When newly qualified doctor Léon Dufour arrived at Fécamp in 1881 he was 25, idealistic and infinitely kind. He would be one of just five doctors in a town of 13,000 people.
Fécamp was a busy port that had earned itself the curious soubriquet of ‘the town of women’. At any time 3000 of the men would be away for many months fishing for cod in the seas around Newfoundland. Back in Fécamp the women were in charge; bringing up their children and working hard to make a living cleaning salted cod bought back over hundreds of miles of sea, and from their own herring fishing.
Dr Dufour’s surgery at 65 Quai Bérigny, looked out at a forest of masts but the air was not fresh. Around him lived and worked fishing families who used the cobbled streets to clean their catch as children played around them. He would recall with horror ‘the detritus of decaying fish, putrefaction and foul smells’.
With medicine expensive, the local families would only trouble a doctor as a last resort, relying on superstition and prayer to help them. But Dr Dufour soon noticed a regular tragedy among his poor neighbours. Babies were dying in numbers far higher than he had seen anywhere else. Measles, scarlet fever and diphtheria took a terrible toll on Fécamp’s babies, but it was enteritis, ’green diarrhea’, that caused more than half of the deaths of children under one year of age.
Living so close to his patients, Dr Dufour clearly saw the causes. Newborns were given, he said, a “vicious diet” and lived in circumstances so unhygienic deaths were inevitable.
The Norman ladies love of alcohol was also blamed for their children’s illnesses. Dr Brunon writing at the time said “They do not eat, they drink!”
During his first year Dr Dufour tried advice, leaflets and even hiring out equipment to sterilize babies bottles, because with little choice many of the poor fisherwomen of Fécamp were bottle feeding.
Breeding ground for bacteria
The mothers often worked from five in the morning to midnight fishing or cleaning their catch and the salted cod. With little time to feed their babies they relied on bottles and preferred those with a sucking rag or tube feed, so their babies could help themselves and needed less attention.
The sucking rags stuck into milk bottles and cans were often dirty and the long tubes nearly impossible to keep clean. Milk was collected in containers brusquely cleaned and babies were given milk from cows that many of their small tummies could not tolerate.
While doctors now understood microbes and bacteria the fisher-women were hard to impress. They traditionally celebrated a tiny baby eating adult food not understanding the damage such a diet could cause them. Dr Dufour noted the “haste that parents have to give the child as much food as possible as soon as possible. . . You must see the joy of these poor people as they say to you: “The little one? But he eats like us!”
There was another problem that stopped the fishing mother’s from breastfeeding. It was probably their own poor diets and the hard work they endured, but they blamed the salted cod for drying up their milk. Others said their babies pushed back their breasts because of the strong smell, a smell fisher-women could never fully wash away.
Dr Dufour was entirely sympathetic. He had no desire to force them to breastfeed, but he did want to save their babies.
The statistics were gruesome. While more babies were born in Fécamp on average than across France, the number dying was on average much higher.
The birthing conditions of many mothers worried Dr Dufour greatly. He wrote to the mayor “Some are forced to give birth in abandoned quarries, the others under lofts where you would not house animals. Others, for bedding, have only fern leaves. In this state of things there is only one remedy, the creation of a maternity hospital.” As M.Bergeron secretary of the Academy of Medicine noted “A child who is born [in Fécamp] is less likely than a man of 90 to live a week and less likely than an octogenarian to live a year”
Dr Dufour was determined to make changes. He was not from a wealthy family but rich in intelligence and sincerity. Fortunately he was also blessed with charm and able to gently influence not alienate people with his new ideas. The daughter of Fécamp’s Benedictine mogul Alexandre Legrand fell in love with the good doctor and they were married. Sadly Léon’s passion for his work did not make for a happy wife and they were divorced. This did turn some people against him for a while, but Léon simply worked on. Nearly two decades later he would marry, happily, a fellow doctor.
A new, fresher Fécamp
Slowly and surely the determined doctor made changes in Fécamp. Alongside his surgery duties, Dr Dufour was appointed deputy physician of the Fécamp Hospital in 1889. He used his position and some remarkable diplomacy to convince the municipality to make revolutionary welfare reforms, winning over the most conservative and unimaginative council members.
In 1890, the town agreed to organise regular street cleaning, instantly improving the poor children’s playground and the sweetness of the air. In 1893 his influence led to the creation of a Hygiene Commission to remove rubbish, install public sinks and septic tanks.
But it was the La Goutte de Lait, the Milk Drop that would go on to saving thousands of young lives, far beyond Fécamp.
La Goutte de Lait
La Goutte de Lait was a club Dr Dufour created to educate young mothers often unaware of the dangers to their babies of poor hygiene. It was based in a building on Rue Précieux Sang, near the port. As Dr Dufour worked among them, the fisherwomen soon overcame their suspicions.
The good doctor and La Goutte de Lait volunteers did encourage working class new mothers to breast feed and they were given a small sum for nine months to do so (including a sum if only partly). But, understanding the hard life the women led, if a new mother was judged physically unable to feed her child herself, or her work made it impossible, she was given pre-prepared milk.
Nine or ten sterilized bottles (and teats, no tubes) of milk, every day, as needed. The milk was supplied by two farms close to Fécamp and the Sister of Saint Vincent de Paul took on the task of preparing milk and baby bottles. First the milk was checked for freshness and purity then ‘humanized’, modified to be more like mothers milk by changing the amount of fat, adding water, lactose and even a little salt. Finally it was sterilized.
Each Goutte de Lait baby was given a booklet to record their weight, appearance of their teeth and any concerns about their health and growth and received regular home visits. The mother was supported to be at home for one month after the birth of her child.
Kind words for young mothers
Dr Dufour gave the infants free consultations with the door to his office wide open, so mothers waiting could benefit from advice given. The walls were decorated with inspiring words:
“A mother must never blame herself for not having done everything to breastfeed her child”
“Wash or bathe your children, with lukewarm water, most often possible; every day is best”
“Air your homes widely”
Unsurprisingly Dr Dufour’s methods had a tremendous effect upon his young patients, who thrived under the new regime. Dr Dufour even gave his young mothers a rare chance to show off their Goutte de Lait babies with an annual bonny baby competition.
The end of the 19th century was an exciting time for medicine and people of Fécamp benefited from recent research into diphtheria. The first diphtheria cure was reported on 22 November 1894 when the police commissioner seized suspicious milk at the entrance of the town, sent it to a chemist to be tested and it was found to be infected.
The success of the Goutte de Lait soon impressed many of the town’s rich ladies who would choose from the poor a little ‘milk sister’ or brother for their children. They would follow their little protégés development, donate financially to the Goute de Lait and help the parents by contribution to their ‘moral recovery’.
The wealthy ladies also demanded a more direct benefit, to be members of the Goutte de Lait themselves. Three levels of membership were developed; free, half pay and pay. As early as 1899, about one-third of the small Fécampois born that year were fed by La Goutte de Lait.
Dr Dufour’s boundless patience and perseverance influence more changes in Fécamp:
In 1895 a service to loan sheets and linen to new mothers was set up. In 1897 inexpensive public baths were installed along rue de l’Aumône. 1898; Dr Dufour held a series of seminars in on hygiene for children aged 10 to 13 years. 1889; a workroom for poor girls was opened. A maternity hospital was opened in 1900.
Thanks to the impressive results of the La Goutte de Lait at Fécamp, by 1914 one hundred La Goutte de Lait organisations were set up across France. Soon they could be found in America, Australia and even Madagascar. The poisonous baby bottle tubes were finally banned in 1910.
A modest celebrity
Dr Dufour became a celebrity but a very modest one. He wrote about his findings and gave advice, spoke at conferences and was very influential. But he did not become rich. Money was never important for himself, but for the good it could do. He was never known to take a holiday and took on the roles of doctor for municipal nursery, doctor-surgeon at the Fécamp hospital, was a member of the council of health for the district of Le Havre and doctor for the office of charity and societies of mutual benefit.
Somehow Dr Dufour also found time to appreciate the history of Fécamp, becoming founding president of the Société des Amis du Vieux Fécamp (Friends of old Fécamp society) and co-founder of the Musée du Vieux Fécamp in 1874. He gifted the Musée his collection of children’s health miscellanea from across the world and the new Fisheries museum on the docks displays it still.
Just reward for a good life
The good doctor was awarded Grand Office of the Chevalier of the Legion of Honour in 1923 and a street was named for him in Fécamp in 1926. He died in 1928, after nearly 50 years of working in the town. His work carried on saving countless young lives.
In 1937 89.2% of children born in Fécamp were fed by La Goutte de Lait. It was not until after WW2 that the Goutte de Lait began to close, but for happy reasons. Maternal and child health centres took on the work of the La Goutte de Lait, safe formula milk was developed, medicines and vaccines developed and hygiene taught widely and better understood.
The last Goutte de Lait organisations closed, in Fécamp, in 1972 nearly 100 years after the good doctor Dr Léon Dufour first arrived in Fécamp. He would have been delighted.
The origins of modern pediatrics: Dr. Léon Dufour and the work of the “Goutte de lait” by Manuelle Sautereau
The Friends of Old Fecamp – Vieux-Fecamp.org