INFANT FEEDING IN HEALTH AND DISEASE.

BY GILMAN P. ROBINSON, M.D., ATLANTA, GA.

It is with considerable trepidation that I approach so broad a subject as that of infant feeding. Within a few years a great deal has been done to enlarge our knowledge of this subject and the physician has been made independent of commercial foods and nurse's suggestions, and been placed on a scientific basis in his knowledge of the best food for the young. Dr. Holt, of New York, and particularly Dr. Rotch, of Boston, have done good work in this line. Much of what I wish to say will not be new to some of you, yet I hope that to others it may be of value. In order to thoroughly understand the artificial feeding of infants one should be cognizant of the possibilities and limitations of nature's method.

I shall not take up your time with a description of the action and mechanism of the breast. You all know that it is a most beautiful living machine, producing within itself a finished product adapted to the needs of each particular infant; not only does it produce the finished product, capable of maintaining life and continuing the growth of its young consumer, but it also measures the quantity suitable for its digestive organs. Such perfection it becomes the duty of every physician to copy when occasion arises to imitate nature. It is not necessary for me to mention the methods by which the constituent parts of mother's milk can be changed by regulation of diet and exercise. It is simply reprehensible for any physician who has the care of chil

dren not to be conversant with these methods. I once heard of a doctor who told a patient whose milk was not agreeing with her child that there was nothing better than breast feeding, and to keep on nursing the child even if the milk did not seem to agree with it; the child died. That physician offered no remedy to the mother to change the constituent parts of her milk which were disagreeing with her infant, nor did he give a substitute food. Nature, as we all know, needs help at times, and any physician who does not help nature to properly feed a child at such a time is as culpable as an obstetrician would be who, in a case of malposition should say to the mother that nature is not to be improved upon, simply wait.

Let us for a moment look at the analysis of mother's milk. This analysis is made from the milk of many different women of different nationalities.

Reaction slightly alkaline or neutral.

These constituent parts are simple and easily understood. You notice it is slightly alkaline. What strikes us all, however, is, that it is a highly diluted food, 87-88 per cent. of water with only 13-12 per cent. of total solids. This is a point we want to remember when we come to modify cow's milk. The fat is the fat contained in suspension in the cream. The sugar is the ordinary sugar of milk. The proteids contain the casein and albuminoids. This is the one constituent that causes much of our trouble, both in breast and substitute feeding. That breast-feeding, in the great majority of cases is the very best feeding, is

without question, yet it should be borne in mind that it is not breast milk as a whole that makes it the best, but the varied combinations of the different elements of that milk. Clini cal observation teaches us that two things must be carefully observed in infant-feeding, viz.: the digestion of the infant and its nutrition. A milk may be easily digested and not be nutritious, or it may be highly nutritious and not at all easily digested. It is the recognition and the regulation of these conditions that we must be ready to meet. In the case of a breast-fed infant much can be done toward this by the regulation of the mother's diet and exercise, as well as by intelligent dilution of such milk. A long paper could be written on the proper care of the breast-fed infant alone, but in my short time it is of the unfortunate babe that is deprived of its natural food, and forced to be artificially fed that I wish to speak.

Naturally, the first question that occurs to us is, "What is the best substitute food?" Unquestionably, the food that comes the nearest to the product of the human mamma is the milk of the mammæ of other animals. Our common sense tells us that milk is the best substitute, and a milk that most nearly approaches human milk. Without going into a discussion concerning the merits of milk of different animals, it is an accepted fact, that the product of the mamma of the cow is the most easily obtained. While cow's milk does not resemble human milk as closely as that of some other animals, yet, as all milk has to be modified, it is as easy to modify to a greater as to a less extent.

COWS.

Accepting the fact then that cow's milk is the most available for substitute feeding, let us consider the difference in The old theory of one cow's milk is now pretty thoroughly wiped out, unless a remnant of it be left among some old nurses. An infant fed from one cow's milk gets the full benefit of any disturbance of the equilibrium

of the mammary gland through unintelligent feeding, fright or disease. The finer herds of cattle from the Channel islands are more liable to disease in our harsher climate and it is a well-known fact among dairymen that a pure bred Jersey cannot raise its own young. The milk of both Jersey and Guernsey cows is somewhat higher in the proteids, already too high in the milk of other breeds. The milk from a common herd or from a herd of such cattle as the Devon, Durham or Holstein is the best for substitute feeding. The average analysis of cow's milk taken from a great number of common cows gives us the following: Reaction slightly acid.

In this analysis we notice that we have a slightly acid product. Also, that it is a well-diluted food. A rather low percentage of sugar, but a high percentage of the proteids. Let us now for a minute, before going on to the recombining of the different elements, compare mother's and cow's milk:

The first thing we notice is that one is alkaline

and the other acid.

Mother's milk is the more dilute

product. The fat in each is practically the same.

The

milk sugar, you see, is higher in mother's milk, a difference

All

easy to overcome by the addition of sugar of milk. The proteids, representing the nitrogenous elements of the milk you will notice are as about 4 to 1.5. It has been shown by experimenters that in the coagulability of milk by acetic acid woman's milk gives no curd perceptible to the eye; cow's milk, raw, gives a large curd; cow's milk 1 part and water 4 parts, a very fine curd; a modified mixture of fat 4. sugar 7, proteids 1.5, ash 2, reaction alkaline, gave a very fine curd; and milk 1 part and water 5 parts gave no curd perceptible to the eye. Fresh cow's milk and milk twentyfour hours old gave the same result. Cow's milk boiled, steamed or raw gave the same large curd; also, with limewater and barley-water the results were the same. this shows that the size of the curd depends on the dilution of the proteids rather than on any particular property of the substitute with which it is diluted. This should be borne in mind in substitute feeding. Water is the best diluent. Knowing how human milk is produced and how constituent parts can be changed in the mother, having accepted cow's milk as the best substitute, seeing its constituents and percentages, and having compared these with mother's milk, I think you will agree with me, that the mere technique of modification must be easy. To make such modification absolutely exact in its percentages is essential for a perfect substitute food, but this requires a wellequipped milk labortory. In home modification however, when proper care is used and directions strictly adhered to, we can so change the constituents and percentages of cow's milk as to make them all that is essential for the copying of the percentages of breast milk. Let us consider what we need to carry out the technique: A simple sterilizer, containing a rack for some six or eight feeding tubes. Into the lid of this sterilizer a thermometer should be fitted. The tubes are simple straight bottles that can be easily kept clean and