Milk: Mother’s Medicine or “White Poison”

Contemporary medical and scientific discourse reflects the paramount importance placed on breastfeeding.7Cheadle, On the Principles and Exact Conditions to be Observed in the Artificial Feeding of Infants; Sadler, Infant Feeding by Artificial Means; Cautley, The Natural and Artificial Methods of Feeding Infants and Young Children; Vincent, The Nutrition of the Infant; and Fordyce, Diet in Infancy. Sir William O. Priestley, a consulting physician to King’s College Hospital in London, argued that the mother’s milk was the most important part of an infant’s diet. If it was not possible for the mother to nurse her child, Priestley argued that a wet nurse should be employed instead; he decried bottle-feeding as practically sinful. Yet he feared that many working-class British mothers lacked this knowledge. As a result, mothers were unwittingly raising the “degenerates” that Cantlie and others feared. According to Priestley:

Contemporary biochemistry also made a compelling case for the importance of breastfeeding. As early as the 1870s, British epidemiologists had discovered that milk, especially when adulterated with contaminated water, could be the vector for serious and widespread epidemic disease.9Steere-Williams, “Milking Science for Its Worth,” 265. In an 1884 quantitative study of the nutritional value of milk, Philadelphia-based chemist Arthur V. Meigs compared cow’s milk and human milk and found that human milk was less watery than cow’s milk and contained more sugar, both of which made it more digestible for infants. The respective fat content, which was important for the infant’s skeletal development, was nearly the same. However, he also observed that the higher volume of casein (the major protein in milk) in cow’s milk made it more difficult to digest than human milk. To make cow’s milk consumable required dilution of the casein with limewater and the addition of cream to increase the fat content and the amount of milk sugar (lactose).10Meigs, “Proof that Human Milk Contains only about One Per Cent Casein,” 219–23; Apple, Mothers and Medicine, 7–8. By the first decade of the twentieth century, however, German physicians determined that boiling cow’s milk broke down and altered the casein into a more digestible form, making it a viable, if far from ideal, source of nutrition for infants.11Apple, Mothers and Medicine, 37.

Meanwhile, an international group of chemists and physiologists working with medical doctors also began to develop a “science of nutrition” that sought to calculate social efficiency and physical and mental productivity as a function of dietary health.12This research continued well into the twentieth century, especially with regards to the importance of vitamins, as described in the essays collected in Smith, Nutrition in Britain. Milk, by the early twentieth century, was deemed “the most important ‘protective food’” for developing children.13Hamill, “Diet in Relation to Normal Nutrition,” 29. According to J.M. Hamill, a Medical Officer of Health working directly for the Ministry of Health, milk was “eminently suitable for the young where growth is rapid and the demands of the tissues for . . . protein is urgent.”14Hamill, “Diet in Relation to Normal Nutrition,” 13. But in the late Victorian years, children’s diets were especially lacking, and legislation focused only on controlling milk’s adulteration.15Weatherall, “Bread and Newspapers,” 180. This became a major focus of ongoing calls for social and public health reform. When Charles Booth and, later, Seebohm Rowntree surveyed poor families, asking them to record the quantity, character, and cost of their consumption, food historian James Vernon notes that Booth and Rowntree heaped praise on “those who kept a clean, sanitary house and budgeted well enough to provide good meals, while gloomy admonishment hung over those less adept.”16Vernon, Hunger, 83–86.

As part of a wider campaign for social reform, promoting the best infant feeding practices became a project for the Medical Officers of Health. Ideally, this meant encouraging more mothers to practice breastfeeding, and to do so for as long as possible. Even early weaning could bring “flies into the ecology of infant feeding,” according to historian of entomology Dawn Day Biehler.17Biehler, Pests in the City, 48. For those mothers who could not breastfeed, bottle-feeding was accepted as a necessary, if sorry, substitute. In these cases, it fell to the Medical Officers of Health and their staff to emphasize the importance of safely storing and frequently refreshing milk supplies. These efforts began through pamphleteering campaigns, but ultimately required the aid of health visitors to really be successful.

The key to the safe use of cow’s milk was to prevent its contamination. The Medical Officers of Health advised mothers who relied on animal milk to acquire fresh milk daily, if not twice daily, and to ensure that they stored milk supplies in a clean basin that protected it from dust and insects. Arthur Newsholme reported in 1903 that cow’s milk is “seldom pathogenic” immediately after milking, but that it had numerous opportunities to become infected en route to the baby’s stomach. Newsholme asserted that contamination of milk occurred most commonly in the home, disputing the claims of Swiss-born, University of Manchester bacteriologist Sheridan Delépine, who believed that contamination occurred in transit from farm to city.18Newsholme, “Remarks on the Causation of Epidemic Diarrhea,” 34–40. Leading authorities in childhood health like George Newman, who served as the Medical Officer of Health for the Borough of Finsbury in London (1900–1907), Chief Medical Officer of the Board of Education (1907–19) and later Chief Medical Officer to the Ministry of Health (1919–35), agreed with Newsholme.19Newman, The Health of the State, 130.

Beyond warning that artificial (cow’s or condensed) milk supplies were susceptible to contamination by flies, Newsholme further lamented “the foul condition of feeding-bottles,” particularly long-tube feeding bottles, which were easy to use but difficult to keep clean, as another common cause of contamination.20Newsholme, “Remarks on the Causation of Epidemic Diarrhea,” 40. Newsholme was not alone in his condemnation of bottle-feeding. His predecessors had, for decades, warned of the perceived dangers that resulted when the “slovenly mother” or the “careless nurse” allowed their child or charge to “fall victim to the feeding-bottle.” One Medical Officer of Health from Alnwick and Cannongate described the feeding bottle as an “utter abomination” that too often contained “milky stuff . . . utterly unfit for the child’s stomach.” He continued, graphically, by explaining that “one of the most miserably painful sights that meets the eyes of medical men is that of a little child gradually wasting away to a skeleton, owing to improper feeding.”21“Infantile Mortality,” The British Medical Journal (May 13, 1882): 712.

Keeping milk supplies clean and safe in turn became a major public health project, but once again one that began at the local level, often under the administration of the Medical Officers of Health.22George Newman would define a clean, healthy milk supply as “(a) derived from healthy cows, guaranteed free from tuberculosis by the tuberculin test, and living under clean and sanitary conditions; (b) obtained by clean methods of milking, strained, and protected from contamination and from infection; (c) kept cool by means of refrigeration; and (d) not exposed to dust or uncleanliness in any way from the cow, the milker, from the vessel in which it is placed, or from the persons by whom it is handled” (Whitelegge and Newman, Hygiene and Public Health, 149). The Medical Officers of Health in our three cities took this project very seriously. In Manchester, James Niven argued that milk must be “given without fail” to children until the age of three, but that milk should “always be boiled, cooled, and kept in a cool place” to prevent contamination.23Niven, “Feeding in Relation to the Health of the Young,” 12. According to the handbill Niven distributed in 1894, “infants should, whenever it is at all possible, be fed at the breast for a period of six months at least; but if that cannot be done, for as long a period as may be. Breast milk is, almost always, much more wholesome for an infant than cow’s milk.” Niven’s handbill also provided advice for the mothers themselves. While nursing, she should “partake only of plain and wholesome food, avoiding intoxicating drinks such as spirits and beer.” If a mother absolutely could not feed her child at the breast, then cow’s milk – while a poor substitute – could be prepared safely and serve as an acceptable substitute for the child’s development. But cow’s milk required careful preparation: “half a pint of good fresh milk and one pint of water, with a small teaspoonful of white sugar, are mixed and boiled and then placed in a clean jug, covered with a clean cloth. Four tablespoonfuls of this should be placed in the feeding bottle each time it is used, and after each time the child is fed the bottle should be cleaned, or a clean one used.”24Niven, Report on the Health of Greater Manchester, 1894, 121. Niven also emphasized the importance of using clean feeding bottles for those mothers using cow’s milk, in order to reduce the incidence of summer diarrhea.

But for many working-class mothers, regularly resupplying with fresh cow’s milk was often difficult (to say nothing of cost-prohibitive). So, they often instead relied on longer-lasting condensed milk instead. From a public health perspective, this was even worse for their children. Cans were often left open and the high sugar content made the condensed milk particularly attractive to flies, especially in hot weather.25Fildes, “Infant Feeding Practices and Infant Mortality in England,” 269. Nutritionists also generally believed condensed milk was a particularly sorry substitute for breast milk because it was “deficient in fat, low in protein, lacked freshness and had an excessive sugar content.”26Bryder, “From Breast to Bottle,” 54. Thus, dried milk was often recommended because it could be produced safely and in a sterile environment, and it was typically sold in resealable tins or cartons.27Fildes, “Infant Feeding Practices and Infant Mortality in England,” 271.

By the turn of the century, some municipal authorities began to establish milk depots to provide mothers with regular access to fresh milk at low cost.28Mepham, “Humanizing Milk,” 239. The first British milk depot was established and financed in St. Helens in 1899, which sought to provide sterilized and pasteurized milk at subsidized prices to poor English mothers (1s 6d per week for children under six months; 2s for those six to twelve months; and 2s 6d for those over one year of age).29Atkins, “White Poison,” 223; Savage, Milk and Public Health, 355–56. Mothers who were not able to breastfeed could receive bottles of good-quality milk weekly to make infant feeding “a very simple matter.” According to G.F. McCleary, the Medical Officer of Health for Battersea, “when feeding time arrives all she has to do is to place the bottle, unopened, in a basin of warm water until it reaches body temperature, to open the bottle, put on a rubber teat supplied at the depot and feed the baby from the sterilized bottle direct.”30McCleary, “The Infants’ Milk Depot,” 338. Liverpool established the largest milk depot in the country in 1901, which supplied over 16,000 children with high-quality milk by the end of the year 1909.31Savage, Milk and Public Health, 358. While we must not attribute improvement in the infant mortality rates to any singular cause, as historian Valerie Fildes suggests, the impact of milk depots “must have had a positive effect.”32Fildes, “Infant Feeding Practices and Infant Mortality in England,” 270. We see this, for example, in the regular decline in Liverpool’s infant mortality rates after 1901.

While some doctors expressed concerns that expanding milk depots would disincentivize breastfeeding, which would undermine their goal of improving children’s health, milk depots often served multiple purposes. In Liverpool, the milk depot did more than just provide food for infants. It provided a point of contact to connect mothers to the broader system of public health. Mothers were encouraged to bring their infants to the milk depot for weighing once per fortnight, and health visitors routinely called at the homes of infants whose milk came from the depots.33Dwork, War Is Good for Babies, 104.

John F.J. Sykes, the Medical Officer of Health for St. Pancras, criticized the development of private milk depots for providing a cheap source of milk without also providing basic education in nutrition to British mothers.34Lewis, The Politics of Motherhood, 96. Rather, Sykes argued that municipal resources should be spent on “Schools for Mothers,” which would be managed directly by a Medical Officer of Health and provide advice on infant feeding and hygiene. Sykes co-founded the St. Pancras School for Mothers in 1907 with Alys Russell and Dora Bunting. It would become a model for other infant welfare centers.35Rowold, “‘If We Are to Believe the Psychologists,” 64. At the St. Pancras School for Mothers, which repurposed a private milk depot into a public infant welfare center, babies were weighed and examined by medical staff, and mothers received medical “advice as to the care of their children.”36Hill, “The Protection of Infant and Child Life,” 14. Mothers were also given advice on cooking, clothing their child (they were told to avoid combustible flannelette, although little came of this as it was the cheapest material available), sleeping arrangements (they were taught the importance of separate cots for each baby to prevent deaths of sleeping babies due to suffocation from one child rolling onto another), and the right frequency of outings and baths for their child. The staff at St. Pancras also taught lessons on home hygiene and educated mothers about the relationship between dirt and infant mortality.37Lewis, The Politics of Motherhood, 97; Davin, Growing Up Poor, 19. Lastly, at infant welfare centers mothers could still purchase milk for infants at low cost.38Hill, “The Protection of Infant and Child Life,” 14.

Systems developed to promote education in mothercraft included the dissemination of pamphlets, the establishment of milk depots which provided cheap milk for those mothers who were not able to breastfeed, and the creation of schools for mothers. But aware that many of the greatest dangers to infantile health existed within the home, many Medical Officers of Health, including explicitly Hope in Liverpool and Niven in Manchester, believed that these non-domestic interventions were insufficient to seriously improve infant mortality rates. Like Newman in London and Newsholme in Brighton, the Medical Officers of Health in Birmingham, Liverpool, and Manchester took up the task of ensuring British children were safely fed through expanding maternal education inside the domestic sphere. Many mothers, especially working-class mothers, could not attend classes at the centers. Thus, the appointment of municipal health visitors to provide in-home observation and education became a critical component of infant care, which in turn represented an expansion both of the scope of late Victorian public health and of the power of the municipal state to influence the private lives of individual mothers and families through class- and gender-based social surveillance.