CHAPTER II.

THE PRINCIPLES AND PRACTICE OF FEEDING INFANTS AND

CHILDREN.

Human milk is the type of infants' food.-All artificial foods should conform as closely as possible to this prototype. The resemblance must be not only a chemical, but also a physical one. The clotting in human milk results in fine flakes, and this should be obtained when artificial milk is given. The specific gravity of good human milk is about 1030. It contains rather less than four per cent. of proteids; rather more than two and a half per cent. of fat (hydrocarbon); and rather less than four and a half per cent. of sugar of milk (carbohydrate); about one and a half per cent. of salts, and about 88 per cent. of water. The proteid and carbohydrate are nearly the same in quantity in the infant's diet, whilst in the adult standard diet (Ranke) the proteid is to the carbohydrate as one is to three. The fat in the standard infant diet is relatively twice as much as in the standard adult diet. The most important salts in the milk are phosphates and chlorides, and chiefly those of potassium, sodium, magnesium, lime and iron. It may be remembered that the solids of the blood and tissues are richest in potash salts and phosphates, whilst there is a predominance of soda salts and chlorides in the fluids of the body. The mother's milk is the best.

The digestive and assimilative organs of infants are of more immediate importance in the economy than any other set of organs. The body has to build up rather than break down. No doubt the expenditure is large, but the income

must be much larger. The digestive organs have to prepare plenty of material for constructive purposes; the body grows very rapidly, and the brain nearly doubles itself in weight in seven years. The feeding is more frequent, and the bowels act rather more frequently in young infants. The liver is very large, relatively and absolutely, because its metabolic functions are very active, and the amount of material manufactured great. The caput cæcum coli is not developed; this is related doubtless to the efficiency of the peristaltic action and the frequency of action of the bowels, which prevents any fæcal accumulation and gaseous generation in the first part of the large bowel. The sigmoid flexure and rectum are thrown into folds as the result of a greater relative length of these parts of the bowel in infancy. Constipation is promoted by the presence of these twists and turns in the last part of the large bowel (see Prolapse of Bowel and Constipation).

The mother as a nurse.-It is good for the mother to nurse her offspring, for suckling favours the involution of the uterus. The infant should be put to the breast a few hours after parturition; this promotes uterine contraction for the mother and peristaltic action for the infant. The milk in the breast for the first two days is a thick yellowish fluid called colostrum. It acts as a natural and mild aperient. It contains a great number of large corpuscles filled with fatty globules-the "colostrum corpuscles." There being nothing but colostrum for two days, it follows that artificial feeding of the newborn with gruel, butter, sugar, and the like, is utterly condemned by Nature herself. An absence of secretion on the third day should be an indication to give the infant milk and barley water, one part to two, sweetened with sugar of milk. The secretion of milk a day or so later is a sign to discontinue all artificial feeding. After the proper secretion of the milk has begun its physical characters change. It is a bluish

white fluid containing an abundance of minute spherical globules consisting of fat coated with casein or alkali albumen. A few colostrum corpuscles are also present, but these should not be found after the first month. An analysis of the mother's milk shows that it does not remain of uniform character. The amount of casein is small during the first month, but it increases during the next month or two, and then remains constant. The salts also increase in quantity for a month or so. The lactine, however, is in greatest abundance during the first two months, and diminishes somewhat afterwards. The amount of fat varies considerably from time to time, and this variation is probably due to alterations in the quantity and quality of the mother's diet. The influence of menstruation and of a fresh pregnancy on the milk is a matter requiring further elucidation, but as a rule the occurrence of either event should be regarded as an indication for weaning the child. The quantity and the quality of the milk varies at different times in the same mother, and there are also considerable differences in the milk in different individuals. Signs of exhaustion in the mother are indications for reducing the number of daily nursings or for suspending them entirely. If there be an excessive flow of watery milk (galactorrhea) during the first few weeks of suckling it is a sign that the mother is unfit to suckle her offspring, and a discontinuance of the nursing is to be advised. Even when the mother is willing to suckle her offspring the milk may be insufficient in quantity or defective in quality. If merely insufficient in quantity the child should have what there is. And the quantity may often be increased by the mother's taking a cup of milk or gruel half an hour before suckling. Defective quality of the milk may not be so easily managed. This defect may be known by the child's not thriving, crying and not gaining weight. Or physical and microscopical and even chemical examination may be practised to ascertain the

nature of the defect. The diet of the mother should be inquired into. The food of the mother should be abundant, of simple kind, and nutritious. It should be taken at regular intervals. Highly spiced, smoked or cured, rich or stimulating articles of diet should be avoided. Beer as a rule does not make good milk, but a little stout is a great help to some women.

Fresh air is as necessary for the mother as for the infant. The maternal alvine evacuations should be absolutely regular. I find that oatmeal porridge for breakfast corrects a liability to constipation not only in the mother, but also indirectly in the infant. Daily exercise in the park promotes a healthy state of the lacteal secretion. Attention should be given to the dentistry. Carious teeth should have the dentist's advice and attention. The mother's breath should be sweet.

Anything calculated to excite or depress the nervous system of the mother should be sedulously shunned. Mental emotion is said so to have altered the character of the milk that serious disturbance of the child's health has resulted, and convulsions, nay, even death, have been attributed to this cause. The mother should have a sufficient amount of sleep every night, and the feeding should be so arranged as not to deprive her of a continuous sleep of at least six hours. This rule is often broken during the first month with advantage to the child, the mother often seeming inclined to wake in the middle of the night, and this without there being any cause for anxiety.

may interfere with Depression of the perseverance. The

Certain local conditions of the breast the proper performance of lactation. nipple may usually be overcome with nipples should receive attention during the last months of pregnancy. They may be drawn out with the thumb and finger, or the common breast pump may be called into requisition. If the nipples be tender they should be hardened by

the use of evaporating lotions composed of equal parts of brandy or rectified spirit and water. Excoriated and fissured nipples require much attention. They may cause serious interference with lactation. The best method of treating them is to apply the solid stick of nitrate of silver to every part of their surface and to every crevice and corner. This coats the surface of the sore with albuminate, and thus forms a protection from the atmosphere. At the same time the caustic cleans the impurities from the surface, and by its stimulant character promotes the healing of the sore. If the fissure or excoriation be very slight a metal or glass breastshield may enable the child to suck the milk without causing the mother much discomfort. But as a rule the pain of these apparently trivial cracks is great, and the possibility of irritation leading to the development of an abscess has to be borne in mind. One factor in the causation of an abscess is the tension due to unescaped milk.

If the mother be suffering from marked phthisis the baby should be brought up by hand. The milk is frequently of poor quality in phthinoids, and the suckling can but still further lower their vitality. Constitutional syphilis in the mother need not prevent her from nursing her infant. She should be treated with specifics, and it may be necessary to treat the baby directly also. But sometimes the mercury taken by the mother acts through the medium of the milk on the child. Should the mother's health be seriously lowered from any cause lactation should not be practised. The presence of inflammatory disease in the mother is, in my experience, also an indication. for her not suckling the child, the milk being deficient in quantity and likely to be deteriorated in quality in these affections. The development of a mammary abscess in one breast is a contra-indication to nursing with that breast, which should be treated with glycerine of belladonna and fomentations, and surgical treatment, if necessary, sought.

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