reasons. For instance, the children would then go to school in the traditional sense, whereas they ought to become members of a family, with a richer and healthier life than that of their existing homes. The parents would look upon the school, not as belonging to themselves, to be used and helped by them, but as an alien institution, or at the best as a convenient means of getting their children taught. A small school of not more than forty children, on the other hand, may become, as experience shows, the pride of its street, and may revolutionize its children's lives. In congested areas it may be desirable for two or more schools to occupy the same building, but each school should be kept distinct, with its own teacher and assistant and its own group of mothers. In the country the position will be different, and a nursery school may often form a separate department of the village school, but here also its aims and methods will be essentially those described.

Of the internal organization of the schools I cannot speak in detail. Open-air space and some form of garden are more important than elaborate buildings. The great difficulty will be to get the right type of teacher, but I believe that the work will attract many large-hearted women if once reasonable conditions of employment are secured.

If nursery schools retain the children till the age of 6, the transition to the elementary school will, we may hope, be easy when the methods of the best junior schools are generally adopted. It is very important that the sympathetic interest of infant and other teachers should be gained for the new movement, and the nursery schools should be co-ordinated in various ways with the elementary school system. On the other hand, the nursery schools should form one of the links in a chain of institutions dealing with young children. In every town there should be one or more child welfare centres, including schools for mothers, day nurseries, nursery schools, and other institutions. Each nursery school might be connected with some centre and under the general management of the centre committee and superintendent, while remaining free to develop its special methods. Nursery schools ought not to be merely the extension downwards of our educational system. They should be our expression of the nation's consciousness that in tolerating the present waste of early life and health it is committing a grievous sin against the little children.

The Victoria University,

Manchester.

BREAST FEEDING AND INFANT WELFARE.

BY JAMES OLIVER, M.D., F.R.S.Edin.

Hon. Gynæcologist to the Hospital for Women, Soho Square, London;
author of "Manual of Diseases Peculiar to Women," &c.

MOTHER'S milk is Nature's food, and is without the least shadow of a doubt the best food for every young mammal. It is the best food for the human infant, not merely because it contains in an easily assimilable form every organic and mineral substance which is requisite and necessary for the welfare of its body, but because it contains these in very definite proportions, in the exact proportions best suited for the maintenance of the well-being of every organ and tissue. This applies more especially to the mineral substances, the lime, iron, phosphorus, potash, soda, and magnesium, for it has been ascertained that the proportions of these foodstuffs to each other in milk are to all intents and purposes the same as they are in the entire body of the infant whilst it is being suckled.

Vital Elements in Milk.

In milk there are, moreover, certain determinants, substances which are as yet but little known, and the chief of which are the so-called vitamines, bodies which appear so far to be indispensable for all the phenomena of life, and which in some obscure manner aid and abet our hereditary powers of growth. By growth I mean increase in stature as well as increase in weight, for the infant, if it be progressing as it ought to do, should add approximately 5 in. to its stature during the first six months of its life, and another 4 in. during the succeeding six months, and its measurement at birth should be about 20 in. The vitamines in milk are of two kinds-the fat soluble and the water soluble-and the importance of preserving these and the mineral substances, too, in their natural state cannot be overrated. Ever since science devoted some attention to the chemistry of milk we have been unearthing new facts abouts its composition and general properties. Until a few years ago we were ignorant of the existence. of vitamines at all in any foodstuff, and our knowledge of the presence. of such remarkable substances in milk is of a very recent date. To the Russo-Japanese War we are, as a matter of fact, indebted primarily for our knowledge of the existence of such a substance as vitamine. That it is, however, a most remarkable substance, and one endowed

with great health-giving and health-sustaining qualities, is now universally admitted. In proof of this tenet we have but to feed fowls for a lengthened period on polished rice, for fowls thus fed soon show signs of ill-health, and symptoms of a grave character which are referable more especially to derangement of the stomach and bowel and the nervous system. As the vitamines are located on the surface of the rice grain, they are removed by the process known as polishing. That it is the removal of these substances from the rice which is accountable for the derangements to which we have just referred has been demonstrated over and over again, because, if the fowls fed on polished rice are not too grossly affected, they rapidly regain their wonted health if the material removed by the polishing art is added to the polished rice feeds. In dealing, therefore, with the question of the artificial or hand feeding of the infant, the virtues connected with the recently discovered vitamines of milk must be kept ever prominently in mind.

The Chemical Constituents of Milk.

For the building up of our bodies, and the making good the wear and tear of tissues, as well as for the production of physical and mental energy, we require an adequate supply of the three classes of substances known as proteins, carbohydrates and fats, and in mother's milk Nature has carefully provided not only for a due supply of these, but has furnished them in the shape of casein, albumin, sugar and fat in a most easily assimilable form. It is a most remarkable fact that the composition of the milk of various animals-of animals living even upon the same food-is so very different, as a glance at Tables I

TABLE I-INDICATING THE PROPORTION OF THE CONSTITUENTS IN ONE HUNDRED PARTS OF MILK.

TABLE II.-GIVING AN ANALYSIS OF ASH OF MILK AND INDICATING PROPORTION IN ONE THOUSAND PARTS OF MILK OF VARIOUS CONSTITUENTS.

and II will show, and, in spite of the rapid advances of science, it is very noteworthy that we are still as ignorant as ever of the reasons why Nature has thus so carefully provided for the requirements of the young of the different species. It has been assumed that it is because the new-born calf doubles its weight in forty-seven days, that it needs and has been provided with a milk richer in those constituents -proteins and mineral substances, which are more especially tissue builders-than the human infant has, seeing that it takes the new-born human infant 180 days to double its weight. (See Table III.) Quite

TABLE III.-INDICATING GROWTH OF MAMMALS FED ON MILK.

incidentally, however, we may remark that the variation in the amount of fat and sugar in the different milks may in some providential manner be related to the natural climatic conditions of the animal, for in cold regions we find man instinctively adopting a diet rich in fat and poor in sugar, whereas in hot countries he reverses this condition, and adopts a diet rich in starch-which is a sugar-producing substance— and poor in fat.

The infant, moreover, that is breast-fed, besides receiving thus a food which contains all the nutrient materials necessary for its growth and development, secures also certain subsidiary benefits and advantages which must not be overlooked nor lightly brushed aside.

The Physiology of Suckling.

To obtain its food from the breast the infant must exert itself. In doing so it expends a well determined amount of energy which is salutary, salutary in as much as it reduces to a minimum its risk of overfeeding itself, and the effort which it makes brings into play certain co-ordinated movements and actions which stimulate and promote digestion. The milk, too, as drawn from the breast is of the temperature designed by Nature, and is as sterile as possible. Now these subsidiary agencies, trivial and unimportant though they may seem, exert, nevertheless, a very decided influence for good, for they aid in fortifying and preparing the digestive organs for the more

arduous and complicated duties which they are required to fulfil when weaning takes place.

To protect and safeguard in every way the helpless infant is undoubtedly a duty incumbent upon us, for it must be remembered not only that the seeds of disease are easily sown, but that they are exceedingly prone to accumulate, and we know full well that functional derangements of the stomach and bowel engendered during the first nine months of life, in consequence of injudicious artificial feeding, are likely to be a cause of much misery and suffering in later days.

Regularity of feeding is again a matter of great importance, and calls for more than merely a passing notice. Our Local Government Board, in referring to this question,' makes the following promulgation: “The need for regular feeding should also be explained to the expectant mother; if possible, she should be persuaded to accustom the infant from birth onwards to feeding intervals which should not be less than three hours, and the feeding should be entirely intermitted between the period from 10-11 p.m. to 5-6 a.m." Tacked on to this is the further affirmation: "Those who have practised these methods of feeding have found by experience that greatly superior results are obtained than by more frequent feeding." Before condemning or approving of the aforesaid authoritative statement, which means that the infant should not receive more than seven feeds altogether in the twenty-four hours, it is imperative that we should have some clear notion as to how much milk the infant should have in twenty-four hours, also how much milk at a feed the infant is capable of making full use of, and if possible how much milk the mother should be capable of furnishing at each feed. Nature practically resolves the two latter questions into one for us, so we need not trouble ourselves about this maternal part of the problem.

After a most careful scrutiny of facts, I have come to the conclusion that the average infant for the due maintenance of its well-being requires in the twenty-four hours slightly more than 2 oz. of milk for every pound it weighs up to the end of the sixth month. During the first week after birth the infant, because of its altered environmental and nutritional conditions, invariably loses a few ounces in weight, but the child which at birth weighs 7 lb. should ingest in the twenty-four hours 16 oz. of milk, and if it progresses as it ought to, and adds 6 oz. weekly to its weight during the first three months, and

1 See booklet on "Maternity and Child Welfare," published in 1916, p. 24.