one of the children's hospitals. In most parts of the city mlik depots have been arranged so that the poor can get pure milk at a nominal price.

MR. ROBERTSON: I would like to state that as far as Toronto is concerned we have the Burnside Maternity Home or Hospital, built with the moneys granted by a Dr. Burnside who lived here 75 or 80 years ago. Of course, in other hospitals there is plenty of private maternity work, and there are also private homes where maternity work is done; but I think I am fairly safe in saying that there is no such annex or no such arrangement in regard to the visiting of nurses as has been suggested in the paper of Mr. Bruère or referred to in Dr. Hurd's remarks. In regard to the question of milk in connection with children's hospitals, I want to say I have been very much impressed with the work that has been done in the United States. A year ago I proposed to establish in connection with the Hospital for Sick Children a milk depot where proper food and proper sterilized milk should be supplied to mothers; in fact, where we could prepare food and give advice to the mothers on the line suggested by Mr. Bruère. We contemplate a new wing for our building when some millionaire comes alonghe is not in sight yet—and we propose that part of that new wing shall be devoted to a milk depot. At the present time I believe there is a milk depot for the sale of ordinary milk that is taken from good, clean dairies in or near Toronto, but I think its work is somewhat limited. There is, however, no organization in the Dominion that equals the organization that exists in some of the large cities of the United States.

DR. ALICE M. SEABROOKE: I want to tell you what has been done in Philadelphia. A newspaper there, "The Press," took up the matter some years ago, and started the sterilized milk depots. The women's hospital has one of the largest depots, handling 8,000 or 9,000 bottles per month. There are different formulas of pasteurized milk. It is furnished for a penny a bottle to those who can pay; those who cannot pay receive it free. Of course, the cases are investigated before we give it to them without charge. Our dispensary take scharge of this depot, and the nurses in charge handle the milk.

MR. BRUERE: There is no better way to increase infant mortality than to encourage bottle feeding by too eager distribution of modified milk. There is no better way to obstruct the campaign for clean milk than to undersell the dealer. In the spring the New York Milk Committee opened seven depots for the purpose of determining the comparative value of modified raw and of pasteurized milk. At the end of the season the balance of credit to the two kinds of milk was precisely equal. It was found that while clean milk is an

essential part of the campaign for the reduction of infant mortality, modified milk must in all cases be used like any other medicineonly upon the prescription of a physician. The most important factor in the reduction of infant mortality is education and the encouragement of breast feeding.

If we are to induce milk companies to produce and sell, under sanitary conditions, a cheap, clean milk, the price which we set upon it must invariably be dictated by the terms of fair business competition. Never should milk be sold below cost or at less than a fair profit. Should those in control of the supply wish to set aside any or all of their earnings for the benefit of their patrons, they should do so not in such a way that the milk dealer whose livelihood depends upon each dollar of profit would be injured. but in actual cash contributions for relief, to be administered by an efficient and discriminating relief agency. The right to do what they will with their earnings is obvious, but philanthropists have no right, by selling below cost or below a fair profit, to injure legitimate business by bidding for the regular dealer's customers on terms which the dealer cannot meet. To attempt to solve the milk problem without taking the dealer into account is folly. To attempt to solve it by destroying the dealer is to foster all those vices of the trade which militate against a pure, safe supply.

MISS MAUD BANFIELD, Philadelphia: I feel as if we get hold of this dispensary question entirely at the wrong end. In the hospital with which I am connected we have an average of between 150,000 and 200,000 dispensary visits in a year, and between 4000 and 8000 who are treated at their homes, depending on the season of the year. I have been acquainted with this work a good many years. While human nature is what it is we shall constantly have this question of dispensary abuse. Jacob Riis says that Charity is not alms, but it is justice, and when I see hundreds of those dispensary patients come in I feel that the abuse is not on the side of the patients only, when we have, printed on every dispensary card, and stuck up over the doors in large letters, "Medical advice free to the poor only." We cannot get away from the fact that hospitals should be kind. Many of those people who come to us are the bread-winners of the family. They have paid what they call their "Family Physicians" down in the slums. I don't think the most eminent men settle in the slums as physicians. Those people tell you they have paid their physicians as long as they had any money, but they did not seem to do them any good, and now their money is gone. I have heard that reply so often that I almost hear it in my sleep. It seems to me it would be better economy to consider the health of the community as an asset, and make those workers well as soon as we could. The U. S. Labor Bureau at Washington says that it costs, on the average, $1000 to bring a

man to maturity. It does not say anything about women; it does not seem to count them, and we know it is not quite so expensive. At any rate, I suppose we can average it up. I believe if a woman's husband gets run over by a railroad, and she has a political pull she may get as much as $5000.00 damages; so that when they get to be real breadwinners and husbands they should be worth more than $1000 to the community. Surely it is better to make that man well as fast as we can and let him keep his own family instead of forcing him to break up his home and put his children in institutions where they are supported by the ratepayers and public generally. We know it happens dozens of times. It happens so often that we get positively tired of it. The more respectable poor can have their feelings hurt too. You think their clothes look too good; it is about all you have to judge by. A woman has a good coat and a hat more or less in style, and you say, "You don't look like a charity patient." The clothes that they have are often given to them, and a woman who has been better off will do everything she knows how to brush up and keep neat. A man does not care so much about personal appearance. They look poor and ragged, and there is a great deal of spirit taken out of them. They have had the wrong diagnosis. They have gone to the physicians in their neighborhood, the only men whose fees they could afford. They may have had a broken arm and have had it set badly. They may have had a bad stomach trouble. Not infrequently they may believe they have cancer of the stomach and never will be well, when they have nothing of the sort. There are hundreds and hundreds of that sort of cases, You may send them out cured, but meantime they have lost all their savings, they have broken up their home, the mother has gone out washing and the children have been distributed. To buy their furniture back again is a work of years, if they can do it at all. You have broken that man's self-respect. You have taken away what very likely you will not take any trouble to give him back. I do not think it is kind; I do not think it is justice. It may be what we call charity, but it is not just. Of course, we want to be just to the physician; we want to be just all around; but I do believe the time will come when you will pay your physicians, pay them well, pay them a living wage, if you have got it, and if not you will just travel around and get it. Give them $4000 or $5000 a year. Pay the young men less, but promote them for merit, and have enough of them. With the dispensary system as it is I suggest that you first want a good doctor. Let the patients be properly treated. We doubt those who are hysterical by letting them be demonstrated by students. I know that patients can be demonstrated with entire and proper decency and self-respect to the patient and the physician. They do not mind that. The most

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respectable poor are willing to earn their treament in that way, but it really does go to one's heart to have patients turned down and hear about this everlasting dispensary abuse. The patients have no one to speak for them. They don't come to this Association, they do not go to the doctors except to be demonstrated. Now, the younger men say, how are they to live? Let them both live and learn. A young poet read a poem, a pretty bad one, to Talleyrand, and when Talleyrand objected the young man said, "But we must live," and Talleyrand replied, "I do not see the necessity." Privately, I feel the same way sometimes. I do not always see the necessity of supporting these young men who do not know enough to write a piece of poetry and are not willing to learn. None of us are bored with too much knowledge, but we try to acquire it. You know how, when you are sick, you are apt to lose your spirits. You kno how the most independent of us when we get tired and ill, lose our energy, and e have not energy to fight. A man will fight for his family, but he does not retain the family very long if he is really sick. By all means the doctors ought to be paid, all workers should be paid what their labor is worth; but I don't think that you should go through all this questioning of patients, because with the greatest care exercised you cannot fail to hurt just those that I think you would feel less willing to hurt if you only knew them.

DR. FREDERIC A. WASHBURN: I am very glad to hear what Miss Banfield has said. I purposely avoided in the discussion of my paper the abuse of charity. I found myself practically alone when I took that stand at one time. I have admitted patients to the out-patient department. I have asked a man who appeared well dressed something about his financial condition, and his reply would be: "You ask me that because I have got on a respectable suit of clothes and am clean; if I was that dirty man in front of men you would not have sai da word to me." There is a great deal of truth in it. What Miss Banfield said about the women impressed itself on me particularly. Women will come with neat appearance and good clothes, but when you question them you will find they have put every dollar they possess on their backs. It is very hard in this matter, as in most questions in this world to reach a point of abstract justice. We must be just to the doctors; we must be just to the hospital, and we must be just to the patients, and that more and more emphasizes the importance of having a medical man question these patients-a man who has tact, human kindness and justice.

DR. HURD: I think there is another point also that ought to be considered; that is the great majority of our dispensaries cover too much territory. It is very difficult for such a dispensary as the one attached to the Massachusetts General Hospital to make

an investigation of the different people who come there. Take the dispensary with which I am familiar, our tuberculosis dispensary, where one-third of all the tubercular patients of the city come. The result is that it is well night impossible to make a proper investigation of the financial condition of such persons, or to do justice to those who require temporary consideration, even if they are not downright poor. It seems to me the great means of relief in all those questions should be the restriction of all these dispensaries to a limited district so that that district may be known and its conditions thoroughly investigated by competent investigators. If a dispensary is open to all the inhabitants of a city like Philadelphia or Chicago you cannot help having abuses, and you cannot help doing a certain degree of injustice.

REV. DR. KAVANAGH: This discussion and the papers have been exceedingly profitable, and I am in hopes that our report may come out soon so that those papers will be in our hands. There is a scientific aspect to the subject that looks severe upon the face of it. We have listened to one or two of those papers without looking at the other side of the question-an analysis of the paper, an analysis of hose that come. They seemed to us severe. I am glad Miss Banfield has sounded the note and that it has been seconded by Dr. Washburn; for good clothes do not tell the whole story, and poor clothes do not tell the whole story. I have known some to rig up in poor clothes to get in. On the other hand, I have great respect for the woman who will try to buy the best clothes that she can, and reject as long as she can the position of a pauper in the community. So that while some borrow clohtes, and some secure clothes as donations, I have a good deal of respect for the woman who will put some of the little money she gets into respectable clothes for the appearance of things, and I will not hastily or readily condemn her. I believe that the greatest gentleness and kindness should meet these classes at the door. We can afford to make mistakes a great many times on the right side, on the Christ side, the charity side, the Good Samaritan side, but we cannot afford to make mistakes that will injure anyone if they can be avoided. I would not put a physician at the door to receive them, unless I knew the physician very well, and knew he was a man with tender heart. I would put a common sense kindly woman at the door. For that reason my registrar is a Deaconess. She is in touch with the hospital, in touch with the physicians and she has sympathy for the patients that come. A careful examination is made from the woman's standpoint of those who come to the door. All these papers have been excellent, and will do us good to study when we leave here, but I am glad that the other note has received emphasis.