In 1893, the Department of Health found that over half the deaths in the city were among infants and children under 6 years. The fault lay in "miasmatic diseases" and "diseases largely due to faulty or imperfect nutrition caused by improper food and feeding." Among deaths attributed to nutrition were 651 from starvation and 378 from "wasting." Agnes Holbrook, a resident of Hull-House, noted the "starved and wan" look of children in the Hull-House neighborhood and Alice Hamilton, another Hull-House woman, reported that Italian children had the highest death rate among the ethnic groups living there. [174]

The field of pediatrics was only beginning to be established, and most physicians treated children as miniature adults. Many childhood diseases went unexamined and deaths were attributed to such ordinary things as teething. Doctors disagreed on the proper feeding of children, especially of infants, but only occasionally admitted the lack of real scientific information on which to base their advice. In terms of nutrition, however, most had begun to acknowledge the special needs of growing children. [175]

Reformers diagnosed two specific problems with the diets of Italian children. First, in an era only just discovering the "specialness" of childhood, Italians continued to feed their children the same foods as adults. Nutritionists objected to children eating the "decayed" fruits and vegetables of their parents, to breakfasts of coffee and butterless bread instead of cooked cereals, and most vehemently to the serving of watered down wine or beer to children. For older children, a flyer from the Department of Health in 1895-1896 advised, "Don't give them rich food--meats, gravies, pastry, cakes, etc.--nor a great variety. The simpler and plainer the better--plenty of milk, whole wheat bread, oatmeal, baked potatoes, baked apples and fruit of all kinds, in season, ripe and fresh." [176]

Winfield S. Hall of Northwestern University Medical School saw a special danger in seasoned foods:

This giving of highly-spiced complex foods and highly-flavored drinks to little children is catering to sense gratification. Eating a thing which tastes good, or drinking a thing because it tastes good, is doing a thing that gratifies the sensual! Mothers, if you begin that way with the child on these simple senses of taste and smell and the flavor of food and drink, what are you going to do fifteen years later when the primordial urge gets into that young person's blood and he looks out upon the world and turns to the right and left for other forms of sense gratification? [177]

For younger children, the Department of Health advised only mother's milk until six to eight months of age:

Up to this time it is a sin to give an infant one morsel of solid food of any kind, or anything but breast milk (if the mother is healthy), except water in very small quantity, occasionally, but never soon after nursing. . . . Many infants are killed every year by bringing them to the table with the family and giving them a little bit of this, that, and the other - meat, vegetables, pie, pickles, etc., which the little stomach is not fitted for.

While illnesses might appear to be caused by other things, the Department concluded, it was food that was the problem. A dietician at the Boston Dispensary reported a diet of too much macaroni, rice, and lentils resulted in constipation, while workers at the Francis E. Clark settlement house in the Italian colony near 22nd Street in Chicago found diarrhea to be a deadly problem. One mother reportedly gave her two-year-old, suffering acute diarrhea, watermelon. Another three-month-old reputedly "starved" to death on a diet of macaroni. [178]

Secondly, and most worrisome of all, was the lack of milk in Italian diets. Rickets, according to the Department of Labor study, affected the "future workingman because while children might outgrow the disease, they would never attain the greatest vigor of manhood." The study found only about a half-cent a day spent on milk for individuals in Italian families (while the average family spent eleven cents a day on beer). One hundred six cases of rickets were counted among 1,448 individuals and rickets was deemed "exceedingly prevalent" among Italian children. [179]

Rickets, generally a disease of infancy and childhood can result in defective bone growth. Dr. Isaac Abt, a pioneer in pediatric medicine described his experience with rickets in his Chicago practice:

During the early days of my practice I saw one child after another who had grotesquely twisted legs or a thorax so deformed as to limit his chest motion. Some children had rickets of the skull; their bones were like parchment. In others the disease was associated with tetany, and the suffers had spasmodic contractions of the hands and feet. . . . The rachitic child suffered from general weakness and poor resistance, and was subject to internal disorders. Some developed bronchitis and gastrointestinal diseases.

Until Vitamin D was shown to be a factor in rickets in 1917, physicians could only rely on their own observations to suggest preventives and treatment. Observing that rickets occurred frequently among children living in dark and unhygienic homes and improved with visits to the seashore, some doctors concluded that the sea or even the sand was beneficial. Few made the connection with sunlight. However, the connection between lack of milk and rickets had begun to be recognized. [180]

Nutritionists and reformers anxious to convince mothers of the benefits of milk faced a tough battle. Not only was milk culturally not a part of Italian diets, but the milk sold in their neighborhoods was far from being a safe and healthy product. Impure milk was believed to be a factor in a devastating childhood disease that stalked the city each summer. Dr. Abt described the problem,

The summer months were the worst. Infant mortality throughout the United States was three times as great in summer as in winter. Infant asylums all over the world were showing a death rate that came close to 100 per cent. There was talk of closing such institutions. In New York and Aboton, doctors tried to save lives by placing children on boats and keeping them out on the water during heat waves. In Chicago, we built children's sanatoria on the lake front. Still there was no abatement of the dread 'summer complaint,' that group of digestive disturbances which generations of doctors had not been able to cure or prevent.

I could easily foresee what I would find when I went to the clinic on a hot day. My first patient would be an infant who looked like a bundle of rags hung on small, fragile sticks, something less human than a scarecrow. His skin would lie in loose folds over the body; when I squeezed it, it would retain the impression of my fingers, like a rubber ball that had lost its resilience. The eyes would be sunken and the mouth cold. This condition had been termed infantile atrophy, athrepsia, and decomposition, among other names; but whatever it was called, it represented the final result of starvation and dehydration, caused by vomiting and diarrhea.

Impure milk or milk not kept sufficiently cool were believed to contribute to summer complaint. Doctors found fewer cases when children were breast-fed and residents of the Clark Street settlement attacked "that death-dealing device, a long rubber tube attached to a pop bottle" and cleaned with a "dirty chicken feather" used by Italian women with no time to hold a proper bottle. [181]

In 1892, influenced by the popularity of the germ theory of disease and the city's long running problem with the healthfulness and purity of its milk, a Bureau of Milk Inspection was created, and in 1893, a municipal laboratory opened for the bacteriological examination of milk samples. The Bureau's mission was to help "that factor of the population which depends so largely upon milk for nutrition, and which suffers so much from disease and premature death caused by an impure, unfit and adulterated article." In other words, children. Seventy-five percent of the first samples taken were below the standards set by the Bureau, and suffered from lack of freshness (time between milking and delivery was between 24-36 hours) and impurity, caused by adulteration by city dealers. Swill milk, from cows fed on the slops of local distilleries continued to be a problem. As the city grew, more milk came from "invisible" outside sources and Dr. Gehrmann, head of the milk and food department of the Board of Health blamed distant country dairies for sick cows fed on improper foods and milked in unsanitary conditions. Dr. Abt explained the added problem of tuberculous:

Most milk that Chicagoans were drinking was dirty and germ-laden. Naturally. The barns and milkers were dirty; many cows were tuberculous. Later, as neighboring states enacted legislation making the tuberculin test mandatory, infected cattle were promptly shipped into Illinois, where there were no laws to protect the people. Ordinances designed to improve conditions were passed with difficulty and repealed with ease." [182]

Settlement houses became distributing centers for clean milk when Northwestern Settlement opened a sterilization and pasteurization plant in 1897. Hull-House acknowledged a neighborhood danger by encouraging Italian mothers whose children suffered from rickets to come to the settlement for treatments consisting of baths and massages and the next year, the settlement assisted in a study which revealed adulterated milk far below accepted quality standards. In 1903, the Children's Hospital Society established a Milk Commission composed of doctors, philanthropists, reformers, and members of the Chicago Women's Club. New York businessman and philanthropist Nathan Strauss equipped a plant for pasteurized milk at the Thomas Haynes School and 23 distribution stations were soon in operation. Milk stations sold pasteurized and sterilized milk as well as formulae. At Hull-House, milk sold for a penny a glass from a 100-gallon tank located in the playground. By 1906, they were selling 63,000 bottles of milk a year to the surrounding neighborhood. In 1909, Chicago became the first city in the United States to adopt compulsory milk pasteurization legislation. [183]

Distribution of milk remained a problem in Italian neighborhoods. Italian-owned dairies were scarce, and any milk company that expected to do any business in an Italian neighborhood would need an Italian milkman. As Leonard Giuliano, who was born in Chicago in 1914, explained:

. . . home delivery of milk had to be, in an Italian neighborhood, an Italian. Most Italians did not believe in drinking milk, to begin with, or feeding it to their children. . . . Now, it was quite a task for the Italian milkman to be a success in an Italian neighborhood. . . . Can you imagine another nationality coming in there and trying to sell milk? Impossible, because he could not communicate. . . . These big companies recognized that in order for them to be a success in selling product, their products, they had to have an Italian representative or it could never be sold and being a milkman in those early days was quite a monumental task. Not only did you deliver this by hand and in a wagon with a horse, in the winter months, you kept the kerosene stove going in the wagon, so that the milk wouldn't freeze. . . . [184]

Keeping milk cold was an issue in neighborhoods with few ice boxes and in 1903, when the city council recognized the severe lack of ice among the poor, it voted funds for ice distribution. Money, however, proved unavailable and the council suggested donations be made to the Chicago Tribune's ice fund, which distributed tickets for free and at-cost ice from milk stations and settlement houses in the city. The wagons to transport the ice were donated, ironically, by the Knickerbocker Ice Company, which had initially helped to drive up prices beyond the reach of poorer consumers. [185]

Infant welfare campaigns were carried out during the summer months to treat sick children and educate mothers in proper feeding and storage of food. In 1893, the Department of Health issued circulars on the care of babies during hot weather and was soon sending doctors to congested neighborhoods during the summer months. In 1909, the Francis Clark Settlement was a reporting center for the Baby Welfare Campaign sponsored by the Health Department, United Charities, the VNA, and the Milk Commission. A woman doctor, nurse, and house-to?house visitor combed the predominantly Italian area between 15th to 26th Streets and State to Halsted Streets examining children and giving out information on their care. Mothers looking for advice on feeding babies could go to the Chicago Commons Settlement House in the Italian community

With improved milk and healthcare, incidences of summer complaint lessened but results among the Italian population were slow in coming. In 1922, reformer Lucy Gillett noted that, "No milk, and too much coffee and candy are the greatest factors of the nutrition problem of the malnourished Italian children." And despite vigorous reform efforts the Madonna Center, which served Italian immigrants on the Near West Side saw improvement but still reported a "disturbing number of vitamin deficiencies" and children "whose teeth fall out when the dentist examines them." [188]

Advances in nutritional information, especially the discovery of vitamins in 1911, vindicated some Italian dietary practices. Vegetables and fruits were no longer considered incidental but central to a healthy diet, and doctors slowly acknowledged the suitability of solid foods for young children at an earlier date. Recalling her days as a physician at Hull-House, Alice Hamilton later wrote:

Then I gave what I had been taught was the best advice about feeding babies--nothing but milk till their teeth came. When I see the varied diet modern mothers give their babies, anything apparently from bacon to bananas, I realize that those Italian women knew what a body needed far better than my Ann Arbor professor did. I cannot feel I did any harm, however, for my teachings had no effect. I remember a young mother who had brought her baby to me, showing me her fine specimen of a three-year-old son, and telling me of his difficulties when he was a baby. 'I gave him the breast and there was plenty of milk, but he cried all the time. Then one day I was frying eggs and just to make him stop I gave him one and it went fine. The next day I was making cup cakes and as soon as they were cool I gave him one, and after that I gave him just whatever we had and he got fat and didn't cry any more. So now when I see an Italian baby sucking a slice of salami I feel quite serene. Garlic, we are told, is full of most valuable vitamins and salami is full of garlic.

Slow results among Italians over the issue of milk, however, convinced some reformers that the problem was not their own advice but the intransigence of Italian mothers who ignored nutritional information for an unhealthy diet based on tradition and habit. [189]