milk Committee stations tried first and foremost to encourage maternal
nursing. Mothers were told how necessary it was and how it would save the
baby many of the dangers of the hot weather. Not only were they urged to
nurse their babies, but they were taught to care for themselves so that they could
nurse them. They were told what to eat and, more important, what not to eat
and drink. When breast-milk seemed to be failing, they were provided with milk,
and, if necessary, nourishing food, to try to increase the ability to nurse. When
nursing was impossible, artificial feeding was ordered by the doctor in attendance
at the station. Each baby was treated as an individual, and the food ordered
according to its individual needs.

Let us trace a baby through its whole progress at the station. The doctor
was in attendance at definite hours twice or three times a week. If a new baby
was brought to the clinic, it was seen by the physician, and its food ordered by
him. If brought in at another time, after a preliminary talk from the nurse
in which the whole system was explained, the mother was asked if she wanted
to enroll her baby. If so, it was stripped and weighed by the nurse and the
weight recorded on the individual chart. The nurse's record and the history
card were then filled out, and the nurse ordered a temporary feeding for the



30 INFANT MORTALITY AND MILK STATIONS

child, according to instructions very carefully prepared by the supervising phy-
sician and indorsed by the Medical Council. If the baby was sick, it was
sent to a station where a doctor was in attendance that day, or the station
doctor was communicated with and arranged to see the baby.

Its food having been ordered, the mother procured her supply of milk,
bottles, barley-flour, etc., and returned to her home, whither the nurse speedily
followed her. At this visit she was taught how to prepare the food; and in her
own home, where existing conditions could be most readily appreciated, she was
given a lesson in general hygiene. The formulae ordered for the babies were of
the simplest kind possible. Whole milk mixtures were used almost exclusively.
She was then told to bring the baby back to the station on the next clinic day,
and to come every morning for her supply of milk. She was also urged, at the
first sign of illness, however slight, to report at once to the station. On clinic
days every baby was stripped, weighed, and examined by the station physician,
its progress discussed with the mother, any necessary changes ordered, and the
nurse instructed what to do. Very sick babies were referred to hospitals or to
private physicians.

If the mother was unable to buy milk, through an arrangement with the
Charity Organization Society, the Association for Improving the Condition of
the Poor, and the United Hebrew Charities, such cases were immediately reported
to them, and were at once investigated. In almost every case — probably in every
deserving case — milk relief was promptly ordered by these organizations.

Regularity in attendance at clinics was demanded from the mothers. If they
refused to attend, they were not allowed to obtain milk.

It was hoped that as many as 75 babies might be enrolled at each station.
By the fifteenth of July many of the stations began to cry for help. They were
so overcrowded they could not properly carry on their work. So many babies
were brought to the clinics that they could not all get in and blocked the side-
walk. The nurses were unable to do the follow-up visiting essential to a suc-
cessful campaign. The situation was carefully considered, and, although July
is not a favorable month to try to raise money, funds were procured, and 4
new stations were opened to relieve those most urgently in need of assistance.
The full list was as follows:

Old Stations 306 E. 21st St.

73 Cannon St.
244 Mulberry St.
438 W. 48th St.

Opened May 2d 248 E. 105th St.

722 E. 9th St.
1391 Avenue A.
229 E. 4th St.
114 Thompson St.
307 Tenth Ave.
35 Norfolk St.
174 Eldridge St.
325 E. 5th St.
239 W. 69th St.
56 Leroy St.



>4'



EDUCATION THROUGH PRINTED MATTER




Exhibit 11
Publicity and Information



THE CAMPAIGN IN NEW YORK CITY IN 1911 31

Opened May 20th. . . .37 Washington St.
326 E. 11th St.
316 E. 56th St.
512 Second Ave.
873 Second Ave.
1705 Second Ave.
235 E. 81st St.
315 E. 112th St.
3E. 115th St.
Vanderbilt Clinic.

Opened May 31st .... 165 Ludlow St.
200 E. 97th St.
Opened July 8th .... 331 Stanton St., to relieve 73 Cannon St.

Opened July 10th 223 E. 75th St., to relieve 1391 Avenue A.

Opened July 12th .... 78 Ninth Ave., a new station where the summer deaths were high.
Opened July 14th 1457 Madison Ave., to relieve 200 E. 97th St.

The dates given above are those on which milk was first distributed. The
nurse and matron had been at work in the district for several days.

Not only was the scope of work increased by adding four new stations, but
every station whose enrolment passed the 100 mark was provided with an extra
nurse. This was essential if the purpose of the station — instruction — was to
be carried out.

In August, therefore, 31 stations were in operation. Doctors were on duty,
holding clinics, and often visiting the sick babies in their homes; nurses were
daily at the stations and visiting in the homes, watching, advising, encouraging,
scolding, teaching, as the case demanded. As the nurse went about from house
to house, from family to family, she found many expectant mothers. Part of
the campaign was to get in touch with these women and to try to advise and
teach them so that they might pass successfully through their pregnancy and be
in physical condition to nurse their babies. It was soon found that this was a
large undertaking, and in August a special nurse was delegated to take charge
of this work. Her salary was kindly provided by Dr. Hastings H. Hart, of the
Russell Sage Foundation. During the summer, 964 expectant mothers were
under observation.

The cooperation existing between the Milk Committee and the various
charitable organizations, especially those already mentioned, was of the closest
kind. Whenever tired-out mothers were found whose babies were doing well
enough to be sent away, through the cordial relations existing an outing was
easily arranged.

The Association for Improving the Condition of the Poor offered to receive any
baby needing hospital treatment at Junior Sea Breeze Hospital. This offer was
gladly accepted, and during the summer months 43 babies were admitted there.
At discharge or death a report of the case was made to the Committee. Discharged
babies were immediately referred back to the milk station from which they came.

Figures showing that a large percentage of deaths among babies occur in found-
ling institutions, the Committeeoffered the services of its milk stations to the New
York Foundling Hospital and the New York Infant Asylum. They explained
to those in authority at these institutions the purpose of the stations. The offer



32 INFANT MORTALITY AND MILK STATIONS

was gladly accepted, and during the summer 110 babies were enrolled from these
institutions. The fact that so many of the foster mothers lived in the outlying
boroughs prevented a greater number from being able to make use of the stations.

The milk which was used during the summer was provided by the New York
Dairy Demonstration Company.* It came from tuberculin-tested herds and was
of the highest standard. It was sold for seven cents a quart. The contract
for this milk was awarded after bids had been asked for from the chief milk-
dealers of the city. A constant watch was kept on the quality of this milk.
Bacterial counts were made daily from samples taken at various stations, and
control bacterial counts were made frequently by the Research Laboratory of
the Health Department, through the courtesy of Dr. W. H. Park. The milk
was used raw. These counts were compared with those made by the Health
Department of the milk dispensed at their stations and compared favorably.
The table showing the bacterial counts will be found at the end of this report.

The central office of the Committee was in charge of the Director, Mr. Paul
E. Taylor, who was selected by the committee because of his proved executive
and constructive ability and his knowledge of the problem from his active parti-
cipation in the Philadelphia campaign of 1910. He was associated with the
Philadelphia Bureau of Municipal Research, who kindly granted him leave of
absence to undertake the work here.

The general supervision of the whole work was in the hands of the Director ;
a supervising nurse was at the office constantly; station nurses were instructed
to report by telephone to headquarters every difficulty or complication which
arose; an assistant to the supervising nurse was constantly in the field, visiting
and inspecting the stations; and a special assistant was appointed during the
summer to keep track of the relief cases.

The work of the physicians was supervised by a volunteer supervising phy-
sician, who visited the various stations as often as possible, and especially diffi-
cult cases when asked, and was general adviser on all strictly medical work.
Much of the supervising work was done by the assistant supervising physician.

The entire scope of the work was submitted to the Medical Council in consid-
erable detail and was indorsed by them.

Work of the Health Department

The Department of Health conducted a very vigorous campaign. Fifteen

stations were maintained by them at the following locations:

Manhattan 108 Cherry St. Brooklyn 185 Bedford Ave,

31 Roosevelt St. 296 Bushwick Ave.

209 Stanton St. 128 Dupont St.

2287 First Ave. 994 Flushing Ave.

207 Division St. 698 Henry St.

651 Manhattan Ave.

Bronx 511 East 149th St. 176 Nassau St.

129 Osborn St.
303 Williams Ave.

u- u *^Y^^ company was organized by the New York Milk Committee to demonstrate that a
high-grade milk from healthy herds can be produced by the ordinary farmer with ordinary
equipment, and sold at a price usually charged for bottled milk of uncertain quality. (See Fifth
Annual Report of New York Milk Committee for details of this experiment.)



Jew York Milk Committee*.



)HP.\RTMEN'T OF.HEALTH*



i'athan Strauss Laboratories! . . . ,



Tew York Diet Kitchen*











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.ROOBO-YN' Children's Aid SociETYf



•GOD Samaritan DiSPENSARvt



lENRY Street Settlement*.



ENSON Dairies!



loRNiNGsiDE Milk Dispensary!. • • •



Home modification of milk taught.
Milk dispensed modified.



Exhibit 12
Number of Babies Registered at Milk Stations September, 1911



THE CAMPAIGN IN NEW YORK CITY IN 1911 33

The same general policy was carried out in the stations of the Health Depart-
ment as in those of the New York Milk Committee. Individual formulae were
ordered, — almost always whole milk formulae, — and the food was prepared at home
under supervision of the nurse. Careful records were kept and the cases were
followed up. The work of the summer corps was coordinated with that of the
milk stations. The district nurses and inspectors received lists of sick babies
from the stations each day, and visited and cared for the sick children of those
unable to pay a physician. The department cooperated with the other organi-
zations, sending their inspectors to see any sick child in the care of a milk station
on request.

The " Little Mothers' League" continued its active and most valuable work
in teaching the future mothers of the city how to care for the little brothers and
sisters left in their charge.

The efficient cooperation of the Health Department was further shown by
the assignment of physicians and nurses to the stations of the Brooklyn Children's
Aid Society and the New York Diet Kitchen stations.

The milk used at the stations was the Sheffield Farms Slawson-Decker
pasteurized milk, and was sold in quart and pint bottles, unmodified, for seven
cents per quart.

Work of Other Organizations

The New York Diet Kitchen maintained 8 stations in Manhattan and one
in the Bronx, as follows:

Manhattan 146 E. 7th St.

205 E. 66th St.

451 E. 86th St.

209 E. 103d St.

169 Mott St.

437 W. 41st St.

205 W. 62d St.

152 W. 100th St.
Bronx 583 Courtlandt Ave.

Daily clinics were held at their depots in charge of the Health Department
physicians and nurses. Formulae were ordered according to each baby's indi-
vidual needs, and mothers were taught by the nurses to prepare the food at their
homes.

Certified milk in bulk was dispensed, the daily quantity being "dipped."
It was sold at six cents a quart. The same records and system were employed
as at the Milk Committee and Health Department stations.

The Nurses' Settlement station was continued as before. Two physicians
were in charge of the consultations, and the settlement nurses did the home
visiting. Milk was tuberculin tested and shipped to the settlement in cans, where
it was bottled and sold in quart and pint bottles at eight cents a quart. Modifi-
cation was carried out at the homes according to individual prescription under
the supervision of visiting nurses.

All the above-mentioned organizations worked along similar lines, laying
3



34 INFANT MORTALITY AND MILK STATIONS

special emphasis on instruction, in the belief that permanent results are more
likely to follow teaching a mother to care for her baby and its food herself, than
by simply giving her the food already prepared. The campaign was also parti-
cipated in by other organizations, who did their share along slightly different

lines.

The Nathan Strauss Pasteurized Milk laboratories maintained eight stations :

322 E. 59th St. 348 E. 32d St.

303 E. 111th St. 402 W. 37th St.

38 Macdougal St. Tompkins Square Park

45 Monroe St. Educational Alliance Roof Garden,

197 East Broadway

From these stations pasteurized milk, already modified to set formulae, was
dispensed in 3- , 6- , and 8-ounce individual feeding-bottles, at ten cents a quart
modified, or for older children at eight cents a quart unmodified. There was no
home instruction or visiting and no compulsory medical supervision.

The Babies' Dairies provided tuberculin-tested milk in individual feeding-
bottles, modified at the station on individual prescription, at ten cents for a
day's feeding. Home supervision was not carried out. Medical supervision at
the station was provided. The stations were located at —

416 E. 65th St.
523 E. 78th St.
511 W. 41st St.
117 W. 63d St. (St. Cyprian's, colored)

The Good Samaritan Dispensary, at the corner of Broome and Essex Streets,
continued its work, dispensing pasteurized milk modified to set formulae. The
Morningside Milk Dispensary, at Morningside Avenue and 122d Street, dispensed
pasteurized milk, modified to set formulae, in individual bottles of 4, 6, and
8 ounces, at two and three cents the bottle.

In Brooklyn the Children's Aid Society maintained 14 stations. Through
the active cooperation of the Health Department in providing the physicians
and nurses, follow-up work at the home was carried on, and consultations were
held. Considerable attention was paid to the educational side. Pasteurized
milk, modified to set formulae, was sold in 3-, 6-, and 8-ounce bottles, at one and
two cents a bottle; unmodified milk in 8-ounce bottles at two cents. The
stations were located as follows :

105 Fleet St. 190 Fourth Ave.
608 Fourth Ave, Pitkin, cor. of Watkins St.
159 Wyona St. 148 Jackson Ave.
817 Park Ave. 165 Johnson Ave.

106 S. 3d St. 85 Java St.
27 Columbia Place 201 Hoyt St.
146 Union St. 15 Garnet St.

These stations were open from June 15th to September 15th.

The various dispensaries and hospitals continued their follow-up work
through visiting nurses. Bellevue Hospital, Presbyterian, Roosevelt, St. Luke's,
Mt. Sinai, The Babies', University and Bellevue Medical School Dispensary, j






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Exhibit 14

The Committee Provided the Board of Estimate and Apportionment With the Facts-

The Number of Municipal Stations was Increased From Fifteen to Fifty-five



THE CAMPAIGN IN NEW YORK CITY IN 1191 35

Vanderbilt Clinic, and many others have visiting nurses who instruct mothers
in the care of their babies, and all are factors in the campaign. There was,
however, no particular change from previous years in their methods. The same
applies to the St. John's Guild and Junior Sea Breeze, except as already noted in
regard to cooperation with the milk stations.

Cooperation was earnestly sought from all the special agencies. The New
York Milk Committee sent out an information card, giving the list of all milk
stations and information regarding kind of milk, method of preparation, cost,
etc. This card was sent to hospitals, dispensaries, social workers, nurses' settle-
ments, and many physicians.

Police Commissioner Waldo distributed lists of the milk stations, provided
by the Milk Committee in size suitable for carrying in the pocket, to all patrol-
men of the police force, and issued instructions to give the address of the nearest
station to any mother with a sick baby seen in the parks or on the recreation
piers. The cooperation of the press was active. Articles appeared frequently
in many newspapers in New York and throughout the country. Editorial help
was also frequently given.

Toward the latter part of the summer the committee prepared to back up
the Commissioner of Health in his request for funds to maintain 75 milk stations
in New York in 1912. All summer special statistics had been compiled through
the courtesy of Dr. Guilfoy, Registrar of the Health Department, who allowed
access to the records. These statistics were put together in as striking a manner
as possible, with charts and tables. A detailed study of the location of the high
mortality centers was made by a member of the Executive Committee, and the
results of this study were embodied in a report which was delivered to each member
of the Board of Estimate and Apportionment before the hearings.

The Committee was represented at the public hearings ; only one protesting
voice was raised there against the appropriation, and in this case it was evident
that the protester did not understand what the money was to be used for. The
Board finally appropriated money to maintain 55 stations, which, although 16
less than the number urged by the Milk Committee, was a very great advance
over the 15 provided for the previous year; and there is hope that if these are
efficiently carried on in 1912, the full number will be provided for in 1913.



CHAPTER IV

Results of the Campaign in New York City

In the pages that follow an honest attempt is made to discuss fairly the facts
shown by vital statistics. As already mentioned, the factors in infant mortality
are many and complicated, and at the present moment many statistics are still
unavailable. Only the most obvious facts can be more than briefly touched upon.

In studying the mortality among infants in this country we are sadly handi-
capped by lax registration ordinances — lax themselves or laxly enforced. The
recognized method of rating yearly infant mortality is to record the number of
deaths in infants under one year of age per 1000 births during the same year.
In New York the registration of births has been incomplete up to the last few
years; therefore comparisons of infant mortality rates (deaths per 1000 births)
cannot be made between widely separated periods. The years 1901 and 1911, for
instance, cannot be compared. The greater the number of unreported births,
the higher will be the rate, of course. A glance at Table 6 will show that in 1901
the rate was 191.5, while in 1911 it was 111.6. Nobody believes this really hap-


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Online LibraryPhilip Van IngenInfant mortality and milk stations → online text (page 3 of 21)