It was shown that there is a great lack of uniformity of action in the several institutions, and for this reason the data collected were difficult of comparison.

While the general object of all the depots from which data were received is the protection of infant life, there is difficulty in determining in every instance whether it is the endeavor to accomplish this by meeting the purely hygienic needs of infants or by simply relieving the distress brought about by poverty.

Poverty is undoubtedly a most important factor in the production of infant morbidity, and in consequence imposes additional responsibilities on communities in which it exists. In meeting these responsibilities milk has been provided by charitable organizations and others, as well as by regular milk dispensaries.

Desirable as it would be to ascertain all the avenues through which milk is furnished to needy infants and the number thus supplied, it has been found to be impracticable thus far to do so. There are undoubtedly many organizations which furnish both milk and instructions to families in connection with other philanthropic work; but the facts regarding such organizations are not at hand, and, if they were, would not properly be comparable with those from infants' milk depots, which are established to fulfill a specific function and operated under medical supervision.

With the view to securing further data from these latter institutions, blanks were used similar to those in the previous compilation, the questions contained therein having been formulated by a committee of the American Association of Medical Milk Commissions, the members being Drs. H. L. Coit, Roland Freeman, and the writer.

Every effort has been made to secure data from all the institutions engaged in dispensing milk under medical supervision to infants. As was the case in the previous compilations, however, it has been impossible to secure data from all of the known institutions and this accounts for the lack of reference to several of the more important ones that are mentioned in previous reports.

It is desired here to acknowledge the assistance of those who furnished data. Without such assistance this report would be impossible, and it is a matter of regret that lack of space prevents individual mention of those to whom credit is due.

Data were received from 43 institutions located in 30 cities. In addition, communications were received from health authorities regarding general measures for the protection of infant life, one of these, for example, being from Dr. J. S. Neff, director of public health and charities, regarding the conference on summer work for mothers and infants in Philadelphia. This conference adopted resolutions providing for a plan of coordination and cooperation with that department of all existing agencies, including day nurseries, settlements, and neighborhood social-betterment agencies having facilities such as baths, camps mothers' clubs, milk stations, etc., agencies providing temporary shelter for mothers and children, modified-milk stations, and hospitals and dispensaries. From this the wide field of operations is apparent, some of them being carried on in regular milk depots.

The following is a list of all institutions from which data were received, their objects, methods of operation, and means of mainte

nance.

The data contained in the following tables relate to the calendar year 1910, except where otherwise specified:

Clinic for infant feed- Proper feeding of infants. Through feeding clinics,

By voluntary contributions, donation days, and aid of Providence Medical Association.

By private donations, assisted by St. Louis Provident Association.

Modified milk supplied by the milk commission.

By efforts of board of trustees and directors of hospital.

Objects of the institutions.-Thirty of the institutions mentioned in the above list furnished similar data for previous reports. Four of the 12 remaining institutions are located in cities not previously mentioned, viz, Honolulu, Indianapolis, Milwaukee, Wis., and Springfield, Ohio, and the objects of all are the prevention of infant morbidity and mortality.

Operation of institutions. The work was carried on either through milk stations, hospitals or medical dispensaries, milk station on farm with substations, or dispensing of milk in the homes on physicians' prescriptions or nurses' orders. In addition to dispensing milk, a large number gave particular attention to house visits, clinics, conferences, or lectures, and some, such as the Babies' Dispensary and Hospital at Cleveland, actually conducted outdoor wards or summer camps; educational measures being made an important feature of the work. In certain cities, for instance, New York, Chicago, St. Louis, and Washington, substations were maintained in connection with central depots, thus enlarging the field of operations in those cities. In St. Louis, as will be seen, one institution operates in connection with the Pure Milk Commission, and, in so far as relates to milk distribution, is probably in reality a substation. The same is true in Washington, the Nathan Straus Milk Laboratory having supplied milk through six substations, two of which were located at Neighborhood House and Noel House. The milk stations at these latter institutions are maintained, however, by the Washington Diet Kitchen,

and the milk depot at Neighborhood House is operated by the Infants' and Children's Dispensary, the milk being dispensed under the direction of the physician associated with the dispensary. This work was begun in April, 1908, and has been continued since that time. The Instructive Visiting Nurses' Society of the District of Columbia is also intimately associated with the above institutions, in reality furnishing the nursing staff of the milk stations. The arrangement as outlined represents very well the character of cooperation rendered by charitable organizations, not only in Washington, but in other cities.

How maintained.-Twenty-nine of the institutions were stated to be maintained by private means, one partly by private means and partly by public appropriations. No information was forwarded on this point regarding the 11 remaining institutions. One of these, which is in Rochester, is believed to be maintained by the health department. New York and Pittsburg are the only other cities known that provided funds for the carrying on of such work.

The following table contains an analysis of the data received regarding measures taken for the education of mothers in infant hygiene, those who gave the instructions, and where given: