Arch Dis Child: first published as 10.1136/adc.23.115.149 on 1 September 1948. Downloaded from MILK: A EUROPEAN CHILD HEALTH PROBLEM* BY HENRY F. HELMHOLZ Chief Medical Consultant, United Nations International Children's Emergency Fund It is indeed a great honour to have been invited The Idel Milk Supply to give the first Windennere Lecture, and it is a Leaving out of account for the moment the fact strange coincidence that I should have selected a that the ideal milk for the infant is breast milk, we topic that is so closely related to the generous donor can define the ideal milk supply as one that is of the Windermere Lectureship. My reason for hygienically produced, that can be delivered to the selection of ' Milk: A European Child Health home of the consumer in a sterile condition, that Problem' for presentation to your Association is will keep for a protacted penod of tme, in conD- that I think the paediatricians of Europe can play tainers of a size that approximates to the im iate needs of the user, that can be converted into the a much more important r6le in obtaining a safe appropriate feeding mixture with a minimum of pure milk supply for the children of Europe than effort and utensils, and that can be produced at they have in the past. Before the World War a cost that does not preclude its use. 1939-45, the milk supply of Europe was qualitatively inadequate, and the war has rendered it also quanti- Milk Pwd Protected by copyright. tatively ipadequate. If the present milk production In table 1 is given the total milk production of can be properly developed it should result in a European countries in 193rand in 1946, the con- much improved supply, possibly an ideal supply of sumption of milk for the feeding of calves, the cows' milk for infants and children in Europe. human consumption of liquid milk, and the amount of milk used in the manufacture of butter and cheese. There are a number of figures to which * The Fist Windrnere L=cture, delvered to the British Paediatric Association at Wiadermere, April 16, 1948. I want to call particular attention: the reduction BLE 1 PRODUCTION AND CONSUMPTION OF MILK IN 1,000 QUINTALS HECTOLITRE Total production Consumption for Liquid milk for Milk for butter, cheese, feeding calves human consumption and other products http://adc.bmj.com/ 1937 1946 1937 1946 1937 1946 1937 1946 Austria .. .. 23,690 13,540 .3,845 2,770 11,785 6,100* 8,060 4,700* Belgium .. .. 28,369 11,576 3,404 1,962 5,957 3,934 19,006 -- Czechoslovakia .. 46,818 25,546 3,448U 3,032 25,969 14,893 17,401 7,621 Denmark .. .. 53,000 45,610 4,000t 4,000t 5,000 6,280+ 44,000 35,330 Fnland .. .. 26,630 - - France .. .. 147,012 96,911 35,425 23,461 35,421 28,911 76,166 43,607 Greece .. .. 5,879 2,900 40 2,800 1,395 3,078 1,465 on September 29, 2021 by guest. Hungary .. .. 15,260 7,428 2,988 1,407 10,350 1,922 Ieland .. t. 22,234 21,026 2,730 2,670 4,187 4,395 15,774 13,960 Italy .. .. 62,794 48,000 17,255 13,210 15,615 11,990 29,924 22,800 Luxembourg .. 1,454 1,250 200 180 410 380 790 690 Netherlands .. 53,396 35,814 1,532 2,200 14,050 18,665 37,813 15,593 Norway .. .. 14,050 12,850 1,000 1,001 6,090 7,200 6,960 4,650 Poland , .. .. 100,619 33,782 8,000 2,800 52,270 18,700 40,349 17,325 Svieden .. .. 27,7831 - - - Switzerland .. 26,130 21,500 4,700 3,200 10,122 9,980 11,308 8,420 United Kingdom .. 80,960 83,145 9,590 6,046 45,550 66,098 25,502 10,865 * EFtimatd figue t Indudng other se on farms t Including milk for crem producton Whoe milk enteredin dairies. 149 14 150 ARCHIVES OF DISEASE IN CHILDHOOD Arch Dis Child: first published as 10.1136/adc.23.115.149 on 1 September 1948. Downloaded from of the milk supply of Poland to one-third, from percentages ofmilk fed to livestock in 1937 and 1946 100,619,000 hectolitres in 1937 to 33,782,000 in 1946, shows (table 2) that in all the countries of Europe and the reduction to half the pre-war supply in studied, except the United Kingdom, there was an Austria, Belgium, France, and Hungary. There is increase in the percentage of milk fed to livestock. a considerable reduction in all the other countries In 1937 the range was from 24-1 per cent. of milk except the United Kingdom, in which there was fed to livestock in France to 7 5 per cent. fed in an increase from 80,960,000 to 83,145,000 hecto- Denmark. The United Kingdom showed a decrease litres. Of even greater interest is the increase of from I I per cent. to 7 per cent. from 1937 to 1946. This increase, in a measure, can be explained by TABLE 2 the increased number of female calves raised, and PERCENTAGE OF TOTAL MILK PRODUCTION the resulting fact that with the reduced daily produc- FED TO LIVESTOCK tion per cow a greater percentage is needed to feed the calf. In Fiance and Italy it is in greater measure the result of a fixed price in liquid milk and no fixed Countries 1937 1946 price in meat that makes it more profitable for farmers to feed the whole France .. .. .. 24-1 31-0 milk to his livestock and Italy .. .. .. 22-2 27-5 sell his animals as meat. In the report of the Belgium .. .. .. 12-0 17-0 French Commission on Modernization (September, Austria -.. .. 11-8 20-0 1946) the inmportance of reducing the amount of UnitedKingdom .. 11-0 7-0 milk fed to livestock is particularly stressed. Poland .. .. .. 8-0 9-2 Denmark .. .. .. 7-s 9-0 Milk Exports and Imports Canada .. .. .. 5-2 4-5 Table 3 shows the average exports and imports U.S.A. .. .. 2-6 4-0 of the various European countries in the period from 1934 to 1938. Switzerland and the United Kingdom were the only importers of large amounts 20,548,000 hectolitres in the human consumption of both fresh and condensed milk, with smaller Protected by copyright. of liquid milk in the United Kingdom, accounted amounts imported by Belgium. France was the for by a 2,000,000-hectolitre increase in production, a saving of 3,500,000 in the feeding of calves, and TABLE 4 a reduction of 14,500,000 hectolitres in the amount ANNUAL MILK CONSUMPTION IN EUROPE that went into the production of butter and cheese. PER PERSON, IN KILOGRAMMES, BEFORE 1939 Another interesting figure is the 4,500,000-hectolitre increase in the liquid milk for human consumption in Switzerland .. 290 Germany .. 125 the Netherlands, with a 17,500,000-hectolitre Sweden -- .. 275 France 90 reduction in the total milk production and a Denmark .. .. 260 Hungary -- .. 90 22,000,000 reduction in the milk used for butter U.S.A. .. .. 251 Greece .. .. 42 and cheese production. A comparison of the Holland .. .. 150 Italy -- .. 30 United Kingdom.. 140 TABLE 3 MILK TRADE FOR THE AVERAGE YEAR http://adc.bmj.com/ BETWEEN 1934 AND 1938, IN 1,000 QUINTALS largest exporter of fresh milk, with Austria next and Ireland, the Netherlands, and Italy in smaller Fresh milk Condensed milk amounts. The Netherlands were by far the greatest Country exporters of condensed milk, followed by Denmark, Imports Exports Imports Exports England, Ireland, and Switzerland. The flow of milk was into Switzerland, the United Kingdom, and Austria . 1 57 2 Belgium, from Denmark, Netherlands, France, and 6 Belgium .. .. 3 44 10 Ireland. 1 Czechoslovakia . 1 on September 29, 2021 by guest. Denmark . 186 European Milk Consumpion Finland . 5 Table 4, giving the consumption France .. 153 23 51 of -milk in the Irland .. various countries of Europe, shows that Greece 26 61* and stand at the Italy .. 3 17 15 Italy bottom of the list with 42 and Netherlands . 26 1,784 30 kg. per person per year. The consumption of Norway .. 11 21 milk in France and Hungary is only 90 kg. per Poland .. 2 person per year, and from that level it ranges Switzerland . 94 2 94 59 upward to Germany with 125 kg. and Switzerland United Kingdom 54 1,049 171* with 290 kg. per person per year. The United Kingdom rates are 140 kg. per person per year * Re-exports inuls and the United States 251 kg. Arch Dis Child: first published as 10.1136/adc.23.115.149 on 1 September 1948. Downloaded from THE EUROPEAN MILK PROBLEM 151 Skimmed Milk cream plus what he can make by feeding skimed As is to be expected, the production of skimmed milk to his livestock and selling the stock as meat. milk (table 5) is highest in the two butter-producing The price that the manufacturer can pay the farmer countries, Denmark and Australia, 60 and 57 per depends on the price that he receives for the butter cent. respectively, dropping down to almost one and the condensed or powdered skimfed milk. half for the Netherlands at 33 per cent. From It is necessary that the milk be of good grade to there the range is gradually downward to the United make a fit skimmed milk powder.