INFANT FEEDING AND ITS INFLUENCE ON LIFE INFANT FEEDING AND ITS INFLUENCE ON LIFE OR THE CAUSES AND PREVENTION OF INFANT MORTALITY BY C. H. F. KOUTH, M.D., M.K.C.P.L. FELLOW OF UNIVERSITY COLLEGE, LONDON ; OP THE MEDICAL, MEDICO-CHIRURGICAL, AND OBSTETRICAL SOCIETIES ; CORRESPONDING MEMBER OF THE ROYAL ACADEMY OF MADRID AND PE8TH, AND TOE GYNAECOLOGICAL SOCIETY OF BOSTON; SENIOR PHYSICIAN TO THE SAMARITAN HOSPITAL FOB WOMEN AND CHILDREN, ETC., ETC. THIRD EDITION NEW YORK WILLIAM WOOD & COMPANY 27 GREAT JONES STREET 1879 197? PREFACE TO THE THIRD EDITION. IN putting forth a third edition of this work, I feel I have much for which to be thankful. It is not only that the public and the profes- sion have regarded my special views in many instances with kindness and partiality, but that the ruling powers have been made to act by the voice of public opinion. Without presuming to take credit for a course of action which may only have been synchronous with the enun- ciation of my opinions, and yet possibly in no way influenced thereby ; still it is gratifying to find that measures have been taken by Govern- ment itself in the very directions I ventured to recommend. The whole official and sanitary powers have been invoked in favor of little children. Their food may no longer be adulterated, even with water, and their lives are more effectually protected in many ways. Much, however, remains yet to be done. In England alone, since the year 1847, over 341,000 babies have died from developmental diseases of children, and nearly 2,500 from want of breast-milk. Even since my last edition in 1863 nearly 146,000 children have died from the for- mer diseases and 12,000 from the latter cause, and unfortunately these numbers are on the increase. Compared to a million of persons living, the numbers which for these two classes were, in 1847, respectively, in the proportion of 653 and 46, are now in that of 695 and 53. Fr from similar causes, is actually diminishing in population. Thef^ is still, therefore, ample room for improvement. The minimum of good done should urge us to more active measures still. The first step to- wards reform is to be fully cognizant of the evils which exist ; the sec- ond is to trace the causes that favor their development. Then only may reform be safely urged and begun. Our Registrar-General, of whom England may well be proud, has by his unparalleled reports done much to clear the mists in the vista before us. Hundreds of IIH-M of H-iciice in every land, actuated by the noblest and most gener- ous impulses, have spoken with division and judgment. It is for us to enter the promised land and take possession. I hope, therefore, for VI PREFACE. better things yet. I look forward to a day when the full benevolent intentions of the originators of Foundling Hospitals will be carried out, because better understood. When woman, instead of being outraged in the day of her distress, will be effectually helped, and infanticide will cease to be the plague-spot of this land. "When true and unpreju- diced religion, walking hand in hand with a morality not merely sen- sational, but real will be based upon the precepts laid down by our Great Exemplar, and arranged on the side of our helpless babes ; then, like Him, " we shall be working while it is to-day ; " like Him, " be ever going about and doing good : " and then of us it may be justly said, " Mercy and truth have met together," and " glory may dwell in our land." 52 MONTAGUE SQUABE, September, 1876. PREFACE TO THE SECOND EDITION. "WHEN the views first propounded in these pages were put forth, I an- ticipated considerable opposition. The voice and practice of the pro- fession were against me. I looked for no favor on the part of the press, and I expected the public would not be more propitious. My opinions, however, had been formed after mature thought and reflec- tion, and I felt urged to set forth what I believed was truth, and to expose what I estimated as error. I am thankful to feel my misgiv- ings, in regard to what I have said, have not been verified. The fundamental doctrines I sought to prove have been in great measure admitted. The dogma, that it is imprudent to mix two milks, or to allow a mother both to suckle and feed a child artificially at the same time, now meets with few advocates. The great mortality of in- fants is now no longer attributed so much to hand-feeding, as to the injudicious manner in which it is generally conducted. Lastly, the full bearings of the hiring of wet nurses upon the spread of illegitimacy, upon the death of the children so deserted by their mothers, and indi- rectly upon infanticide, are becoming daily more appreciated. It is true, that in putting forth a second edition I am anxious to irive more development to the views enunciated, and to make more <-.ii verts to my opinions; but I have also another object, I desire to influence public benevolence in another and an analogous direction. There is a sphere of usefulness open, and one in its accomplishment well calculated to benefit the masses. I long to see our Foundling Hospitals, and other analogous institutions, with their large prospec- tive revenues, extend their philanthropic operations, and open wider their doors of relief. There are many honest, hardworking mothers whose circumstances as to money and health prevent them from fulfill- ing their maternal duties to the advantage of their children. The crowded and overburdened workhoiiM- U surely not a lit place for them. Why should not the-e rich institutions hold out a helping hand to the offspring of these poor mothers, without necessarily neglecting the Vlll PREFACE. children of our more frail and unfortunate sisters? It would be a glorious thing to see all these children taken up and fed upon thost- plain, simple, common-sense principles which the knowledge of the day has developed, and thus rescued in many cases from disease, de- formity, and premature death. Some of these rules I have endeavored to point out ; others will become matured in the course of experiment, and I hope the day is not far distant when they will be put into full operation. Let me be clear, however. I do not presume to say that I have done even a tithe of what may yet be done, for I feel progress will not stop here. But I believe soberly, that the measures I have ventured to recommend are a step, however feebly made, in the right direction. All I can say for myself is that my heart is in the cause, and that the views herein set forth are, so far as I am able to judge, founded on practice as well as science. Humbly, yet hopefully, I look to my profession and its many ardent workers to develop more clearly any doubtful points. Confidently and brightly I look to the time when the benevolent public will, by extended and continuous experiment, consolidate our work, and all by common consent carry out our Heavenly Master's injunctions, when He said, " It is not the wish of your Heavenly Father that even one of these little ones should perish ! " 52 MONTAGUE SQUARE, May, 1863. PREFACE TO THE FIRST EDITION. THE influence of injudicious feeding upon infantile disease and mortal- ity has occupied my attention for some years. Accordingly several of the divisions of the subject, now given collectively, have from time to tune appeared as separate papers in the medical periodicals. They are put forth in a more connected form it is hoped also in a more ma- tured shape. Like most other subjects, however, the question has grown under consideration, and this must be my excuse for the length to which these remarks have been necessarily extended. Possessing, moreover, a strong affection for little children, and for this reason much interested in the well-being of mothers to whom they are natu- rally confided, I have wished to develop the subject in its double phase. In the hope of effecting this, I have spared no pains in the investiga- tion, and have given myself heartily to the work. I may also say that I have not intentionally allowed myself to be biassed by preconceived opinions : I have honestly sought out truth ; in proof of which I may add, that many of the results obtained have taken me by surprise. I was not prepared for them.* I could scarcely have supposed that the ignorance of the masses of the proper manner of feeding infants was so great that the constituted authorities in the realm could permit so much dishonesty in those who <> provide food for infants; still less that the whole question was so intimately connected with the development of much social evil and moral crime ; yet beneath the careless sanction of the community these are gradually yet certainly attaining alarming proportions. Fortu- nately for me, the public have begun themselves to see the danger. Mothers in high position are exerting themselves to remove this igno- rance. Already the Ladies' Sanitary Association has done good service. If the Government be slow in carrying out tin; work of reformation, those hiirh in authority and connected with it, united in sanitary asso- ciations, are bestirring themselves to stem the torrent, and preparing the ground for future X PREFACE. The medical profession and the clergy, always foremost in works of charity, are heartily co-operating in the work. This is a cheering aspect. Ere long we may hope to see this land, blessed with so much spiritual and general knowledge, also stand pre-eminent for sanitary improvement in tliis direction. AVe may soon see the movement ripening, to the sal- vation of many lives now annually sacrificed before the shrines of igno- rance and vice. For myself, I pretend to no knowledge superior to that of my compeers, but I have some zeal to acquire it ; and it is im- possible for even an ordinary mind to look closely on any subject with- out obtaining from the very application some useful information. In the wish to follow in the public wake, and to communicate the lessons I have learnt, I have been led to publish my views. In doing this I may have erred in two ways. Perhaps my style is not so popu- lar as some have wished ; still I trust the majority will understand my meaning. Others, on the other hand, perhaps think I have spoken too plainly ; but on so important a social question to speak too scrupulously from a mock attempt at prudery, would be puerile. I have a higher game to play than merely to court the popularity of the fastidious. In cither case my fault will only tend to bring out, by the clashing of dif- ferent opinions, that which I should scorn to obscure the plain, in- controvertible truth. Notwithstanding, to 1 contribute in any way to- wards the elucidation of so complicated a question, or to assist in the smallest degree in unravelling laws, which in their future development may insure public weal, is in either case a difficult task ; but, from the magnitude of the good hoped for, it becomes a pleasing duty to the active philanthropist. 52 MONTAGUE SQUARE, June, 1860. CONTENTS. PAGE INTRODUCTION 1 PART I. CHAPTER I. General Division of Causes of Mortality and Viability Classes of Disease General Comparison of these, showing the great Influence of Diseases which may be produced by Injudicious Food and Defective Hygiene 5 CHAPTER II. Conditions which favor Mortality : First, Nature of Food, particularly Want of Breast-milk Results obtained in London Foundling and Parisian Hospi- tals Late Diminution of Mortality in France Evidence from Facts and Figures that other Causes are in Operation Calculation on Registrar- General's Return for England and London 8 CHAPTER III. Mortality dependent on Nature of Food, continued. Hand -feeding as practised by the Mass of Population. Conclusions in favor of Breast-milk from Drs. Merei and Whitehead's Tables from Brighton Cases. Breast-milk from a Mother generally agrees better than from a Stranger Chateauneufs Experi- ence Foundling Hospital. Private Cases. A Mother's Breast-milk, how- ever, occasionally Disagrees 13 CHAPTER IV. Mortality in Connection with Defective Hygiene. Influence of Hospital Attnos- 1'hiTc and Close Habitations. Remarkable Exception of Ireland. Greater Mortality in Towns for Infants. England Ireland French Foundlings. Fearful Effects m Knim-** and England. Influence of Removal. Of Abase of Recumbent PoMitinn. Violent Deaths among Infants 10 Xll CONTENTS. CHAPTER V. PAGE On some peculiar Physiological Relations which Influence the Mortality of In- fants. Mortality greater in Early Periods both for Foundlings and Children in a General Population. Season. Influence varies with Locality in Public Institutions as compared with Private Residences. The Mortality is greater for Male Children than for Females. . . 29 CHAPTER VI. Conditions which Favor Viability. Tables of Viability up to Five Years. Positive Influence of Breast-milk, despite Injurious Hand-feeding combined, proved by Foundling Hospital Returns. Case of Wales. Positive Beneficial Influence of Light, if not too Stimulating. Of some Colors. 39 CHAPTER VII. Conditions affecting Viability, continued General Remarks on the Characters of Food It should be Animal for a Young Infant, and supplied by the Parent, as proved by Analogy among Animals and the Anatomy of Infants The Food should be given to a Child in Semi-erect Position, and Warmth required by an Infant 44 PART II. CHAPTER I. Lactation. Quantity of Milk normally Secreted. Three kinds of Wet Nurses : First, the Healthy Nurse; Second, a Nurse affected with Galactorrhcea ; Third, a Nurse affected with Defective Lactation. Also three Varieties. 51 CHAPTER II. Disadvantages to a Healthy Woman if she does not nurse. Sore Breasts. Nipples. Development of Cancer, or other Uterine Diseases. A Diseased Offspring. 58 CHAPTER III. Causes and Treatment of Galactorrhoea. Causes: a Peculiar Temperament A Menorrhagic Tendency Patients who suffer from Breast Symptoms during the Catamenia Suppression of some Habitual Excretion Over-suckling Hypertrophy of Breasts Treatment : Dietetic ; Medicinal ; Iodide of Potas- sium ; Belladonna ; Colchicum ; Iron Other Remedies. CONTENTS. Xlll CHAPTER IV. PAGE Defective Lactation. Causes Age : Atrophy of Breasts : Obesity of Mamma : Insufficient Use of Organ : Bad Air : Torpor of Organ : Influence of Terror : Malformation. Treatment 1. Mechanical: Suction: Electricity: Becquerel, Althaus, and Skinner. Conjugal Life to be Maintained. 2. Hygienic. 3. Dietetic : Animal Soups, Vegetable Aliments, Galactagogue Drinks, Beer, Wine, etc 71 CHAPTER V. Medicinal Treatment. Remedies : Laver Borage Lettuce Sow-thistle Rock- et Castor-oil Leaves Tapioca Partridge Berry Cytisus Milk-weed Mal- low Gith Pulsatilla Common Salt Crystal Sakeik Fesire Iron and Cod-liver OiL . , 88 CHAPTER VI. Circumstances under which a Mother should not Suckle. Specific Disease in the Mother When the Mother's Milk disagrees When the Mother can only Suckle with one Breast When the Milk in both Breasts is Diseased In Ex- haustion from Hyperlactation Sore Nipples 103 CHAPTER VII. Reasons which Influence Selection of a Wet Nurse from among Fallen Women Benevolent and Selfish. Difficulties of Selection Injurious Influence on a Household It is an Incentive to Crime Workhouse Experience It is an Encouragement to Infanticide. Returns. Mr. Acton. Registrar-General. Danger from Substitution of a Wet Nurse for the Child's Mother Danger from Nurse's Misconduct 108 CHAPTER Vni. The Physical Qualifications of a Wet Nurse to be Selected 1. Should have Good Milk : Characters of Good Human Milk 2. Hereditary Predisposition Good 8. Age not to exceed 30 4. Near the Age of Milk of Mother 5. Melancholic Temperament 0. Milk in Sufficient Quantity 121 XIV CONTENTS. PART III. CHAPTER I. ON SOME GENERAL DEDUCTIONS IN EEFEEENCE TO ALIMENTATION MADE FROM THE COMPOSITION OF MILK AND ITS SUBSTITUTES. PAG* Saline Ingredients of Milk. Phosphate and Carbonate of Lime Uses. Phos- phate of Soda. Phosphoric Acid. Important Kelations of Chloride of Potassium. . 129 CHAPTER II. Of the various Kinds of Animal Milks to be substituted for Human Milk. Composition of Human Milk at different Ages. Ass's Milk. Goat's Milk. Cow's Milk. Difference of Milk, Town and Country, Summer and Winter, Morning and Evening. Results of various Foods on its Composition 140 CHAPTER III. ON SOME OF THE OBJECTIONS TO THE USE OF ANIMAL MILKS. Ass's Milk: Excess of Sugar and Salts. Goat's Milk: Advantages from its Employment. Cow's Milk : Difficulties in its Employment Adulteration chiefly with Water Acidity. Meyer's Experiments. Unhealthy Shedfe for Cows. Revolting Filthiness of some in London. Necessity for Parliamentary Interference 148 CHAPTER IV. Of other Animal Substitutes Cream Desiccated Milks: Moore's and Grims- dale's Eggs Bone Soups and Jellies Beef-teas Sweetbread Tea Raw Meat Caution in Employment of latter 157 CHAPTER V. Mode of Correction of Impure Milks, and of Preparation of Artificial Milks to Resemble Human Milk. . 168 CONTENTS. XV CHAPTER VI. PAOB Vegetable Substitutes for Human Milk. Inferiority of the Vegetable as Ali- ment. Indigestibility of Starch. Injurious Qualities of Arrowroot Of White Bread. Objections to White Bread Pap Generally contains Alum, and no Chloride of Potassium An Insufficiency of Phosphoric Acid. Advan- tages of Aerated Bread Is rich in Cerealin. Adulteration of Flour. Good Effects of Tea. Period when a Child should take Vegetable Food 173 CHAPTER VII. Vegetable Substitutes for Milk : Lentil Powder, or Revalenta Baked Flour Mrs. Wells' Vegeto-Animal Food Nestle's Milk Food Liebig's Malt Ex- tract Food Dr. HassaH's Views of it Dr. HassalTs Milk Food Yorkshire Food Tea Cocoa When Vegetable Food should be given 182 CHAPTER VIII. On the Method of bringing up Children by Hand. Advantage of allowing Chil- dren to suckle Animals directly The Volatile Principles of Milk are thus not lost. Difficulties in conveying Milk. Error in our Foundling Hospitals. 192 PART IV. CHAPTER I. General Remarks on Prevalence of Abdominal Diseases. Defective Assimila- tion. Forms of Disease Three Stages Malignant Variety Post-mortem Appearances Nature of the Disease. Principles of Treatment. The Dietetic Means of insuring Digestion of Nitrogenous, Fatty, and Saccharine Aliments Need of Pancreatic Juice. Vegetable Aliments. Mineral Aliments Water; Lime-water. Advantages from the Combination of Milks Precautions necessary in using. India rubber Nipples Advantages of using for a Time other Animal Milks. . . . 199 CHAPTER II. Dietetic Treatment, Continued. Of the Nature of Aliments to be given, and the Mode of their .Administration. Cow's Milk, Adjuncts to. Necessity of using Test-Paper. How some Kinds of Diarrhoea which Supervene are to be Treated. The Exhibition of Soups. Raw Meat Dr. Leveret's ( 'ases. Examples occurring in Dr. Morris's Practice. Analogous Experiments with Adults. Underdone Meat. Cases. Vegetable Remedies to be Conjoined. Frequency of Feeding 215 XVI CONTENTS. CHAPTER III. PAGE Hygienic and Preventive Treatment of Defective Assimilation in the Appoint- ments of a well-regulated Nursery. Extent and Ventilation of a Nursery. Cleanliness of a Nursery. Impropriety of Keeping Dirty Linen in Them. Temperature. Curtains Ablutions. Warmth of Water and Variety of Soaps. Exercise, Clothing, Perambulators. Early Rising and Going to Bed. External Light Cleanliness of Wet Nurse 225 CHAPTER IV. On the Medicinal Treatment of Defective Assimilation. Carminatives, Purgatives, Cod-liver Oil. In the Diarrhoea, Nitrate of Silver and Sulphate of Copper Opium. Febrile Excitement best quieted by Inunctions Rationale of their Operation. Nutritive Injections. Aphthae, Malignant Variety. Treat- ment. Conclusion... . 232 APPEND rx A 241 " B 241 " C 242 " D , 245 " E 246 " F 247 " G.. . 249 INFANT FEEDING, AND ITS INFLUENCE ON LIFE. INTRODUCTION. " A CHILD in a house is a wellspring of pleasure." So said Tupper, and he spoke truly. The mother has suffered in her travail, and the husband has grieved over his wife's sufferings. But even in her weakness it is an unalloyed pleasure to gaze on the little babe that sleeps by her side. First, helpless to a degree, it commends itself to her protection; and gradually, as the stream of life acquires power, new feelings of love ex- pand her maternal heart. Soon the infant by a smile rewards the fond- ling look, and by its little exclamations of pleasure makes her rejoice also. A part of herself, so long as it continues a suckling, it is first loved by those who love her, or by those who see in the little innocent the image of their own present or expected babes. And thus it grows daily, and daily by more distinct childish prattle gives evidence of opening intelli- gence; it enlivens all around, and, twining itself round the hearts even of the sterner sex, it is loved by all who know it for itself. How different the picture when illness creeps in ! How sad the looks are now of those who loved it: the little babe in itself, how changed in aspect ! It is sorrowful to behold its now haggard, now excited, rest- less look, and to hear its pitiful moan. The wellspring of pleasure has become an occasion of grief and despondency, and who knows how soon, lik- the blighted floweret, it may droop beyond recovery? The mother still tends upon it with unceasing love; self is forgotten in watching over the tender one, but " who can tell whether God will be gracious to the child that it may live?" It is laid down by Quetelet that a tenth of the children born die in the first month after birth, and one quarter before the year is completed. This is a fearful fact to contemplate, and one well calculated to alarm parents. In England, in 1872, there were 825,907 births. The number of children that died under one year old was 123,500, so that there was 1 2 INFANT FEEDING AND ITS INFLUENCE ON LIFE. death out of every 6 births; while in London there were 118,440 births, and 18,740 deaths of children under one i.e., 1 in 6. In the city of London, the mortality is lixed at a higher rate by Dr. Letheby. 1 "Twenty per cent., or just a fifth, of all the deaths in the year were among infants of less than a twelvemonth old. In the eastern union, the proportion was much larger; it amounted to one-fourth of all the deaths. If these facts are examined from another point of view, it will be seen that in the east- ern and western divisions of the city about 1 in 5 of all the children born die before they are a year old; whereas in the central division of the city the proportion is only 1 in 7. The first of these numbers is greatly above the average in the country, and the second is below it. Again, nearly 41 per cent, of all the deaths were among children of less than five years old, and as children up to this age constitute about one-tenth part of the pop- ulation of the city, it is manifest that they die at the rate of about 10 per cent, instead of rather less than 7 per cent., which is the average for the whole county. In fact, in the eastern division of the city, the pro- portion is rather more than 11 per cent., and in the western nearly 14. It is this large mortality of children which swells the death-rate." In 1876 the account given is more terrible still for some places; for " turning to the great manufacturing districts of the North, we are star- tled at the extravagant cost at which the battle of life is fought and won. It is, for instance, absolutely shocking to read that in the East Riding of Yorkshire more than one quarter of the infants born die under one year of age. In Leicester the case is still worse, more than 4 infants in every 10 being thus swept off in the first few months of their existence;" while the case is far more terrible for France. M. Bertillon has shown that a child just born has less chance of living one week than a man of ninety, and less chance of living one year than an octogenarian. In France more than one-fifth of infants (21.7 per cent.) die by the end of the first year. Of the 54,000 born annually at Paris, the half die ere they reach four years, and if we include infants sent out to nurse, half die before the year is over. Among the classes in circumstances of poverty, the mortality is 75 to 80 per cent. (Lacassaque, Annales (FHygiene, 1876.) Now is this mortality a necessary evil? I believe not; and it shall be my endeavor to prove that it arises in great measure from preventable causes, and the improper manner in which children, speaking more espe- cially in reference to food, are brought up. Man, it is true, is born to sorrow as the sparks fly upward; but many of these sorrows are of his own creation. To prevent by any means the great infant mortality in these realms is a work well worthy of a philanthropist. The first step is necessarily to obtain statistics upon which we can reasonably argue, and from which we may deduce the vital laws which regulate and control this mortality. Unfortunately, however, although there is an outcry everywhere against 1 Times, April 29, 1862. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 3 red tape and routine, yet both are still very prevalent among ourselves and our medical institutions. Most of the latter, except a few which stand out in honorable contrast, do not give us the benefit of their expe- rience; and thus it is that, in England, much information which, if regu- larly published, might lead to a just comprehension of many difficult questions in science and in medicine, is lost to the world. The subject of this work is in this category. The books and pamphlets that have been written on it are legion. De Watteville enumerates a hundred and thirty; yet all this foreign and British experience has, after all, effected but little practical good. To what cause is this failure due ? Chiefly to a very general, if not universal, influence. It is a fault with many authois, first, to take up peculiar theories, and then upon these to work out their facts. The di- rection of these theories is guided by the fashion of the day, or the popu- larity of particular schools; and thus, as a great variety exists in these influences in different places and at different times, we seldom have data given in one country in such a form as to admit of comparison with those of another. The facts are good, but worked out in a different way, or in a sectarian manner ; and so those great truths, which, as belonging to the one family of man, should be applicable to all nations, can only be imper- fectly deduced occasionally only glanced at. In other words, we have, it were, a host of weights, but we possess no means of reducing them to a common scale. True, the Registrar-General's statistics of England are invaluable; but in many points they cannot be compared with those anal- ogous tables which set forth the experience of Europe. Even England, Scotland, and Ireland, in this respect, have no common language. From sheer necessity, therefore, 1 have been compelled chiefly to use French returns, although of course wishing to make them bear almost ex- clusively on England and Ireland. Upon this point, however, I wish to say, and that explicitly, for I have been already misunderstood and mis- represented, that from the very nature of the data used, strict exactitude in the figures given is not to be expected. At most, I can only bring out results which shall be true relatively; and this I hope I have done. Stat- ing this much as a caution 1 am bound, however, to add that, in many cases, my conclusions may be also true absolutely. Vital statistics, in the present day, are found to be governed generally by the same common laws; and, although the actual figure of percentage does occasionally v;iry to a small degree, the difference is not by any means so great as it may at first appear, even where the populations of different countries are t.iki-n. Hence it is often allowable to deduce from data which we do not possess for our own country, conclusions which, nevertheless, are perfectly true when applied to ourselves. Take, for instance, Paris and Ix>ndon. The mortality may vary by one or two per cent., but, nevertheless, it is still governed in the two cities by the same general laws. With these few remarks, necessary as an introduction, I proceed at once to the consideration of my subject. PART I, CHAPTER I. General Division of Causes of Mortality and Viability Classes of Disease General Comparison of these, showing the great Influence of Diseases which may be produced by Injudicious Food and Defective Hygiene. IN the present inquiry I propose in a first part to consider the causes of mortality and viability of infants. In a second, the subject of wet nursing in its physiological as well as social relations. In a third, the general principles and practice of alimentation; and in a last and con- cluding part, the symptoms and the treatment, dietetic and hygienic, and medical, of such diseases as are likely to shorten life or impair their well- being through defective assimilation. The causes of mortality among infants may, in the first place, be con- sidered under three heads : First, the actual mortality which prevails in a general population and taken as a whole among infants and young children. Secondly. The especial conditions which favor the increase of this mortality. Thirdly. Those which, on the contrary, favor the viability of children. First, then, what is the actual mortality of infant population ? Under the able direction of Dr. Farre, the Registrar-General, a series of tables has been devised in which the causes of death are so tabulated and classified as to admit of their being readily understood. These dis- eases are 1st. Zymotic, or diseases which are either epidemic, endemic, or conta- gious, induced by some specific body, or by want, or the bad quality of food. 2d. Constitutional sporadic diseases affecting several organs in which new morbid products are often deposited, sometimes hereditary. 3d. Local sporadic diseases, in which the functions of particular or- gans or systems are disturbed or obliterated, with or without inflammation, sometimes hereditary. 4th. Developmental special diseases, the incidental result of the for- mative, reproductive, and nutritiv processes. Last. Viol, nt r London, as we did for England, the number of deaths, from want of breast-milk alone, 12 INFANT FEEDING AND ITS INFLUENCE ON LIFE. would be for the years 1851, 1861, and 1871, respectively, .3, .4, and .29 per cent. a very small number; while, if we include, as before, deaths from want of breast-milk, teething, thrush, diarrhoea, dysentery, tabes, con- vulsions, and atrophy, the numbers would be for these three years re- spectively 6.6, 6.6, and 8 per cent., as compared to deaths from all causes, 14.9, 15.3, and 16.8 per cent. The same general conclusion may be brought out for all England on a different scale, where the record extends over several years, where the annual deaths from want of breast-milk are given for children to 1,000,000 living; and, for comparison, I annex deaths from developmental diseases of children: 5 years, 18/50-54 Developmental Diseases of Children. 1335 Want of Breast-Milk. 33 5 tk 1855-59 995.4 46 5 " 1860-64 656.4 53 5 " 1865-69 680 68 1870 667 63 1871 672 , 55 1872. . , 695 53 If these results show that children are better cared for nowadays than formerly, which I think they do, and that want of breast-milk causes many deaths, still it is clear that the great majority of deaths are evi- dently due to other causes. 1 1 See Chap, iv., Part I., p. 34. INFANT FEEDING AND IT% INFLUENCE ON LIFE. 13 CHAPTER III. Mortality dependent on Nature of Food, continued. Hand-feeding as practised by the Mass of Population. Conclusions in favor of Breast-milk from Drs. Merei and Whitehead's Tables from Brighton Cases. Breast-milk from a Mother gen- erally agrees better than from a Stranger Chateauneuf s Experience Foundling Hospital. Private Cases. A Mother's Breast- milk, however, occasionally Disa- grees. IT cannot be denied, however, in the second place, that hand-fed children are much more likely not only to be weakly and imperfectly developed, but also that the chance of life is much smaller for them than for chil- dren who are suckled by a healthy mother. But here we must remark, the argument applies only generally, and has reference more especially to infants taken as a whole in an entire population, and who are brought up by hand upon the most unwise popu- lar principles, indeed, in many cases upon no principle at all. It cannot apply to cases where judicious food is given and proper care taken of the children. In my introduction I had to allude to the little public good usually derived from hospital experience to the profession. I have now to direct attention to one of the honorable exceptions, viz., the first, second, and third Reports of the Clinical Hospital for the Diseases of Children, in Stevenson Square, Manchester, prepared by Drs. Merei and Whitehead. These are most able and philosophical documents, no fact being asserted which is not substantiated by accurate statistical researches such docu- ments as might be yearly produced by every hospital, and confer endless good upon thousands. I shall first, in a short summary, quote a few of these results which bear upon this portion of my subject. 1. The direct and baneful agency of want of good breast-milk may be inferred from the table given below, 1 from which it appears that the larger the supply of breast-milk and the more exclusively it is given, 1 Results observed in 1,041 children. Firtt and Mcoml yttr. Percent 1. Children having bad breast-milk alone to \ 94 Well developed or 62.0 9th month or longer, some to 15th, 18th, or V 35 Medium " or -':{.;< 24th month, ) 21 Badly " or 14 Total.. ..150 14 INFANT FEEDING AND! ITS INFLUENCE ON LIFE. the better is a child developed, and vice versa. Thus, taking the extreme points of the table, we have in the former case 62.6 per cent, well de- veloped, and only 14 badly developed; in the latter case, 10 per cent, well developed, and 64 badly developed. Again, it is further stated, that among the cases noted during the first Report, there were 34 children who were marked as having an, emi- nently good development and a strong habit of body of these 32 had breast-milk exclusively, and it was generally continued to an advanced period. Thus 4 had it to 18 months and upwards to 2 years; 7 had it up to the 15th or the 17th month; 7 up to the 12th or the 13th; 7 up to the 9th or the llth; 3 up to the 6th or 8th; 4 up to the 4th or the 5th month; of the remaining 2 one had an abundance of breast-milk from birth, together with bread and milk; the other insufficient breast-milk with bread and milk food. Among those noted in the second Report as being of very good de- velopment i.e., those most rapidly advanced in dentition, ossification of the skull, and facility of walking (most of these having commenced to walk before 12, many at 10 and 11 months) there were 59, of whom 43 had breast-milk alone to 9 months and upwards, to 12, 15, 18 months, a few of them even longer; 8 had breast-milk alone to between 6 and 9 months; 8 only received, besides the breast, other kinds of food before the 6th month. It may be added, that the respective 59 mothers were at most not only healthy, but of strong constitutions, and had great abundance of milk. 2. Those who had breast-milk up to 6th, 8th, 1 Per cent. and 9th months ; after which they were partially | 65 Well developed or 57.4 weaned; about 20 percent, of them partially}- 20 Medium u or 25.6 receiving for some months Jonger other food) 18 Badly " or 15.9 beside the breast. Total 112 3. Those having breast-milk moderately} 110 Well developed or 51 abundant and bread- food along with it from / 54 Medium u or 25 birth or early ages. ) 52 Badly " or 24 Total 216 4. Children who from birth or the age of 2) or 3 months, besides an abundance of breast- J 55 Well developed or 52 milk (as stated by mothers), had received addi- > 29 Medium " or 28.6 tional food, generally boiled bread and milk, or | 21 Badly " or 20 merely with water, sugar, and arrowroot. Total 105 5. Children who have had from the earliest in- ") fancy a moderate or small supply of breast milk ; I 109 Well developed or 26.8 some for a few months only, others up to 9. 12, > 107 Medium " or 2(5.3 15, or 18 months, or longer, with other food] 191 Badly " or 45.9 from birth. Total 407 ( 5 Well developed or 10 6. Children fed entirely by hand, and with-] 13 Medium " or 26 no breast- milk at alL (32 Badly " or 04 Total.. . 50 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 15 Out of the 1,548 children affected with various diseases mentioned in the second Report and treated in the Clinical Hospital, there were Per cent. Well developed 585 ... 37.1 Medium 462 .... 29.1 Badly 451 29.1 Not noted 50 3.2 Of these, 27 per cent, had a full supply of breast-milk, or at least for upwards of 6 months; 29 per cent, had a medium supply, with bread or other food; 38 per cent, had scanty breast-milk and some farinaceous food from birth or earliest infancy; 3 of them had no breast-milk at all from birth or earliest infancy. 2. The valuable notice of deaths occurring at Brighton, given in Appendix C, was kindly forwarded to me by a lady correspondent, who is deeply interested in all efforts made for improving the sanitary condi- tion among the lower classes. It can be fully relied upon, and emphati- cally illustrates the same fact, although brought out from a different point of view. These 50 cases may be thus classified : Convulsions (in 7 coroner's inquests, verdicts "overfeeding: " several not investigated) 22 Diarrhoea, and other disorders of stomach and bowels 12 Total cases traceable to overfeeding and injudicious feeding 34 Or per cent 68 The other cases (16 in number) were affected with hereditary, struc- tural, developmental, and epidemic diseases : most probably in these cases death was wholly independent of diet. At least, it is remarkable that in these last-named 16 cases, the children were in general either fed from the mother's breast entirely, or if brought up by hand were fed with more judgment than is commonly observed. The cases of convulsions (Xos. 12 and 15) could not be traced to any cause. They were not handfed at all; and probably the attack in each might have been induced by some irregularity in the health or diet of the mothers. Fed on bread-food without the bottle; some having the breast in ad- dition to bread-food ; some having other food, as sago, arrow- root, etc. ; dying of convulsions or of diarrhoea 24 Fed entirely from mother's breast 11 Fed from the bottle 1 Fed entirely on COW'B milk and water 2 The mortality of those artificially fed is very much greater than that of those fed at the breast, but from the preceding table it is obvious more is due to the injudicious method of feeding the child than to mere absence 16 INFANT FEEDING AND ITS INFLUENCE ON LIFE. of breast-milk. Thus both classes of cases prove that breast-feeding is the most encouraging where it can be successfully carried out. 1 Another circumstance, having direct relation to the food given, and which may tend to explain the fatality is, that 3. The mere substitution of a hired wet nurse increases the mortality ; for it should be borne in mind that the chances of life, precarious as they always are in a young infant, are rendered still more so by transferring a child to a wet nurse other than its mother. From a reference to the Annuaries of Mortality in Paris, Quetelet obtained nearly everywhere the same result, that, in the first three months after birth, twice or three times as many children die as in the other months of the first year. Other authors, he says, have made the same observations ; and from their inquiries they have thought to find the cause of this disproportion in the mortality in the habit which mothers have either of suckling their own children or of abandoning them to hired wet nurses. Here is what M. Benoiston de Chateauneuf, in his excellent work on the Enfans Trouves, says on this subject : " It is true that, to preserve the life of a child, care does everything, and climate nothing, or very little; and Switzerland and Holland are the countries where the smallest number die. Is the explanation of this fact, already offered by Muret, to be found in the habit which all the mothers, at the foot of the Alps as on the borders of the Amstel, have of suckling their children themselves ? We cannot say; but we shall only add, that, having been curious to compare the mortality of children at nurse with that of children brought up in Paris, we obtained the following results. Of 100 children suckled by their mothers, 18 die in the first year; of the same number at nurse, 29 die."* The following facts, for which I am indebted to the kindness of Mr. Brownlow, the efficient Secretary to the Foundling Hospital, direct to a conclusion similar to that arrived at by Benoiston de Chateauneuf. From some parish registers given in the Report of the Special Committee to the Governors of the Foundling Hospital, it appears, also, that the mor- tality is much greater among those children nursed by strange women, than amongst those nursed by their mothers.* 1 Dr. Yeld found that in Sunderland in 1874 the deaths of children under 5 years amounted to nearly one half of the total mortality. Out of 102 cases attributed to the commonest of children's diseases, 71 or 66 per cent, had been fed by the bottle. Med. Prens, April 21, 1875, p. 3. 5 Recherches sur la Population, Deeds, etc., du Royaume de Pays Bos. Par A. Que- telet, f. 18, pp. 142-3. 3 Thus, between the years 1762 and 1770, the annual mortality was as follows from children of and under 4 years old : Admitted : Foundlings 877 Illegitimate 5,283 Casual 1,821 Legitimate 19,562 Total 27,543 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 17 This table gives a gross mortality of 14.2 per cent, upon admissions; or, out of 100 deaths, 51.2 will occur among those nursed by their own mothers, while 68.8 will occur among those nursed by the workhouse nurses. These numbers have, of course, no absolute value, as it is not stated how many children were nursed by their mothers, and how many i-y workhouse nurses. Still as, out of this number, only 887 were found- lings, and as many as 7,109 were removed to the Foundling Hospital, mothers, or friends, we may presume this number only were not nursed by their own mothers at the workhouse. Deducting, also, those children who, as sent to the Foundling Hospital, were probably among the num- ber previously included in Foundling Hospitals, we shall have 7,641 chil- dren who were probably nursed by the workhouse nurses, giving a mor- tality of 36.1 per cent, for such children, to 6.1 per cent, for those nursed by their mothers. These numbers are doubtless exaggerated, from the nature of the data, but I think the reasoning adopted will justify our concluding, that the risk of substituting a wet nurse for a mother is great, and that it will certainly increase the probabilities of the suckling's death. Another fact confirmatory of this view was communicated to me by the late Dr. Henry Wright, who had it from a lady correspondent. It applies to six twins i.e., twelve children. Six were fed by their moth- ers, and all did well. Six were entrusted to hired wet nurses; three died; and of the remaining three, two at twelve months were looking puny and delicate, as if they could not live long; the sixth was quite healthy. From these facts we cannot do otherwise than conclude, that bringing up a child on its mother's breast-milk is, without doubt, far safer than entrusting it to another wet nurse. The worst that can be done under ordinary circumstances for a child, is to bring it up exclusively by hand; at least, in the way in which it is usually done. Let me, however, here give a caution. While the rule is very general that pure unadulterated breast-milk from its own mother is the best food that can be supplied to an infant, it is equally true that, in a certain number of exceptional cases, breast-milk does not agree with a child. Thus, from Drs. Merei and Whitehead's tables we find that 14 per cent. Died : Nursed by their mothers 1,229 Nursed by workhouse nurses. 2,698 Total 3,927 Removed : To the Foundling Hospital 525 To their mothers 8,623 To friends 2,961 Total 7,109 18 INFANT FEEDING AND ITS INFLUENCE ON LIFE. of the children did not thrive upon breast-milk, and in 23.3 the develop- ment was only medium; while on the other hand, 10 per cent, of those brought up by hand throve very well. Without relation, therefore, to the intermediate classes enumerated in the table, we have at least 24 per cent, who did not thrive upon breast-milk. It is an incontrovertible fact, that some mothers do not possess a milk calculated to benefit their off- spring, but to this class I shall again allude. INFANT FEEDING AIS'D ITS IXFLUEXCE t it 8.4.. .... 4.2 " . Ulster. 12.3.. .... 6.9 measure was taken to stay this plague, and during 10 years a million niirsfiiii:rs who might have been saved have perished. How account for such iii'iiflVn-nce, when in our defeats we were everywhere overpo\\ n \ by numbers? There exists for France another cause of depopulation, tin- mortality of foundlings, which in certain departments attains enor- 32 INFANT FEEDING AND ITS INFLUENCE ON LIFE. mous proportions. Few, perhaps, nowadays ask what have been the results of the suppression of the Tour, or secret depot, the transforma- tion of the hospital foundling service into departmental service, shrouded everywhere in obscurity and mystery. These consequences are deplorable. The number o^f infanticides is immense, the number of abortions incal- culable. The number of the stillborn, which has now risen to l-15th of the births, has quintupled in 20 years; the average annual mortality of foundlings is 50,000. Such are the results obtained demoralization, depopulation. How long it will take for public opinion to be stirred up by these facts, and at last demand an account of these living forces of the country thus yearly left to perish, I know not, but probably a good deal of time. It is not a question here, as with the' nurselings, of con- tending with maternal or public indifference. A more powerful force has to be struggled with, which in France nothing can overcome the Bureaucracy. I say the Bureaucracy, and not the Administration, for there is not a Prefect or Minister who knows what is going on in the Foundling Department. There everything is signed with confidence provided one does not tell the truth. I have pointed out these facts, I have called the attention of philanthropists and statisticians to the mortality of these little creatures, who have neither a father's rights nor a mother's love to protect them. My voice has been stifled, but I have not been answered. I forget I have been insulted in the street; I have been dismissed from my functions of Inspector of Creches and Nurse Register Offices at Lyons. The Jetme Mere, in which I teach mothers to bring up their children, has been threatened with suspension. Lastly, my expulsion from the Legion of Honor, to which I have belonged for 22 years, has been called for. Have I, then, all at once become a bad citizen because I have divulged a social plague spot ? If the facts I have revealed are false, let me be accused of falsehood; if they are true, let them be remedied. It is a mistake to think of silencing me by threats or insults. These infants of whom nobody thinks cry to me from their graves to take up their defence to tell all I know. Buy my silence, if you will, by making the reforms. I demand nothing better. Meanwhile, I am obeying the dictates of my conscience. From this Bureaucracy, which hides the truth, because afraid of it, I appeal to that supreme tribunal to whom everybody in France is responsible, whose decrees everybody respects public opinion. If I run some danger in tellihg the truth, if I am once more to be publicly insulted, I shall console myself. My conscience, the recompenses I have obtained, the sympathy of good people, tell me I am doing a good action an action useful to my country." Dr. Brochard advocates the re-establishment of the secret depots for foundlings or the legalization of investigations into paternity, a modifi- cation of the system of assistance to unmarried mothers, the transfer of the Foundling Department to the hospital managers, and the substitution of medical for administrative inspection. When we come to consider the question of the mortality in early INFANT FEEDING AND ITS INFLUENCE ON LIFE. 33 months of the first year, this appears to be far greater. Burdach gives a table of the mortality in the several quarters of the first year. 1 From this, deaths appear to be three or four times more frequent in the first quarter than in the second, and so on diminishing as the child grows older. The same fact is brought out by Mr. Acton in his paper on Illegiti- macy.* Out of 336 illegitimate children born in St. Marylebone, St. Pancras and St. George, 110 died under three months. It may, therefore, be said that the younger a child is, the greater is the chance of death; or, to state the proposition otherwise, every day in early infancy gained by a child renders the probability of duration of life greater. Quetelet expresses his views on this subject in the following terms : " To have a just idea of the great mortality of infants soon after birth, it is sufficient to note that in towns as well as in country dis- tricts there die during the first month after birth four times as many children as during the second month after birth, and almost as many as during the entirety of the two years that follow the first year, although even then the mortality is very high. The tables of mortality prove, in fact, that one-tenth of children born die before the first month of life has been completed." This mortality is so great, especially for male children, that from the first year after birth the number is reduced to one-fourth. This law will be seen by reference to Appendix D to apply to all coun- ties indifferently.' The subjoined table, also from Quetelet, which relates to the mortal- ity of Brussels, makes it during the first year of life, 1,034 deaths in the first month, against 3,538 for the whole year, or 29.2 per cent. See table below. 4 So that more children die in the first month than in any of the 1 Mortality in dil 523, p. 387.) B Mean Term 1 I erent qnar ;m--='-U. in 17 ... in 8 ... in 23 ... in 2.J.07. . . ters of thi Bruns- wick. ..1 in 10. ..1 in 3. ..1 in 13. ..1 in 21. . 1 in 41. 3 first year. Berlin. ...1 in 16. ...1 in 7. ...1 in 19. ...1 in 23. ...lin 21. (Burdach Physiologic, vol. iv., s. Ham- burg. Paris. Vienna. ...Iin21....1 in24....1 in 17.6 ...1 inll....l in 8....1 in 7.4 ...1 in 27. ...1 in51....1 in 26.6 ...linSO.... ....lin 31.8 ...lin 26. ... - ....lin 28. 1st 3 Months 1 2d3 Months 1 3d 3 Months. 1 4th 3 Months 1 'itticnl Society ' Journal, December, 1859. * These facts are BO important that some assurance societies will not assure lives at all under one month old. According to the English life table of one million chil- dren born 149,493 die before they reach the age of one year; and of these 149.493. 46,503, or nearly one-third, die during the first month of life. The annual rate of mortality per 1.000 among infante is 571.3 in the first month of life, declining 91.6 per 1,000 in the eleventh month. 4 1st Month 1034 1 7th Month 162 2d " 890 8th 152 3d " 231 9th 140 4th " 185: 10th 150 flth " I"." IHh 142 tith " 150 12th 140 34 INFANT FEEDING AND ITS INFLUENCE ON LIFE. remaining months of the first year. In Paris, and for the year 1823,' the corresponding numbers are in the proportion of 1,704 to 693, or 59.2 per cent. We observe the same thing for children of the early months in the returns for England. 1 have taken as an example the year 1842. By reference to the table annexed (Appendix D.), in which I have taken indifferently several counties, the same truth obtains. In England, out of 100 children born, while for the whole period of one year 15.2 per cent, children will die, 4.7 will die the first month, 1.7 the next, and so on. From later data published by the Registrar-General, from the corrected births and from the deaths registered in the 17 years 1838-1854, the life table below * has been deduced, showing the mortality for each month in the first year of infant life. (Supplement to 25th Report, p. vii.) From this table we gather the appalling fact that the annual rate of mortality per cent, of infants under one month may be estimated at 57 per cent. ; under two months, 21 ; under three, 15, and so on. Fortunately it dim- inishes gradually every month. The annual rate of mortality among infants aged one month and under one year does not exceed 114.6 per 1,000 ; whereas among infants, from birth to one year of age, it is equal to 165.6. (British Medical Journal, June 12, 1875). The same fact is brought out in a different manner for the first and following months in the Irish tables, from which it appears always to be greatest in the first month, in the civic districts of Connaught reaching the high figure of 38.8 per cent. To account for this great mortality, various inquiries have been made. Many of these instituted in foundling hospitals will be found to apply, although in a lesser degree, to children generally, and as such it may be of advantage to consider some of the causes in operation in these institu- tions. 1 Annuaire du Bureau des Longitudes pour 1S26. Annual rate of mortality per cent, at each month 2 Month. under one year of age. 57. 132 1 21.837 2 15.710 3 13. 187 4 12.004 5 12.050 6 11509 7 10.992 8 10.501 9 10.033 10 9.534 11 9.061 12 In France, out of a million births, 29,131 die in the first week, 22,123 in the second, and 22,236 in the 16 days following. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 35 Influence of Season. It results from the inquiries of the Registrar- General that the mortality varies greatly with the temperature. A fall of the mean temperature of the air from 45 to 4 or 5 below the freezing- point (32) of water, destroys from 300 to 500 lives in London. It pro- duces the same results on a larger scale all over the country. 1 The return (see table before given, Chapter IV. p. 23,) where the percentage mor- tality for town and country is given, proves it to be highest in winter when cold is most prevalent. This is chiefly true for cities well-drained and for dry country soil. Summer, however, may be most fatal to inhabi- tants of marshy districts or of cities which are badly drained. In Rome, as formerly in London, the old words of Celsus still apply " Saluberri- mum ver est, proxime deinde ab hoc hiems, periculosior aestas, autumnus longe periculosissimus " because as the temperature advances, and au- tumn comes on, dead vegetable and animal matter undergoes rapid de- composition, the living animals are infected, and where the Miasmata are concentrated in cities or in undrained lands, remittent fevers, dysentery, plagues, and malignant maladies are generated. Among the most pernicious influences to young children, however, we may include cold. The change of temperature from 45 to 4 or 5 below zero, as before stated, producing an increase of mortality in London alone of 300 to 500. As out of 100 deaths, however, from all specified causes, nearly 24 occur to children under one, and 36 to children und** five, the great increase of mortality to children by cold is thus at once made ob- vious. Indeed, it is a household word amongst us, which takes its origin from the Registrar-General's returns, that a very cold week always in- creases the mortality of the very young and very aged. The influence of cold in increasing mortality among children is well brought out by the Registrar-General's report. The winter of 1874 was a remarkably cold season. In the urban dis- tricts, in a population which may be stated in round numbers at 13,000,000, the death-rate was 28.9 per 1,000, or 2.3 per 1,000 in excess of the mean death-rate of the corresponding quarter for the 10 years 1864-74. In the rural districts, in a population of 10,000,000, the death-rate was not so high relatively, being only 25.7 per 1,000; but this lower rate exceeded the average for the same districts for the 10 previous corresponding quar- ters to the large extent of 3.7 per 1,000. This applies to a general popu- lation; but when we apply the test to infants in the 18 large towns, the infantile mortality averages 165 per 1,000. In Portsmouth it was 123; in Leicester, 213. The total infant mortality, measured by the proportion of deaths under one year to births, was equal last winter to 167 per 1,000, against 143 and 146 in the first quarters of 1873 and 1874. \\'e cannot, however, come to a similar conclusion for children if kept in public institutions. It is true, the Abbe Gaillard pointed out this con- tingency in the case of the Foundling Institution at X. Thus, in Novem- 1 Eigfoh Report of the Regwtrar- General, p. 87. 36 INFANT FEEDING AND ITS INFLUENCE ON LIFE. her and December, 1829, out of 29 children, 19 died in the first month after admission; whereas, in July and August of the same year, there died only 11 out of 25 admitted. But we learn from the Irish tables that in public inmtitittiiws the greatest number of deaths take place in spritiy, the least in autumn. It appears that, the deaths being 100 in all seasons, 30.8 will take place in spring; in summer and winter it will be about the same 27.1; while in autumn it will be least, only 14.3. The corollary to be drawn from the above facts is, that as children in public institutions are not allowed out-door exercise so long and so frequently as those of a general population, it is wise in very cold and changeable weather to restrain this pastime within reasonable limits. If cold is, however, particularly fatal, and the winter season one there- fore of peculiar danger, the autumn quarter is also a trying season for children, and especially so in urban districts. In the Registrar-General's report for the quarter ending September 30, 1875 (Times, November 3), the mortality at this season and its causes are lucidly set forth: " It will be useful to notice briefly a few of the principal features of the age distribution of the mortality during last quarter, more especially with reference to infant mortality, which in summer is always exces- sive owing to the epidemic prevalence of diarrhoea. The 121,459 deaths of all age^jncluded 37,118 of infants under one year of age, equal to 176 per 1,000 of the births registered. Infant mortality last quarter, measured in this manner, slightly exceeded the proportion in the same pe- riods of 1873 and 1874, when it was 173 and 174 per 1,000; but was con- siderably lower than in the three preceding years 1870-1-2, when 200, 194, and 182 deaths under one year occurred to each 1,000 births regis- tered. In the agricultural counties of the south-western registration di- vision infant mortality last quarter averaged but 119 per 1,000, and was but 95 in Dorsetshire and 114 in Wiltshire, whereas in the principally mining population of Durham and Northumberland it was equal to 222 and 223; in Nottinghamshire to 215, and in the East Riding of Yorkshire to 252 per 1,000. In explanation of the high rate of infant mortality in the East Riding of Yorkshire it may be mentioned that in the districts of Hull and Driffield this proportion of infant mortality was as high as 317 and 290 per 1,000 respectively. Excessive rates of infant mortality are almost invariably found in urban populations; but it is also important to bear in mind the wide range in the rate of mortality among infants in different towns. In the 18 large English towns for which weekly returns are published, infant mortality averaged 222 per 1,000, exceeding by 46 per 1,000 the proportion in the whole of England and Wales, and corre- sponding with that in the mining county of Durham. In these 18 towns, however, infant mortality ranged from 149 and 178 in Oldham and Ports- mouth, to 277 in Liverpool, 288 in Hull, 300 in Norwich, and 407 in Lei- cester. The remarkable difference between the rate of 149 in Oldham and 407 in Leicester appears to afford ground for special inquiry, which INFANT FEEDING AND ITS INFLUENCE ON LIFE. 37 could not fail to result in a useful contribution to our, at present, limited knowledge of the true cause of these wide variations in urban infant death-rates." " In England and "Wales 14,006 deaths during the three months end- ing the 30th September last were referred to diarrhoea, of which it may be estimated, from the experience of previous years, that 9,224 were of in- fants under one year of age, 2,948 of children between one and five years, and only 1,834 of persons aged upwards of five years. Fatal diarrhoea is, therefore, essentially an infantile disease. In town populations the deaths of infants from diarrhoea bear a larger proportion to the total deaths re- ferred to this disease than they do in rural populations. In London last quarter 74 per cent, of the 2,128 deaths from diarrhoea were of infants under one year of age, 19 per cent, of children between one and five years, 2.7 per cent, of persons between five and sixty years, and 4.4 per cent, of persons aged upwards of sixty years." " Infant mortality from all causes in London, which had been equal to 144 per 1,000 in the three months ending June last, rose to 194 in the quarter now under notice; and as the rates exclusive of the deaths re- ferred to diarrhoea were 133 and 141 per 1,000 respectively, it is evident that the increase of infant mortality during the past summer quarter was almost entirely the result of diarrhoea. In England and Wa|B the pro- portion of deaths from diarrhoea under one year to the deaths from this disease at all ages has increased steadily in recent years from 44 per cent. in 1847 to 64 per cent, in 1873. In London, in 1873, the proportion was 72 per cent., whereas in the third or summer quarter of this year it was, as before stated, 74 per cent., against but 34 per cent, in the second or spring quarter. It appears that the greater the fatality of epi- demic diarrhoea, the larger is the proportion of infants that succumb to it." "The annual rate of mortality last quarter among children and adults aged between one and 60 years was equal to 11.0 per 1,000 living at these ages in the whole of England and Wales, which differed but slightly from the rate at these ages in recent corresponding quarters; in the 18 large towns it averaged 13.3 per 1,000, whereas it ranged from 9.7 and 10.3 in Norwich and Portsmouth, to 16.8 and 19.9 in Oldham and Sal- ford." No wonder if, after a review of these facts, Dr. Farr should ask, What is the treatment and food of infants in the diarrhoea-stricken towns ? Is the fatal disease traceable to any zymotic poison in the dwellings or in the waters? And this is true for whatever country selected. Another peculiarity to be mentioned under this head is the greater mortality of male as compared to female infants, although more boys are \>rn than girls. M. Quutelet states, the birth of boys as compared to girls for Belgium for the years 1815 to 1829, to be a mean of 1,000 boys to 944 girls in towns, or 938 girls in cities. From tables which he has drawn 38 INFANT FKKIUXG AND ITS INFLUENCE ON LIFE. out, he finds that the number of still-born children in towns is double that of still-born c-hildrvn in rural districts, and that for three still-born males there are only two still-born females, and that even afterbirth for the two following months the proportion of males that die as compared to females is about 4 to 3 for the fourth and fifth it is 5 to 4; afterwards as 6 to 5, although after the eighth or tenth month the mortality for both sexes seems to be equal. The same general conclusions apply to all countries, though the exact cipher of mortality may vary a little. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 39 CHAPTER VI. Conditions which Favor Viability. Tables of Viability up to Five Years. Positive Influence of Breast-milk, despite Injurious Hand-feeding combined, proved by Foundling Hospital Returns. Case of Wales. Positive Beneficial Influence of Light, if not too Stimulating. Of some Colors. IN* Quetelet's work, Researches on Reproduction and Mortality of Man at Different Ages, we have a table given us of the viability of man. This table is calculated upon that of mortality, the inverse rates of each number placed opposite to the age may be considered as the relative de- gree of the viability of man at different ages, or, in other words, of his relative chance of life. I have annexed it for reference for five years. 1 Many of those causes which have been enumerated as favoring mortal- ity, are precisely those which, if avoided, are best calculated to favor viability. Thus abundance of breast-milk, especially from the child's own mother; the exclusion of other food, especially that of a vegetable char- acter, as we shall see more distinctly in the sequel; the purity of the atmosphere in which they live, especially in country districts; eschewing travel or exposure in cold weather; the abuse of the recumbent position; and violence, are all circumstances which tend to favor the viability of an infant. Many of these causes have been fully considered before in their relations to death, yet it may be of advantage to allude to some of them in a more positive manner in their relation to viability. And, first, in regard to breast-milk. We have seen, from Drs. Merei and Whitehead's tables, 9 that feeding a child on breast-milk exclusively, produces a good development in 63 per cent., medium development in 23 per cent., and bad development in 14 per cent. Nor, further, is there any advantage when the mother is in good health and has abundance of milk, in feeding an infant on extra food besides. On the contrary, the results then obtained are only 52 good, 28.6 medium, and 39 bad develop- I ARC. D*t eeof AK-P. IX*r ... ,.f Mortality. Viability. Mortality. Viability. Month. Firat . ... 960 1 Year. First 115 9 Second . . 273 4 77 u Third 200 5 Third 60 17 Fourth ... 118 | Fourth 27 37 Fifth 118 7 Fifth 21 48 Sixth 127 8 * pp. 13 and 14. 40 INFANT FEEDING AND ITS INFLUENCE ON LIFE. ment. Lastly, and as opposed to these results, injudicious feeding by hand produces 10 good, 26 medium, and 64 per cent, bad development. By reference again to these tables, and by uniting the third and fifth classes together, which include children who have had breast-milk in moderate abundance with other food, from birth or early ages, which we are bound to assume from general experience was injudicious, the results are 35 good, 25.7 medium, and 39 bad development. Between the cases where children are fed by hand, and those in which they are assisted by artificial food, there is a great and manifest differ- ence. If, therefore, with injudicious feeding with moderate breast-milk the results are so favorable, the wonderfully preservative influence of breast-milk must at once be admitted. But we may bring out this truth still more forcibly. a. When we consider the gross ignorance of those who take care of children, injudicious feeding is too mild a phrase. The food supplied acts in many cases little better than a slow poison. This I shall be able to show in the sequel when speaking of babies fed with aluminized bread pap, and the vegetable aliments usually supplied. b. Actual experiment in this direction, and on a large scale, has been carried out by the London Foundling Hospital, and the returns prove that the plan is eminently successful. In this hospital, the children are sent into the country to wet nurses, for the most part married women, with a baby of their own to suckle besides; and these women keep them during the period usually allotted to suckling, and for some time after- wards, and so bring them up. They are afterwards brought back to the hospital. Now it is manifest in such cases, that by far the larger major- ity of women are quite incapable of nursing two hearty children at the same time exclusively upon the breast. Indeed, the exceptions in which this can be done, without very serious injury to the woman, I conceive are very rare. Clearly, therefore, other food is given; and if so, know- ing the little knowledge such women usually possess of what is proper food to give, we may well rest assured that the hand-feeding pursued is not always judiciously carried on. Notwithstanding these disadvanta- ges, the results prove again how strong is the preservative influence on life of breast-milk, even when partaken of only in partial quantities. The following is the mortality, as given us in Mr. Brownlow's book, before referred to. Out of 100 children under five years of age, received at two separate periods, viz., from May, 1835, to May, 1837, and from May, 1837, to March, 1839, Mr. Brownlow shows the following was the mortality: First Period. Second Period. Deaths in first year of their age 12 9 Deaths in second year of their age 5 10 Deaths in third year of their age 2 2 Deaths in fourth year of their age Deaths in fifth year of their age 1 20 21 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 41 The causes of death were convulsions in 9; diseases of membranes of the brain, 5; water on the brain, 4; inflammation of bowels, 4; inflam- mation of lungs in 3; malformation of chest, 3; diarrhoea in 3; croup, 2; scarlet fever, 2; hydrocele, atrophy, bilious vomiting, scrofula, hooping- cough, teething, and breaking a blood-vessel, of each 1. Now, making all allowance for a country residence, which we have seen before exercises a favorable result upon hand-feeding, the results are very satisfactory. The same conclusion may be brought out in another way. It is not generally known, but it is nevertheless almost universally the practice in North Wales to feed children from birth, besides giving them the usual breast-milk. Now it were natural to suppose, that if such a course of action were injurious to children, the mortality among infants would be greater in this part of Great Britain than in other counties. The reverse, however, is the fact. From the table given in note below, it appears that the deficiency of breast-milk has comparatively but a small effect in North Wales, the mortality being actually less out of seventeen counties, taken indifferently, if we except Dorsetshire and Devonshire. 1 The efficacy of this plan is, however, more obvious for the later months. The child so brought up, if he weathers the first quarter, has more viability. Thus fewer upon the whole die under one year. In reference to the number of cases dying from want of breast-milk, the Registrar-General's tables give also a lesser mortality absolutely from this cause in Wales. This is an important conclusion to arrive at when we consider the injurious quality of food given, to which I must again refer, and is strongly illustrative of the preservative influence of breast- milk. Secondly, in reference to light. If close and ill-ventilated apartments are injurious to children, so is absence of light. We are all cognizant of 1 Proportion of deaths to 1,000 births in England, London, and several counties, taken indiscriminately, from want of breast-milk, in the years 1863 and 1872 : 1862. IST'J. England. 1.4 1.4 London 46 2.1 Oxford 1.2 2.9 Cambridge 1.1 4 Durham 1.0 1.5 Norfolk 2.4 1.5 Kent (extra metropolitan) 1.8 1.8 Surrey (ditto ditto) 3.9 1.3 Westmoreland 5 Dorsetshire 3 0.17 Devonshire 8 6 Monmouthshire 1.4 1.8 South Wales. 2 1.0 North Wales. 08 2 York, Went Riding 4 1.1 York, East Riding 2.03 8.4 NorthRiding 5 1. 42 INFANT FEEDING AND ITS INFLUENCE ON LIFE. the salutary influence upon plants which light exerts. Deprived of light, th> v become pale, emaciated, lose finally all color, and elongate without keeping their consistence, and lose all their usual properties. The ordi- nary chemical changes in the plant do not occur. The same is true with animals; whether in the obscurity of a cell, in dark habitations, in caves or mines where the light of the sun does not penetrate, man loses his strength and color; his flesh becomes soft and flabby; and this habit, if long continued, degrades him to that point that he cannot bear the light of the sun but with pain. The above remarks, in part extracted from De Bureaud Riossey's work on the physical education of women, are extended at length to illustrate the importance of light to children. Dr. Milne-Edwards' experi- ments on the development of tadpoles in the dark and in the light are alluded to. An animal which, in the first stage of its existence has the character of a fish, with a tail, branchiae, and no limbs; and in the second stage no character of fish, no tail, no branchise, and four limbs, afforded an excellent subject for these experiments, and it is well known that the results proved that these changes, if not absolutely prevented, were sin- gularly retarded by the privation of light. The infrequency of deformity among the Chaymos, the Caribs, the Mexicans, the Peruvians, is ascribed by M. Humboldt to the free action of light on their bodies, rather than to any peculiarity by which their life is distinguished from that of the in- habitants of more civilized countries, and it is certainly probable that the use of what the French call insolation a free exposure of the body to the sun and air might, as suggested by Dr. Edwards, be advantageously had recourse to in scrofulous affections and other maladies of degeneration. "It is presumed by some physiologists, that the frequent and free ex- posure of the body to the atmospheric air in the fine climate of Greece tended to the development of the exquisite forms which yet live in ancient works of art. The traveller in Ireland, if acquainted with the condition of the poor in our large manufacturing towns, may usefully compare ap- pearances, resulting on the one hand, from habitual residence in dark habitations; and on the other, from almost constant exposure to sunshine and air. The manufacturer's younger children leave the cellar or the garret, but only for the narrow court or damp, neglected back street; but the Irish cottager's child, although born in even greater poverty, runs about as soon as it can run at all in the open air of a temperate cli- mate, not at all overburdened with clothing. The pale, unhealthy, scrofulous character of the manufacturer's child is too well known, whereas it is impossible to imagine finer examples of childish beauty and grace than are beheld at the doors of Irish cabins." ' In fact, light is a very effective stimulant, and, except in diseased states of the body or where the light to which an animal is exposed is excessive, it materially increases the vitality of the animal. 1 British and Foreign Medical Review, vol. v., p. 404. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 43 Dr. La\ r cock, in his work on the Reflex Function of the Brain, has alluded to some of the influences of light on the nervous system. How it maintains activity and tone, and prevents sleep is well known. This influence is subject to the law of diffusion. Sometimes it acts powerfully. Jungken was acquainted with two persons who were instantaneously seized with asphyxia if light were excluded, or awoke in a state of suffocation if their taper had gone out. A case of this kind is mentioned in Dr. Forbes's translation of Laennec. In these instances the incident excited impression of light, maintained the activity of the respiratory ganglia prevented them, in fact, from going to sleep. The diffused influence of light will pro- duce an opposite effect. Observation 86, in Bordeu's Hecherches sur le Pauls, is that of a very aged female on whom a single ray of the sun, or the light of a candle, excited an abundant sweat, so that she was obliged to be always in the dark. 1 A bright surface will often suffice also to induce in a person affected with hydrophobia a characteristic paroxysm.' These are examples of diseased action, and useful as illustrations of a common law. Exposure to excessive light, on the other hand, is injurious. Headaches, apoplexies, and even mania, may be produced by insolations. There is a need, therefore, of moderation. Light so used will do good, and promote viability, because the strength of the child is also improved thereby. The influence of colors, which is due to a modification of light, is also important, though the full effects of them are not yet made out. Under a yellow-colored glass plants will not thrive, and it has been stated that school boys kept in rooms painted yellow are sufferers. It is well known also, that the yellow-colored glass is taken advantage of by photogra- phers because it does not admit the chemical rays. Here is, probably, therefore, the reason it is unhealthy. The colors of porous bodies have been shown by the experiments of Dr. Stark, to exert a decided influence over the absorption of odors, the dark colors being most efficient. He has suggested, therefore, by a fair analogy, that color may modify also the absorption of contagious effluvia. 1 1 British and Foreign Medical Review, vol. xix. , p. 308. /a., v. p. 201. 44 INFANT FEEDING AND ITS INFLUENCE ON LIFE. CHAPTER VII. Conditions affecting Viability, continued General Remarks on the Characters of Food It should be Animal for a Youug Infant, and supplied by the Parent, as proved by Analogy among Animals and the Anatomy of Infants The Food should be given to a Child in Semi-erect Position, and Warmth required by an Infant. I HAVE before alluded to injudicious food given in the absence of breast-milk, in its relation to mortality. I have now to consider food when given, in its relation to viability. It may then be broadly stated, that animal food is indispensable to a child in the earliest periods of life. I may so far anticipate here in a few words what I purpose to refer to more fully in the sequel, when speaking of alimentation. Food, as is well known, to be capable of supporting life, must contain three substances in due proportion: 1. Plastic or nitrogenous matters, to nourish the fleshy or muscular parts of the body. 2. Calorifiant or combustible matter, i.e., hydro-carbons, to supply the respiratory process, to keep up animal heat, and to provide fat for the body. 3. Mineral matters, or salts, to supply the bones, and hold in chemical union, combination, and action, the solids and liquids of the body. Among the first class are fibrine, al- bumen, or casein; among the second, fats and oils, sugar and starch; among the third, lime, potash, soda, magnesia, in union with phosphoric, sulphuric, hydrochloric acids, and many others. Some one or more of these are contained in all aliments in beautiful combination, and so they are found capable of supporting life. Singly, however, or as a simple substance, these plastic, fatty, or mineral matters cannot do this; starva- tion, in modified forms, being always observed to follow their employment when given alone. Milk contains these three substances in combination. There are ca- sein, the plastic ingredient; fat and sugar, two combustible substances; and the several mineral matters needed. As such, if good in quality and given in sufficient quantity, it will support life for an indeterminate length of time. The proportions in which these substances are contained in other aliments vary, but it should at least be 10 of plastic to 30 or 40 combustible, and the mineral should vary from 1.5 to 6 or 7 per cent. Now the whole analogy of comparative anatomy proves that all young animals require animal food for some time after birth, because (a) this is generally supplied by the parent, or by some adventitious animal struc- ture, (b) The infant itself is so anatomically and physiologically made as to be capable of digesting animal food only. 1 1 See Burdach'a Physiologic. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 45 (a) The following facts, chiefly taken from Burdach, will illustrate the ' first proposition. In many species of mollusca, and especially in gastero- poda, in many insects, and among the batrachian reptiles, the mother produces, together with the egg, what is called a nidamentum, which nourishes it for some time after its birth. Certain insects even feed upon the external envelopes which surround them, as in the case of the stra- tismys chameleon. The yellow substance which surrounds the abdominal walls in some animals, or which is enclosed in the central abdominal cavity, is an aux- iliary of this kind. Its presence explains the fact that spiders and snakes, for instance, remain some time after birth without requiring any other kind of food. The raw food which the greater number of birds give to their young is exclusively animal; hence the more readily attain- able and digestible. The northern ducks and the petrels, with their nests situated on high rocks near the sea, easily procure this food, and they always return to their nests richly laden with fish. The sparrows nour- ish their young with insects and worms, which they find everywhere in abundance; and hence certain rapacious birds, which require a greater amount of animal food for their young, become at the breeding season particularly audacious, in order to procure it. Some of the sparrow and crow tribe bring the nourishment in their beaks, emptying it into those of their young. The rapacious birds, on the contrary, bring it in their claws, place it before their young, and tear it in small pieces for them. The heron and the pelican bring the fish in the pharynx, which is dilated to a large pouch below the bill; and the pelican, applying its lower jaw against its own breast, allows its young to eat out of this pocket as out of a plate. Among some species of vul- tures and dark-winged eagles, the crop seems to serve as a reservoir for the food intended for the young. Approximating to a higher degree of maternal co-operation, the female does not give nourishment to her young till she has in part digested and assimilated it. The bees and wasps are of this class, and swallow some pollen, and then disgorge it mixed with honey. Among pigeons, the greater number of grallatores, some palmi- pedes, and many sparrows, the mucous membrane of the oesophagus is dilated into a crop, well supplied with vessels, into which the grain, which is difficult to digest, is first conveyed, and then softened under the chemical influence of a fluid analogous to the gastric juice of the stomach. When half digested, and converted into a kind of chyme, it is subse- quently disgorged into the beak of their young. This modified chyme it is which is popularly called pigeon's milk. The male assists in this opera- tion as well as the female. Finally, in mammalia we arrive at the pro- duction, exclusively by the mother, of real milk, which bears in its com- position considerable resemblance to the diluted yolk of egg, and in some respects to the ///> B& 1 tl Strong and healthy 629 420 Ill 95 or 66. p. cent. 2( Hi Proportion per cent M 7 18.1 l.V 34 s Delicate and sick 323 88 69 i 66 or 33.9 p. cent. 2: 5 Proportion per cent 27 2 19.2 27 4 4fi 6 Total 952 ra 181 c 161 4 4 Proportion per cent 3 I'.i 2 27. 4 40 5 54 INFANT FEEDING AND ITS INFLUENCE ON LIFE. less firm, and is generally remarkably pallid. The women affected with lliis variety are generally women who have begun to bear children late in life, and are usually of a weak or leuco-phlegmatic habit. In their ap- pearance they do not materially depreciate. The quantity of milk is so sp.-ftlily increased by a high regimen that they generally avoid it, and thus after a time the child becomes weak, and obnoxious to tubercular diseases, more particularly water on the brain, and is generally very exci- table, and liable to convulsions. In the second variety there is an excessive or moderately abundant flow of milk. The mother herself is the chief sufferer. All she takes seems to go to the formation of milk, which acts as a drain upon her sys- tem. Dyspeptic troubles soon creep in ; the appetite is bad, food seems to disagree with her, and she becomes less able to supply the milk required. This secretion seems finally to be obtained from the very waste of her body. She becomes thinner and thinner, and weaker daily, till perhaps fainting fits supervene ; gradually, there being no source from which the secretion of milk can be kept up, it ceases, and lactation becomes impos- sible. At this stage the case is one of defective lactation, and symptoms present themselves which belong to the second variety of the third class, under which head it is best considered. The remarkable circumstance is, that all this while the child often thrives well. The milk secreted has been comparatively good, and such mothers have often such heavy children that they have not the physical force to carry them. Serious functional, and sometimes organic lesions, and diseases of the womb and chest are not uncommon in cases of this kind. In an able paper by Dr. Ashwell, 1 this has been well shown: still in these cases Dr. Ashwell lays down distinctly the proposition, that, " al- though lactation to be morbid need not be long, and that evil conse- quences may ensue occasionally after a few weeks of suckling, still these symptoms occur more frequently when the period is protracted beyond nine months " (p. 60). This is so far a ground for comfort to a mother who is anxious to try her utmost (as I think it is always her duty to do) to suckle her child, and thus give it a better chance of life. Drs. Merei and Whitehead have enabled us again, from their tables, to estimate the probable percentage of these women. " Out of 952 mothers examined as to their sanitary condition, 323 were delicate or sick, and of these 88, or 27.2 per cent., had abundant milk." The third variety of galactorrhcea, I have generally observed among weak and deli- cate women, although it may be found among the more healthy. The milk flows outwardly suddenly and in large quantities after some emotion in which the child is concerned, and especially if the child comes to the mother. It flows so rapidly that the infant is well-nigh choked as the milk comes into its mouth, and overflows all round it, completely wetting the mother. Usually between the periods when the child takes it the a Hospital Reports, v. 1840. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 05 milk keeps oozing out. The breast as it were, like an incompletely closed tap, leaks. Upon the whole, the quantity of milk secreted is below the normal standard, and such cases are rather remarkable for the watery character of the fluid. The disease here is one of weakness, analogous to that which occurs in weak persons of both sexes in incontinence of other secretions, and arises from a relaxed state of the whole system, especially of the outward openings of the lactiferous tubes. The third class includes wet nurses affected with defective lactation. The tables of Drs. Merei and Whitehead above quoted, prove that among healthy mothers, as we should naturally expect, only 16.5 per cent, will suffer from defective lactation, whereas, among weak and delicate women, the number will reach 46.6 per cent. But when we come to compare the cases of defective lactation among themselves, as to the causes of the in- sufficient supply, the figures tell a different tale. I have here taken two tables of Drs. Merei and Whitehead from the First and Second Reports (see below'); and these prove that the number of women affected with defective lactation is unexpectedly large. The affection is, therefore, far more common than is generally supposed. My experience is pretty nearly the same, although I cannot yet as sat- isfactorily reduce my results to figures as Drs. Merei and Whitehead have done. For convenience, however, I may speak of them more generally as follows: There are three varieties of defective lactation 1st. One arising from a state of hyperaemia, or from over-feeding. This is the rarest variety, and by far the most remediable. 2d. One accompanied by a weakened or anaemic state of the body, contributing about 11 per cent, of the number of cases. This is improperly supposed to be the most frequent variety, and it is among such examples that the effects of hyper-lactation, and the termination of the second form of galactorrhoea, are most generally ob- served. The third variety is by far the most common, amounting to about 30 per cent. It usually obtains among middle-aged women, 01 those who have married at a late period in life, or who may be rather masculine in form and character. It commonly happens in these cases that during suckling periods the secretion of milk is never properly estab- lished, or, if present, soon disappears. As in cases of obstinate constipa- nr-t Second Report. Report. Total. p. c. p. r. p. c. Mothers going out to work 32 or 24.9 152 or 29. 7 184 or 28. 7 rational debility 1 ) Buckling irregularly and immoderately. | oo 17 > 132 or 25.8 ) Illness or disease in mothers r ^ or 17. I r . [ 193 or 10. Adranced age J 89 or 7.6^ Destitution, want of sufficient or suit- able food. 19orl4.7J 52orlo>2 71orll.O Domestic troubles . . J Natural scantiness of secretion, without obvious reason 56 or 43.4 136 or 20.6 192 or 30 2 129 or 100 511 640 56 INFANT FEEDING AND ITS INFLUENCE ON LIFE. tion of the bowels, so here, there is difficulty in secreting milk, although the body itself is well developed and the physical powers good. These three varieties require separate notice and treatment. 1. Defective lactation from hypercemia or plethora. This is a variety which I have chiefly observed among hired wet nurses selected from the poorer classes, and admitted into wealthier families. It is a peculiarity of many of our London poor, indeed of domestic servants generally, that when obliged to support themselves, or put upon board-wages, they live as it were upon the smallest quantity of food possible; but when feeding at the expense of a master or mistress, the amount they devour often sur- passes all moderate imagination. They, in fact, gormandize. If in such instances a wet nurse is given all she asks for, she will be found often to eat quite as much as any two men with large appetites; and as a result she becomes gross, turgid, often covered with blotches or pimples, and generally too plethoric to fulfil the duties of her position. The plethora, as first induced, is of the sthenic variety; but it soon assumes an asthenic character, and as the immediate result, the breast no longer secretes its quantum of milk. There may be good milk secreted, but it is in small quantity, and this quantity diminishes daily. The breast may also en- large, but it is from a deposition of fatty tissue in and about it, as in other parts of the body. The veins on the surface become less apparent, always a bad feature in a suckling breast, till finally the flow of milk ceases altogether. 2. Defective secretion from anaemia, or privation, or exhaustion. This, as I have before stated, is generally believed to be the most common variety. But this is a mistake. From the tables before quoted, it ap- pears that in Manchester they constitute about 14.7 per cent, of all the cases accompanied with defective lactation. Drs. Merei and Whitehead have offered another table, 1 showing that there was not that close relation between a deficiency of milk secreted, and the degree of cpmfort enjoyed or aliment taken by their patients; so far as these could be measured by the amount of their wages.* This insufficiency of milk, however, is here taken relatively to the infant; the mothers, perhaps, might have had an abundant supply, had they not separated themselves from their infants during part of the day to attend to their trades. But this circumstance, of course, more frequently happens with those engaged in the less lucra- tive trades. The reason which has led probably to the belief that these cases so frequently occur, as compared with other varieties, is, that they are pre- cisely those which come most commonly under treatment. Thus, in Drs. Merei and Whitehead's Reports, we find it stated, under the head of 1 Second Report, p. 10. i A full supply Medium Insufficient of breast-milk. breast-milk. breast-milk. Upwards of 18s. per week 120 60 122 Leaa than 18s. per week. . ..122 72 112 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 57 " suckling mothers' diseases," in the first year 43 cases, 30 of bronchitis, diarrhoea, etc., and 13 of anaemia lactantium; in the second year, 53 cases, nearly all of constitutional debility and deterioration of milk from hyper- lactation; and in the third year, 79 cases, more than 60 of which were af- fected with anaemia lactantium; nor is it surprising that such cases should be common among those examples of poverty which crowd our cities. Insufficiency of food must produce insufficiency of milk. The symptoms of this variety are well marked. The face of the patient betrays a hag- gard and starved look; it is remarkably pallid; the eyes are preternatu- rally bright, and with dark marks beneath them; there is breathlessness, with pains along the back; frequently copious leucorrhoea; and the pa- tient generally complains of a sinking sensation at the epigastrium, and of exhaustion. It is extraordinary how, in some of these cases, the little children themselves keep up a remarkable amount of fat in their appear- ance; but in such cases, though not by any means in all, I have frequently traced the source of this embonpoint to the fact that those children were also fed artificially. The most fearful symptom, however, to which these women are liable is loss of sight, and frequently of memory; and in the lower orders, where the want of food, required to compensate for the drain which has been made, is supplied with so much difficulty, the recov- ery of the sight and of the mental integrity is a very long process, ex- tending often over years. I know one case in which this recovery, not- withstanding a long-continued chalybeate treatment, with good food which was procured, failed to restore complete integrity as at first over a period of two years. Dr. Ashwell, in his paper before alluded to, on hy- perlactation, enumerates several examples of this result; in addition, he shows that epilepsy, and even insanity, may result from women oversuck- ling theif infants. I cannot say that my own experience confirms the oc- currence of similar symptoms in women who, having an insufficiency of milk, have still persisted in nursing their children. I have seen many examples of weakness and anaemia to a marked degree, but none of these more severe results; and the reason is obvious: where defective secretion of milk first arises from debility, the complete suspension of the secretion will follow long before these mental and bodily symptoms to any marked degree can occur. 3. The third variety is the most common. A natural scantiness of se- cretion, not due to want, occupation, constitutional debility, advanced age, etc., constitutes 30 per cent, at least of all cases. But I would in- clude under this category many of those cases which occur in women of more mature age, probably included in the tables under the term "ad- vanced age," but which certainly cannot be fairly so designated. I would also include under this heading many of those cases of defective lactation produced by irregular suckling and going out to work, because neither of these cases may be included under those of hypersemia or anemia. 53 INFANT FEEDING A>TD ITS INFLUENCE ON LIFE. CHAPTER II. Disadvantages to a Healthy Woman if she does not nurse. Sore Breasts. Nipplea Development of Cancer, or other Uterine Diseases. A Diseased Offspring. SHOULD a healthy -woman suckle her children ? This, and the disadvan- tages which are likely to result to herself if she does not, are what we have next to consider. " La femme," says Burdach, " 6prouve un sentiment voluptueux en tetant son enfant;" and naturally so. It is always delightful to perform a duty, how much more a maternal obligation! Is there a more delight- ful occupation for a mother than to watch the little babe hanging upon her breast, so helpless, and yet so fondling, nestling so closely to her, and feeding so contentedly upon her milk ? Is there any means by which love can be more riveted between two beings in such intimate and close relation ? " Can a woman forget her sucking child ? " And when every day brings new pleasures, and ripens on both sides the mutual affection, when the child thrives well, and, as if in tender gratitude, lies smiling upon the mother's lap, what a comfort, what a happiness for the mother! It is scarcely credible, yet a painful evidence of our fallen nature, that there are to be found those who can so far forget themselves, and their responsibility before God and man, as to transfer to others the perform- ance of those duties, nay, who will even conceive them irksome, because for a time they interfere with their pleasures and gay occupations. Could the brute creation speak, they would cry " shame " upon such, and all nature united would re-echo the cry upon such egotistical and cruel parents. But this is not all. The mother will not only suffer moral punish- ment: in this ^natter the chances are that she will find if she sows to the flesh, she has of the flesh reaped corruption. Not only may her own natu- ral feelings and those of her offspring towards herself become blunted and callous, but she may also be the victim of immediate bodily suffering, perhaps ultimately of loathsome disease. Painful distention of the breast, fever, and very painful abscesses may occur, which, by weakening the system, lay the foundation of exhaustive diseases, such as anaemia, indigestion, and even consumption. The less selfish mothers fare better. Young, 1 quoted by Ferris, gives the cases of 2,400 women in different lying-in hospitals; two only of such had milk 1 De Lacte, p. 7. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 59 sores: and Nelson, in his Essay on the Government of Children? in- stances 4,400 cases, of which four only had milk sores, and " these had no nipples, or had had formerly sore breasts." ' All these women suckled their own infants. But it may be worse than this. It has been said that cancer is the ultimate result. Haller, Ferris, and Sir A. Cooper all adhered to this opinion. The late Dr. W. Hunter also believed that a very considerable proportion of those unfortunate women who are afflicted with cancer of the breasts are such as refuse to nurse their own children. I am aware this opinion is not quite confirmed by recent inquirers. Mr. Birkett has favored me with an analysis of 485 cases of cancer which he has made, and which have come under his personal observation. Of this number there were 389 married women, and only 96 single women. This proves that the disease is more common among married women. Most of these belonged to that class of life in which the mothers usually suckle their own infants, so that it is difficult to show that the dis- ease is mainly produced in those who suckle least. However, this opin- ion appears to be the most probable, from the observation of the high authorities before quoted. For it remains to be seen whether all Mr. Birkett's cases not only suckled, but did so regularly and for a proper term. It is known that at least twenty-eight per cent, of these women usually go out to work, and neglect to nurse their children properly. The question must, therefore, be still considered sub judice. Still, Haller's opinion is certainly more in accordance with theory, if we compare the appearance and condition of those mothers who do not nurse their chil- dren, with those who do. The former, as a rule, deteriorate in every way. Their nutrition is defective and perverted a condition highly favorable to the development of cancer. On the other hand, suckling mothers ac- quire proportion, size, and health, a condition in which cancer seldom if ever occurs. The exceptions are only found in those cases where either suckling is carried on to excess, or where poverty and want forbid the taking that quantum of food necessary to the proper performance of this function. Nothing tends so much to develop women as suckling. But if there be any doubt as to the influence of not suckling upon the production of cancer, there is none whatever on its influence in the development of other disease of the womb often of a very severe and painful kind, of long duration, and it may be, incurable. Owing to the sympathy which exists between the breast and the womb, if the function of one of these organs be not properly fulfilled, the other is sure to suffer. The immediate effect of suckling is to cause the womb to contract. Hence the reason that sucking a breast when a woman is flooding often causes the flooding to cease by directly exciting the wished-for contraction. \Vln-n pregnancy has terminated, the volume of the womb is still large, and, unless it becomes lighter, it will by its weight have an increased 1 Page 52, in a note. * Ferris, On. MUk, p. 12. 60 INFANT FEEDING AND ITS INFLUENCE ON LIFE. tendency to fall out. This is particularly the case with a weakly patient, especially if she maintains the erect or semi-erect position too soon after her confinement or walks out when still in a weakly state of health ; and this is the common cause of prolapsus. Hence the need of the constant maintenance of a contracting influence upon the womb, to promote its absorption and diminution of size, and this is what suckling brings about gradually but effectively. The organ becomes reduced in volume, and finally acquires a healthy standard. But if this condition be not arrived at, then the womb remains large and heavy. Bearing-down sensations, back-aches, and copious leucorrhosa result, due to inflammation of the lining membrane of the womb orendometritis, and congestion of the organ, and ulceration of the cervix, etc., with all the painful consequences. Thus, for a moment of selfishness, a life may be made miserable. Another result is apt to follow if suckling is not practised. Women will have children too rapidly for their strength, and thus another cause of endo- metritis is brought into operation. Aran believes that out of 100 cases of uterine disease, at least 62 were due to abortion in pregnancy recurring too frequently. Out of 100 other cases, 70 had not suckled their children. Scanzoni, moreover, attributes displacement backwards, or retroflexion of the womb, to a similar cause. Fifty-four women affected with this dis- ease had 86 children, only 57 of whom were suckled by their mothers. In these the volume of the uterus was not diminished by suction of the breast, and hence the womb fell back by its own weight. 1 In another place, the same writer states that, out of 196 women affected with uterine flexions, only 56 had suckled their children. It would be difficult, per- haps, to find for a woman a severer punishment than this last affection, if combined with local inflammation. It is not unusual to see her ere long a confirmed invalid, and, what is worse, years of suffering may be the result. In the meanwhile, matrimonial life becomes unbearable. She can no longer attend to her duties. She has paid a severe penalty for a selfish disregard to a law in nature, and she must esteem herself fortunate if cured after months, it may be years, of suffering. But more than this. If a woman bears children too frequently and too rapidly, which is a likely occurrence if she does not suckle, or does so for too short a period, disease may be thereby engendered in her offspring. According to Sir William Jenner (and my own experience is so far quite confirmatory of the opinion), frequent child-bearing is the common cause of rickets in the children that are born latest, and deformity in the child may be the result. But even if the extent of mischief done does not amount to rickets, the offspring will very probably prove diseased and weakly and it is to be feared that the mother may not have the felicity of seeing her children attain the age of maturity. The laws of nature are irrevocable, and no woman can afford to maintain a code of her own, in defiance of them, with impunity. 1 Scanzoni, p. 75. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 61 CHAPTER III. Causes and Treatment of Galactorrhoea. Causes : a Peculiar Temperament A Men- orrhagic Tendency Patients who suffer from Breast Symptoms during the Cata- menia Suppression of some Habitual Excretion Over-suckling Hypertrophy of Breasts Treatment : Dietetic ; Medicinal ; Iodide of Potassium ; Belladonna ; Colchicum ; Iron Other Remedies. IF it be undoubted that, in the case of a healthy woman, it is her bounden duty and for her good, that she should suckle her children, it must be ad- mitted that there is more room for hesitation in the case of a woman affected with galactorrhoea but even in these cases much may be done, if not entirely to cure our patient, yet to preclude the arrest of wet-nurs- ing altogether. The causes of this variety have not been so well studied, but a few may be mentioned (a) In the first place, a peculiar temperament a pale face, or, if not pale, a white skin, with almost hectic flush a sort of con- gestion of the cheeks, which would rather give evidence of plethora or over-fulness of blood, but which, in fact, arises from the very opposite influence, and a general tendency to local determinations of blood to parts. Among this class of women it is not unusual to find a tendency to galac- torrhcea. (b) A menorrhagic tendency, i.e., a state in which the ordinary monthly secretion is unusually copious, clotty, and of long duration, is another peculiarity which may be observed in such women when they are not in an impregnated state. The secretion of milk which supersedes menstru- ation, and is for the time vicarious of it, is therefore unusually copious. The system has been accustomed to a heavy drain, and so makes amends in another way. It is for this reason that women affected with galactor- rho3a, more especially those suffering from the first variety, appear, for a time at least, to experience no loss of strength. The flow has become a necessity. The following is a good example of the vicarious nature of lactation, with a copious flow of the catamenia, terminating in actual menorrhagia. Cazeaux, in his Accouchements, mentions a case reported by M. Go- dets, where the regular monthly period induced lactation. A woman, aged 25, was suckling her fourth child, when she took in a second child to suckle also. Her several duties, however, soon obliged her to give up the double office. The secretion of milk ceased readily enough. A month later, the regular courses appeared, and with them a slight fulness of the breasts. At each recurrence of the period, however, the breasts 62 INFANT FEEDING AND ITS INFLUENCE ON LIFE. became fuller and more swollen, till, finally, after a few months, she was compelled to seek the aid of a female to relieve her. Measures were taken to reduce the engorgement of the breasts with some advantage, although at each period there was always a slight enlargement with a smaller flow of milk. The case terminated in the establishment of men- orrhagia, for which she sought hospital relief. This remarkable sympa- thy between the breast and womb was noticed long since by Marshall Hall, who believed that in many cases there was functional engorgement of the breast at the monthly periods, and milk in the organ, although it was in rare cases only it was secreted outwardly. Dr. Tilt found that, out of 419 women, the breasts were said to be habitually painful during menstruation in 169. Brierre de Boismont had noticed this occurrence in 100 out of 365 women. The fact affords a ready explanation of the tendency to galactorrhoea during ordinary lacta- tion, if the flow during a catamenial period is great. The following is another case illustrative of the same law, although, as before, exceptional, but sufficing to show the tendency. Dr. Wehr, of Cassel, mentions the case of a laborer's wife who, beginning to menstru- ate at 18, continued regular till her marriage when 28 years old. Ten months after her marriage, she had a healthy child, which she suckled. Since that time,-now six years ago, she has never been pregnant ; but after her usual period, which occurs every four weeks, she has always had a burning sensation in the breasts, both of which swell up and become hard, and secrete more or less milk. Some days before the recurrence of these periods, the breasts again diminish, and the secretion gradually ceases. 1 (') It is but an extension of the same law, in an analogous direction, to say that the disease may likewise be observed in women who have suf- fered much from leucorrhcea, or from diabetes insipidus in a greater or lesser degree, or who habitually perspire a good deal, even in health ; the sudden arrest of the usual drain, as before, calling for a flow from another active gland, and as the breast is chiefly stimulated, so the discharge takes place from that organ. The fact is well established, that when an habitual discharge is suppressed, such as bleeding from haemorrhoids, the catamenial function itself, pus from an ulcer in the leg which has dis- charged freely, etc., serious symptoms may occur, such as internal con- gestions, apoplexy, etc., unless some other secretion takes up a vicarious action to relieve the system; and, in truth, lactation itself is but the new drain that is established to keep up the equilibrium of the constitution, which, having been kept above par to supply the requirements of the child while in utero, now that it is born, needs another outlet. Again, it is but the same law in operation, when lactation is arrested, and a metas- tatic or vicarious secretion of milk takes place from the skin, navel, groin, stomach, intestines, or mucous surface of the genital organs. 3 There is 1 &riti*h and Foreign Medical Review, vol. xii., p. 558. * Lenoir'a Chemistry. INFANT FEEDING AND ITS INFLUENCE OX LIFE. 63 thus no reason to doubt that the exact opposite effect is produced, al- though in all those cases where such a metastatic change has occurred, it has always been milk which has been secreted from the mamma. These cases, it is true, are not numerous. In those instances, besides, where it has been secreted from the groin or skin, the milk may have, in many of them, as it undoubtedly has in some, been secreted from some supernu- merary mamma there placed; the case is, in fact, a lusus natures. In other examples, however, when casein, fat, and sugar the elements of milk have been found in urine, the secretion must be metastatic. One case is recorded where, from some defect, the breast, although full of milk, could not be drawn either by sucking or pumps, and a metastatic secretion of milk, accompanied with general symptoms of cough, took place from the lungs. The quantity of milk so expectorated varied from three to four ounces daily, and it ceased altogether after fifteen days. The same symptoms recurred during four pregnancies. After the sixth no milk was expectorated, and the symptoms were those of consumption, of which the patient died. These facts are of great importance, as con- firmatory evidence of the disposition to metastasis in many cases of lac- tation; also, as explanatory of the converse symptoms, and suggestive of the treatment which, in many cases of defective lactation, should be adopted. Another very analogous case to the preceding, 1 in which the expectoration was also milk, is given by Dr. S. Weir Mitchell. There had been, however, in this case, a scanty excretion from the breast. It is remarkable that this patient also died of phthisis, after the birth of her second child. (<7) Another cause of galactorrhoea is immoderate suckling, although in the long run the opposite result will obtain; the immoderate suckling carried on so over-stimulates the breast, that the discharge from it is materially increased, only the effect upon the system is not so marked. In many cases the secretion becomes habitual, and is kept up so long as there is a requirement for it. In no other way can we explain the cus- tom which obtains in some countries of mothers continuing to suckle their children for three or four years at a time, and even during a subse- quent pregnancy until another child is born, which then supersedes the older one.* Dr. Carpenter quotes a case published by Dr. Green, 3 where a lady, aged 47, the mother of four children, had an abundant supply of milk for twenty-seven years consecutively. A period of exactly four years and a half occurred between each birth, and the children were per- mitted to take the breast until they were running about at play. At the time when Dr. Green wrote, she had been nine years a widow, and was obliged to have her breasts drawn daily, the secretion of milk being so copious. I have myself met a large proportion of cases in which a little 1 American Journal of Medical Science, 1855; Banking's Half- Yearly Abstract, vol. xxii., p. 209. ' See Carpenter's Phynotogy, p. 1068. 1 New York Journal of Medicine and Surgery, Sept, 1844. 64 INFANT FEEDING AND ITS INFLUENCE ON LIFE. milk might be drawn off even months after all suckling had been aban- doned. () There can be no doubt, however, that irritation in the womb it- self, or its immediate appendages, has a similar effect. Undue excite- ment here has been known while it lasts to produce a jet of milk from both breasts, which has only subsided with the cessation of the stimulus. We are all familiar with the flow of milk from the breasts of married women who are not pregnant, and even of virgins. The quantity secreted under these exceptional circumstances is very scanty; but I have seen women who, after slight titillation of the nipple, were able to milk out a very sensible quantity. The immense amount of hypertrophy ' to which the mammae will attain in many cases of disease of the womb, and the concomitant pain in them, are well known to all practitioners. The en- largement in these instances is not one merely of the fatty structure around the breast, but of the lacteal tubes themselves, which are as large as, and even more numerous than, those of a wet nurse. When the ducts are present, then there is no reason to doubt that if the ordinary stimulus to the breast itself were brought to bear, milk would flow. What this particular womb irritation may be, does not become me to speak of here, but it is probably either analogous to that which occurs in a pregnant woman, when milk appears in the breast before delivery, consequent to the death of the child, or local excitement which may affect the organs connected with the womb. The following is an exam- ple of this kind. M. W., a fine healthy-looking woman, applied to me for some uterine disease. This, on inquiry, proved to be fundal endome- tritis. She had been twice married, had had three children by her first husband, but none by her second, although married to him upwards of two years. Her last labor, ten years ago, had been severe, instruments having been used. While suckling, her milk had been exceedingly abundant, although she was obliged to give up nursing at the end of three months, because of weakness and some loss of sight. " Her medical attendant had told her all her substance went to form milk." Besides the uterine symptoms, which need not be further detailed here, the appearance of the breasts was remarkable. They were very large, hypertrophied in every way, in the glandular as well as fatty structure, and milky fluid could be extracted from them. The areola was dark, and in other respects very like that of a breast in pregnancy. The catamenia occurred regu- larly, and till lately had not been very copious; but what was remark- able was, that immediately after they ceased, the breasts would swell up, become painful and turgid, and secrete milk. So soon, however, as the catamenia reappeared, they would become smaller and cease to secrete; 1 Velpeau, in an article published in the Gazette Medicals de Paris, No. 42, 1858, gives the statistics of 807 cases of diseases of the breast, 400 malignant, and 407 benign. Out of the 407 benign, hypertrophy occurred in 121 cases, i.e. , 29.6 per cent, on the benign, and 14.7 per cent, on all cases. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 65 but even at their smallest size they were unusually large and hypertro- phied. The treatment to be pursued in these instances will, of course, vary with the different cases ; and it will in part also depend upon the causes which have called the disease into action. It may also be dietetic as well as medicinal. In the first place, the quantity of fluid which is taken should be limited, if the secretion be abundant; and particularly those drinks (to be hereafter noticed) which have a tendency to increase the flow of milk should be avoided. If the disease occur in females who have suffered from menorrhagia, or from other habitual discharges, and should there be no weakness present, then purgatives and other derivative medicines may be used with advantage, while the breast itself is kept cool, and the child not applied to it more frequently than every three hours. The disease is, however, far more generally one accompanied by a state of weakness, and therefore tonics are, as a rule, to be ordered, and those of an astringent character are to be preferred, such as oak bark, cinchona bark, and most of the vegetable infusions, the bowels being regulated by alteratives. Together with those in the second variety, good wholesome solid food, of an animal nature, should be given to improve the quality of the milk, as well as the strength of the wet nurse herself. When cases of the second variety of galactorrhoea are treated, it should be remembered that the ultimate tendency of the dis- ease is to defective lactation, if the strength of the mother is not main- tained. In these cases, therefore, drinks may be allowed in moderation, especially those which have a nutritive quality, and are not very stimulat- ing. Where, however, the flow is excessive, then the treatment to be adopted is to be more direct, and comes very closely to resemble that adopted in cases where it is wished to wean the child, and at the same time to prevent the occurrence of inflammatory mischief or abscess, which so commonly occur when it is attempted to disperse the milk in the breasts. Ml!,-!i,>il Treatment. There are four remedies at least which are known to have an antigalactic effect: these are iodide of potassium, belladonna, colchicum, and iron. In regard to the first of these, Profes- sor Rousset ' was led to employ the remedy in inflammation of the breasts and abscesses to diminish the fulness of the organ, and to dissipate the troublesome milk knots. " The iodide of potassium," he says, " occa- sions a considerable decrease of milk, and consequently prevents and re- moves milk knots, particularly if nt the samo time the child is not put to the breast. The milk returns quickly if the medicine is not used longer than two or three days. Its effect is more decided if the dose does not exceed five to eight grains daily. The secretion of milk can almost be completely prevented if the iodide of potassium is given on the first or 1 Journal dt Bordeaux, Maj, 1858 ; Banking's Half- Yearly Abstract, vol. xxix,, p. 178. 5 66 INFANT FEEDING AND ITS INFLUENCE ON LIFE. second day after delivery." The author gives a full report of seven cases to confirm the above statements. Dr. Gardner, Professor of Midwifery at the New York Medical Col- lege, in a paper on galactatics, speaks approvingly of iodide of potassium as an antigalactic, or, as he terms it, iscliigalactic, i.e., an arrester or sup- pressor of milk; and his opinion is confirmed by that of Dr. Gallarcl Thomas. Both, however, admit that it occasionally fails. 1 The accounts given of belladonna, in its influence upon the secretion of milk are somewhat contradictory, yet I think all these apparent differ- ences are to be explained by the method of its exhibition. Mr. W. B. C. Fifield, of Weymouth, states 1 that the use of bella- donna as an antigalactic was known as long back as 1829. M. Ranque, of the Hotel-Dieu, Orleans, employed it to allay the irritation of the breast as a liniment night and morning, with rigid diet and sudorific drinks. Dr. Schnttr also referred to it in a paper published in the J)h- lin Journal (1834). He rubbed it in as a liniment, to arrest milk abscess. This liniment consisted of laurel water ij., sulphuric ether | j., extract of belladonna 3ij. ; well shaken before use. The whole breast was to be rubbed over with it even to the axilla. Sehnur, however, believed the ether to be the principal active medicine in the compound; and therefore urged its employment with it, notwithstanding its bad odor. He cites three cases in which it was used, and in which it acted most beneficially. Dr. Goolden, in a paper published in the Lancet? instances two cases in which this remedy was employed. In the first, the case was one of rheumatic fever, admitted into St. Thomas's Hospital, and from whom, by the rules of the hospital, her child, aged four months, was taken away. This patient had consequently the breasts in a very full and tumid state. They were hard, painful, knotty, and extremely tender. The superficial veins were distended. The axilla and both breasts were smeared over with extract of belladonna; a little colchicum wine was also given. By Dr. Goolden's third visit the breasts had become soft, all further secre- tion of milk having been arrested. In a second case, the wife of a clergy- man, desirous of travelling with her husband, had weaned her child; a state of breasts very similar to that in the last case soon resulted. The belladonna extract was ordered, and a purgative. Within two hours after its application the milk was absorbed; and what is very important, there was no fever or other inconvenience attending the sudden suppres- sion of the milk; and instead of taking the opening medicine prescribed, she was able to continue her journey the next morning quite comfortably. One case of milk abscess prevented by belladonna is given by Mr. Hughes, Surgeon to the Brighton Orthopaedic Hospital. 4 1 Braithwaite's Retrospect, vol. xliii. , p. 342. * Ibid, vol. ixxviil, p. 283. * Lancet, August 9, 1856 ; Ranking's Half- Yearly Abstract, vol. xxiv., p. 189. 4 Braithwaite's Retrospect, vol. xlii., p. o9G. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 67 Mr. Burrows, of Liverpool, has given another case confirmatory of this antigalactic effect of belladonna. A lady, aged 26, commenced the weaning of her child March 10, 1857. On March llth she was seen. Painful symptoms in the mammre, as in the cases before mentioned, pre- sented themselves. A dilute belladonna ointment was applied. Although the effect in this case was made doubtful by the lady having washed off the ointment and then re-applied it, and because purgatives were also given, on the 13th the breasts had lost all tenderness, the fulness was re- duced, and all secretion of milk was arrested. Mr. E. U. Barry, of Covent Garden, gives an account of two cases treated with extract of belladonna, in which, however, unfortunately, as the exhibition rather affects the question, a saline mixture with half- drachm doses of colchicum was also given. 1 In the first case, the third day after her confinement, the symptoms of inflamed breast were very prominent. They were red, tender, throbbing, the milk oozing out a little but insufficiently. The patient was in great dread and anxiety, fearing she would have a bad breast. The child was too weak to suck. The day following the application of the belladonna all the inflammatory symptoms had subsided. The milk was not, however, arrested, but es- caped freely into a bread-and-\vater poultice, also applied. The mixture was omitted, and the woman was about in a few days, and able to resume the suckling of her infant. The second case closely resembled the for- mer, also occurring the third day after labor. The pain in the nipples when the child happened to suck was agonizing. Shields, ointments, and lotions gave no relief. The extract of belladonna was now applied with a bread-and-water poultice externally. The milk flowed abundantly into the poultice, and the active symptoms rapidly subsided. Here, also, the belladonna did not act as a repressive, and the mother was able to resume her wet-nursing as before. The gentleman who seems, however, to have used the belladonna most extensively and philosophically, is Mr. W. Newman, of Fulbeck, near Grantham:* 1st. In cases where the suppression of the secretion is desir- able, as (a) for instance, when the children have been stillborn or died prematurely; or (b) in cases where it has been found necessary to wean a child suddenly, and the flow of m'ilk has continued unabated. 2d. Whore engorgement of the breast has supervened and lacteal abscess is threaten- ing, (a) Whether this engorgement is due to flat nipples, to injury of the breast from a previous abscess in it, or to a defective secretion of milk, thereby rendering the breast more prone to inflammation when the mother is compelled to desist from suckling; and (ft) where the mother has suckled, or is continuing to suckle her child, and for some cause or other congestion of the organ has supervened. Mr. Newman stales that he has used the belladonna extract softened with glycerine, singly and 1 Braithwaite's Itetrotpect, vol. xlii, p. 800. 68 INFANT FEEDING AND ITS INFLUENCE ON LIFE. external to the areola, without giving the usual concomitant remedies, as calomel, purgatives, salines, etc.; and in all his cases, twelve in number, he has been successful in bringing about a resolution of the engorgement, or in arresting the secretion of milk a very short time after the applica- tion of the belladonna. 1 I have frequently myself used the belladonna, and it has certainly, in my experience, had a remarkable effect in allaying the inflammation, in- duration, and swelling of the breast; and I believe that the apparent contradictions as to the effect of this agent are to be reconciled. Berry gives, doubtless, the proper explanation. The belladonna acts primarily on the muscular fibre. The lacteal tubes, in part muscular, are thus dilated. Once this muscular tension in the tubes is removed, one of two things occurs. The milk contained within them is either absorbed, like any other effusion, by the absorbents or veins, in sit A or, secondly, if the external openings of these lacteal tubes on the nipple be particu- larly patent, and any means be adopted which will encourage the flow of the milk externally, it will be drawn out. This effect is produced by a poultice, or the direct application of a child. The poultice encourages this result, by assisting the dilatations of the external openings of the lactiferous tubes, and in this manner the oozing into the bread-and-water poultices in Mr. Berry's cases is to be explained. In like manner, if a child be put from time to time to the breast, the milk will be drawn out- wards by the act of suction. On this supposition the belladonna, I believe, cannot properly be called a repressive, or, according to Dr. Gardner, a ischiyalactic, i.e., a medicine which will disperse the milk. In cases of threatening abscess of the breast, it acts chiefly as a sedative, and, it may be, has a distinct influence in allaying inflammation. In my experience I cannot therefore say that it checks the production of milk. It merely prevents its accumulation in the breast; and with proper care, even if the child is not put as frequently as it should be under ordinary circumstances to the breast, nay, if it be kept away altogether for a time, and the milk be encouraged to flow out by a poultice, or drawn by a pump, so soon as the inflammatory symptoms have subsided the function of the gland may be allowed to go on as before, and the child safely re- applied to the breast. In using the belladonna, I do not use it sparingly, but freely, in the form of extract, all over the breast, except the nipple n< ri.-nce I have found that these pumps, unless very carefully used, do harm, and blood from the ruptured surface is frequently drawn out by them. The measures before recommended, when speaking of the un- wholesome milk secreted by some mothers, may be well adopted here also; but what is far more to the purpose, because it involves no waste or loss of the milk, is the gentle titillation of the nipple previously, catching hold of it between the finger and thumb, and pulling it gently outwards from time to time, imitating, in a milder degree, the milking movement which is practised upon cows. Another mechanical mode of stimulating the breast to secrete milk is electricity. " A gland," says Mr. Lobb, in his work on Nervous Affec- tions^ " receives the stimulus from the nerves of the part. A rush of blood is the immediate consequence, and secretion the result." Mr. Lobb illustrates this flow of blood by the well-known experiment on the frog's web: "The foot being firmly fixed, the wire of the electric magnetic apparatus is placed in contact with the leg, the other at the extremity of the toe of the portion of web under examination, and a weak current passed through. The arteries of the web immediately transmit a large supply of blood, which is forced through the capillaries with great rapid- ity, the consequence being that the foot is bathed in serum. The nerves of the part stimulate the arteries to an increased flow of blood, and secretion goes on actively, until the stimulus is removed to some other complementary gland." He applies this doctrine to the breast, which, although capable, if excited to do so, may not perform its office for years; but the nerves, once stimulated, "allow a plethora of blood, and secretion " (of milk) " is the consequence." ' The presence of a child, by producing a mental influence; friction or suction, by determining a flow of blood to it, have the same effect; in both cases the nerves are stimulated, and thus plethora favorable to secre- tion occurs. Electricity is, perhaps, of all agents that which most closely resembles the nervous force, and most effectually stimulates the nerves. Reasoning d priori, therefore, we should expect it would act very effective, ly, but here experiments are still in their infancy. It has, however, been known for some time that the secretion of glands is increased when an electric current is passed through them. M. Ludwig proved, before the Scientific Congress of Vienna, that the secretion of the salivary glands could be considerably increased by the action of electrical currents prop- erly applied. 1 1 Lobb on Nervoiix Affections, p. 88. * Quoted by Becquerel, Appendix de T Elect ricite, p. 420. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 79 Two cases, however, of electrical application to the breasts, and its effects in reinducing the secretion of milk after its suspension, are given in M. Becquerel's work before quoted. 1 Such cases are so rare that I may be excused in giving them here in abstract. The first of these is borrowed from the Gazette des Hopitaux* and occurred in the practice of M. Aubert: A woman, aged twenty-six, mother of three children, and suckling the last, eleven and a half months, was attacked with inflammation of the lungs. Suction was maintained regularly, and spite of proper food and exercise, very shortly the breasts ceased to secrete milk. Artificial food was now given, but the child refused it, and as a result atrophy visibly set in. In this dilemma electricity was applied to the mother's breasts four days successively for twenty minutes at a time. From the first there was amelioration of the symptoms, and at the end of four days the secretion was completely re-established, and continued till the re- covery of the child. Another case related by M. Becquerel occurred in his own practice. A young woman, aged twenty-seven, of good health and constitution, was suckling a healthy child, aged seven months. All was going on favorably, when in October, owing to repeated moral emotions, the secre- tion began to diminish in the right breast, and was almost entirely stopped in the left. The child was made to suck the breast some twenty times daily, but without success. Artificial food was now attempted, but diarrhoea supervened, and a wet nurse was recommended. This course, however, was obstinately opposed by the mother. M. Becquerel, therefore, as there were still a few drops of milk on the right side, was satisfied with applying electricity only on the left side. This was done three days successively for fifteen minutes each day. On the very first day the milk appeared in the left side, on the third it did so abundantly, and from that day continued to flow in sufficient quantity. The right breast was not experimented upon. Dr. Althaus, of Bryanston Street, well known as having great ex- perience in electrical therapeutics, has favored me with the following ex- ample: " The particulars of the only case of milk-secretion excited by elec- tricity which has come under my observation are as follows: "The patient was a lady in good circumstances, slightly hysterical; aged thirty-one, primipara; parturition had been somewhat protracted, but no operation had been necessary. Both mamma; were extremely painful, hard and hot; no trace of colostrum, neither before nor after parturition. Both in the evening and in the morning she had sensations as if the milk would flow, but in spite of the usual local and external treatment it did not come. Six days after parturition, I applied a strong current (with moistened conductors) to both mamnue for about twenty 1 Ibid., p. 418. September 2. 80 INFANT FEEDING AND ITS INFLUENCE ON LIFE. minutes. The following morning the milk flowed for the first time, though not yet abundantly. No further application of galvanism WHS made, but in a few days afterwards the secretion and excretion became as abundant as could be wished." These cases are sufficiently encouraging to warrant the belief that elec- tricity may often be found a successful galactagogue. But I believe M. Becquerel has since applied this treatment to six other cases, and with perfect success. 1 Dr. Skinner, of Liverpool, has kindly favored me with a report of six cases in which this agent was employed. CASE I. Mrs. , aged about thirty-six, consulted me on account of vaginal irritation and other symptoms, evidently of an anaemic origin. She had been lately confined of her fifth child, and she was then suck- ling her infant. Moderate doses of steel drops were prescribed, but they were speedily followed by a complete stoppage of the breast milk. The right breast had been useless for lactation since an attack of mammary abscess some years before, so that I was only required to re-establish the se- cretion in the left breast. On the 13th August, 1861, 1 applied the stimu- lus of a mild electro-galvanic current to the left mamma. At the time of the application, the patient said that she felt a distinct sensation as of " a rush of milk to the breast." On the 16th the patient reported that, al- though perfectly incredulous of any good result, yet within a few hours of the faradization a copious supply of milk was permanently established in the left breast. On the 21st August I adopted the same measures to the right breast; and to my great .surprise, after two short sittings of less than ten minutes each, the function of this breast was restored, and it became as useful for lactation as the other. The anaemia was subse- quently successfully treated with the effervescing carbonate of iron. CASE II. Mrs. , aged twenty-one, was confined of her first child on the 28th of August, 1861. The labor was normal, and the patient in every respect, to all appearance, healthy and robust. Within a month, in spite of well-directed efforts to the contrary, the milk steadily and gradually decreased in quantity until it was all but entirely stopped. I could divine no cause for the accident. On the 7th of October, 1861, I galvanized both breasts with a similar current to the lastj namely, a mild intermitting, combined current (primary and secondary) from a powerful electric coil machine, made for me by Messrs. Home, Thornthwaite & Co., of London. A similar rush of milk was felt as was experienced by the patient in case No. 1. The result was most satisfactory, as in a few hours the secretion of both breasts was fully and permanently established. As in the previous case, so in this, the patient was perfectly incredulous, and looked upon the operation " as a good joke." CASE III. was a strong and healthy woman, wet nurse to a patient of my own, who, from a purely mental cause, suffered a sudden and all 1 Medical Times. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 81 but total loss of breast milk, and which did not return when the cause passed off. One single sitting of about ten minutes restored the secretion in both breasts within a few hours of the faradization. CASES IV., V., and VI. were mothers, where the supply of milk was always at a minimum and never altogether sufficient for the infant. One or two applications of the galvanic stimulus were followed by the desired result in all of them. The following is Dr. Skinner's mode of operating: " 1. Direct. Both poles must terminate in cylinders with sponges well moistened in tepid water. The positive pole is pressed deep into the axilla, while the nega- tive is lightly applied to the nipple arid the areola; the current being no stronger than is agreeable to the patient's feelings. The poles are kept in this position for about two minutes. Both poles are then to be insert- ed into the axilla and gradually brought together, the negative to the sternal, and the positive to the opposite side of the organ. This latter step may occupy one or two minutes more. " '2. In tra mammary. The poles are to be, as it were, imbedded in the mamma and moved about, raising and depressing both poles at once, in and around the organ for the space of another two minutes. The same is to be done to both breasts daily until the secretion is properly estab- lished. Hitherto, one or two sittings have always sufficed in my hands." Dr. Skinner adds: " Although I have only tried the ' combined currents ' of my own electro-magnetic machine, I am of opinion that any galvanic, voltaic, or magneto-electric apparatus, if strong enough, will as effectually restore the lost secretion." ' Under any circumstances it appears well to employ this simple mode, before having recourse to a wet nurse. 2dly. It is a known physiological fact, that there exists great sympa- thy between the breast and the genital organs, more especially connected with parturition. The proper functional use of the one will influence the other. References to such sympathies are unnecessary, and on the score of morality are better avoided; but I have alluded to them, because it re- moves one of the objections usually made to the selection of married women as wet nurses; and for which preference is usually given to fallen women. It points out the great impropriety there is in keeping a hus- band for a long period away from his wife, when she is suckling, particu- larly if she is a hired wet nurse. This is generally done, because it is feared she may again become pregnant, or, by seeing her husband occa- sionally, may become discontented with her situation, and abandon the child; on the contrary, this very separation (where there is affection be- tween the parties and no disease in the husband) is, I think, cruel, and is liable to bring on those very sorrows and anxieties which so soon and so effectually dry up the fount, when nature points out that the result of an occasional reunion would improve and excite the flow of good milk. 1 Private letter. 82 INFANT FEEDING AND ITS INFLUENCE ON LIFE. Sore nipples, and imperfectly developed nipples, are best considered here as requiring local treatment. Sore nipples may be treated in three ways (a) by soothing applica- tions; (b) by caustic remedies; (c) by shields. (a) Soothing applications. Some persons have recommended lead Lit ion, or opium lotions. These doubtless do good, but as it is desirable that the child should continue to suck so as to allow the lacteal secretion to be maintained in the breast, it would necessitate a constant washing of the nipple each time the nipple is used, else the child might be poisoned. All such remedies are therefore objectionable. In mild cases, gum, honey, solut. tolu, or Friar's balsam, may be applied by means of a camel's hair brush every time the child has been suckled. Often melted mutton fat, put on warm in the same manner and then allowed to cool, will heal such sores when everything else fails. Fuller's earth or bismuth have been also recommended, and sometimes proved useful. But among powders, the powder of the civeolia laevigata, of Mr. Taylor, Baker Street, which is a variety of powder very superior to the best fuller's earth, indeed superior to any other I am acquainted with is that to which we must give the undoubted preference. This preparation is eminently soft, and will cure sometimes the most obstinate of sores. (b) By caustic applications. Experience has proved that occasionally the applications of various caustic solutions, or even of the solid nitrate of silver, skilfully and litnitedly used, are very efficacious. A solution of from 5 to 10 grains of lunar caustic in 1 ounce of water, or 10 grains of chlorate of potass., or bicarbonate of soda to the ounce, will prove very healing. The nipple must, however, be gently wiped with a very soft sponge, or, better still, by a very soft shaving brush, or large camel's hair brush dipped in water, before the child is allowed to resume the sucking. This precaution is, however, unnecessary if we use the soothing remedies recommended in the last paragraph. Often, however, they do no good, and rather irritate, and so we have to try the effect of shields. (c) Shields are generally of four kinds the cow udder, caoutchouc, glass, and wood. The cow udder is an old woman's and a very popular medium ; and if kept very clean and frequently renewed, it often answers very well. The caoutchouc nipple is, however, generally preferred. It is less liable to decompose, which is a great difficulty we have to contend with in warm climates. Kept in a little water and glycerine, when not used, after having been nicely washed in a little warm water, it will re- main sweet for weeks. Occasionally the caoutchouc nipple is made sessile on a glass shield. This form is, perhaps, better than a nipple all of india- rubber. Its very hardness enables it to be kept more closely to the cir- cumference of the breast, so that the nipple is more air tight. But, thirdly, sometimes the shields are made completely of glass or wood, re- sembling in shape and form the ordinary nipple of the areola of the breast, the nipple portion being perforated with holes. I have occasionally been disappointed in finding that a child could not suckle through them. The INFANT FEEDING AND ITS INFLUENCE ON LIFE. 83 fact is, the infant does not suck from the nipple as it should; and, indeed, in the employment of these glass and caoutchouc nipples, not only must the child be tenderly educated to suckle with them, but a good deal of precaution is oftentimes necessary with the instrument itself. The glass should fit the nipple as exactly as possible, and should especially not be too deep. Otherwise, if the mother's nipple be (by the suction made on the artificial nipple) pulled upwards too far, the fissures are again put on the stretch, and the effect is equally painful. Suction must needs, also, be made gradually and by some kind Samaritan, before the child is applied. Once the cavity of the shield and artificial nipple is filled with milk, the child may be allowed to suck, and it will often be able to do so with but little discomfort to the mother. Again, the shield and artificial teat may be filled with warm water, a little sweetened, and applied in this state to the mother's nipple before the child is allowed to suck. In very bad cases, again, it is well to use belladonna, as before stated, p. 68, to the breast, to facilitate the flow of milk. The same precautions being ob- served, in regard to the nipple as before insisted, to prevent poisonous results. The chief and the best course in such cases to pursue is the preventive. Many women, previous to attaining the age of twenty-five, have only the conical-shaped virgin breast, and the nipple is not sufficiently drawn out to admit of its prehension by a child, particularly during the first days of life, when its powers of suction are not strongly developed. Hence much annoyance is sure to occur to the mother during the very early period of lactation. If suction, temporarily, by an older child be practised, or if pumps be used, the nipple is very likely to become fissured, and then ere long suckling will be so painful a process as to be greatly dreaded. But those nipples may be and should be prepared for their function. For two months or so prior to delivery they ought to be carefully sponged every night and morning with some astringent lotion, such as oak bark, or spirit such as eau de Cologne, to overcome the delicacy of the skin. The nipple should also be brought out by the use of the breast-shields. Of these, four kinds are made : wood, gutta-percha, glass, and metal. The two last are to be preferred. In one case I saw the ordinary glasses for Ic.'ikinir nipples used with the greatest advantage, the nipples being brought out very readily by them. This was a lady who had had the greatest difficulty to suckle her child, and then could do so from one breast only, owing to the manner in which the nipple of the other breast was drawn in. Using the glasses before spoken of, she was able to suckle her second child with the greatest comfort from both breasts. Tlu> glass and caoutchouc shield before referred to may be used with great advantage during pregnancy, and so naturally tend to the bringing out of tlio nipple and to lengthen it, so that it is more easily seized by the suckling infant. It should also be used, when suckling has begun, in the interval of rest, and so continues to fulfil the same lengthening func- tion. It also protects the sore nipple against rubbing or any external injury. 84 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 2. Hygienic Treatment. Upon this point there is little need to say much. Nurses, of all others, should have frequent exercise as well as good food. Cleanliness in their persons is equally indispensable, a prac- tice I fear which our poorer classes do not always adopt, since unpleasant emanations arising from neglect of personal ablution are frequently ob- served among them. To expect that a child nestling amidst such odors could thrive, were absurd; but even in those who are cleanly it is astonish- ing how pure air, or rather a change to a more rural air, will often induce a flow of milk in a patient laboring under previously marked symptoms of defective lactation. I remember the case of a lady, against whom, cer- tainly, no blame could be attached for want of cleanliness of person or activity of habits, who, while residing in London, had scarcely any milk whatever, but in whom, when removed to the sea air, a most copious flow was induced, which persisted for months after, when she again returned to London. We all know that with milch cows and goats the effect of keeping the animals themselves and their stables clean is to increase the quantity and improve the quality of the milk supplied. The same general principle is, of course, equally applicable to the human female. The question is one varying only in degree, not in kind. 3. Dietetic Treatment. It has been long known that one of the most effective methods of increasing the flow of milk in all animals is to give them an abundance of food, and it is almost exclusively this plan of treat- ment which has been followed out by practitioners of the present day with their female patients. Simon has proved already, by a special ex- periment made upon a woman in very poor circumstances (and whose milk he examined at fifteen consecutive periods, commencing with the second day after delivery), that in proportion as he gave her good food, so did the quantity of solid matter in the milk increase, albeit the quantity of liquid matter was not so much affected. Hence one reason why prac- titioners have so much faith in this method of increasing the quantity and quality of milk, that they rarely adopt any other. The quantity of food given is far more closely investigated than the quality. Here, again, much that may be said on the subject of the feeding of milch cows or goats applies equally to the diet of a suckling woman. It is the same common office which has to be performed in both cases to pro- duce milk not only sufficient in quantity, but rich in quality, and in this respect, therefore, the disadvantage of a diet too exclusively composed of vegetables with a small amount of azote is to be guarded against. Such food generally makes the milk thin and serous, and it is only when we give leguminous plants, or the higher cerealia, or flesh, i.e., when in point of fact a due quantity of nitrogenous matter is taken, that both quantity and the quality of milk supplied are good. Experience among suckling women proves equally the efficacy of nitro- genous alimentation. First among animal compounds, several are spoken of as galactapoietics. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 85 There is a remedy that has some notoriety in the present day, viz., whiting -soup, which is generally believed to provoke a flow of milk. I believe that this is true, but that its effects are somewhat exaggerated. Still it is good as a change: fish, and particularly those varieties which are rich in phosphorus I allude to oysters and crabs are very effica- cious. Of course these last must be sparingly taken at first, and particu- larly during the first months of suckling, because they do not always agree with the infant, producing' urticaria and roseola; but where this ef- fect is not observed, these kinds of food afford ready means of supplying the phosphates which are so beneficial to both mother and child. As far as my own experience, however, goes, I give very much the preference to conger-eel soup. It is not generally known, but I am told it forms the stock of turtle and many nourishing soups; and for this reason our Frvnch brethren, who have so much taste for " potages," import these eels in immense quantities from this country, and particularly from Jer- sey and Guernsey, where they abound. As a soup it is peculiarly nour- ishing, and very readily improves both the appetite and the strength. Like lentil powder, the stomach will often retain it when it will reject all other kinds of food. Mr. Jones, of Jersey, speaks highly of it, and gives a case in which, when all other means had failed, it checked vomiting after chloroform. Its comparatively low price also renders it very easily obtainable by the poor. 1 Crabs, as a remedy for increasing the flow of milk, are of very old date. 'They are recommended by the author of Gynceciorum* who also prescribes, with the same object, a bluish colored fish (ylaiiciscics), taken in its juice, and a variety of smelts (tmarideti), taken with fennel sauce and boiled in milk. Certain kinds of solid food and flesh have been recommended by emi- nent authors, in preference to those commonly in use. Aetius enjoins the use of fine bread, the legs of swine, tender birds, and the flesh of kids. Indeed, swine's flesh is generally preferred to other kinds of flesh, and among these it probably claims the most favorable mention, after the varieties of fish already alluded to.' Secondly, there are several vegetable aliments which act in a similarly favorable manner. First among these stands revalenta, only another name for the ordi- nary lentil powder' but pea-soup and bean-soup have also a marked effect 1 Three pounds of conger eel and two calves' feet, with two quarts of water. Boil gently until the first is reduced to rags, then strain, and add sweet herbs and asparagus or peas, a pint of milk, a piece of butter the size of a walnut, with a little flour to thicken. When used as a galactagogne, use fennel in lieu of sweet herbs, and haricot beans in lien of the peas and asparagus. * Page 634, A. * (From Oalen.) " Sunt autem hacaves C. conia (swan) vespertalis, noctua apis, et qn baccis junipero pascuntur, undo nominnntur Qermanis quam olifer turtorum genere adnumerant .... Quam merito ejus ramenta jusculis adjiciuntur utpote saluberri- maj etiam puerperorum." See also ./Egineta on eome kinds of game. 86 INFANT FEEDING AND ITS INFLUENCE ON LIFE. in improving the flow and richness of milk. The lentil and bean, however, are preferable to peas, where they are easily procurable. Besides the bet- ter tasti-, the first is slightly aperient, and the latter does not produce flatus either in the mother or child, which peas are apt to provoke. There can be no doubt that some of the culinary plants usually taken an- preferable to others. Women popularly ascribe peculiar galacta- gogue properties to turnips: and the Commission appointed to investi- gate the subject spoke very favorably of potatoes. To a certain extent, 1 think it must be admitted, this popular belief is founded in truth. It is, however, among those numerous edible fungi which infest our pasture lands that those plants are to be found which are chiefly concerned in in- creasing this secretion. Their richness in nitrogenous matters may prob- ably be the cause of this, as before stated. I must content myself with mentioning only one of these, the Elaphomices granulafou, 1 or Boletus (L;j<-<>]n i' don cervinum), or deerballs, which if taken increase the milk. The question as to which of the varieties of mushrooms influence most favorably the secretion of milk, opens a wide field to further experiment and observation. As to drinks, the greatest diversity of opinion prevails. When I come to speak of a kind of food administered to cows, I shall have to notice the effect which refuse slop from whiskey distillers has in increasing the quan- tity of milk of cows to which it may be given. Upon the same principle it is that ale and porter have so high a reputation as milk generators. From Aetius downwards all authors recommended them, and there is no doubt of their efficacy with many nurses. Many of these will tell you that they cannot do without them. To stout, and double stout especially, the preference is given, and in my own experience I have found the dou- ble stout of Barclay, Perkins & Co., most efficacious in many cases. The use of such beverages, however, is frequently abused. Apoplectic tendencies of a slight character are induced; although I have never seen anything like the result which obtains in animals fed on the exciting food before alluded to. If the porter, however, be taken too copiously, it soon ceases to exert the same beneficial effect upon the breasts, the function of which becomes less active, till, at last, it is entirely suspended. What is true as a physiological law in other points, that continued excitement of the same kind exhausts nervous energy, is true also for the breasts. The exciting influence should vary in character as well as degree; and in this manner the exhausting tendency is counteracted. Fortunately, we have in an analogous bland fluid I allude to milk from the cow or goat a liquid peculiarly adapted to produce milk readily in the suckling mother; and if in such cases the stout and milk are given alternately to the extent of two or three tumblers of the latter, to one of the former, or if they are drunk in combination (a beverage more agreeable to the taste than would appear to the imagination), a less exciting and more nourishing food and 1 Redwood, p. 563. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 87 drink is thus provided for the mother, which will often enable her to per- form with much ease to herself her maternal duties. Another kind of drink which was much praised by the ancients is sweet wine. Aristotle, it is true, forbids it; Oribasius, Aetius, Avicenna, Paulus ^Egineta, and a host of others, on the contrary, recommend it. My own experience, I must say, except in those cases where there exists such de- bility as to necessitate the employment of stimulants, is in this country against our ordinary wines; or spirits, indeed, of any kind. I do not say a wineglass or two may not be indulged in ; but the habit does not in- crease the flow of milk. Much more efficacious are some of those soups usually made, and which have been already alluded to. 1 1 Old recipe from A Rich Storeluwse in Treasury for the Diseased. By A. T. Lon- don : 1596. 1. A very good medicine to increase milk in a woeman's breasts, ch. clii. , p. 31 :^-Take Fennel Bootes and Parsnepe Rootes, and let them be boiled in broth, which must be made of chickins. Then let the patient eat the same rootes with Fresh Butter, which must be new made, as possiblie it may be gotten, and this will cause great store of milke to encrease in any woeman's breastes. This hath been often proved. 20. Ch. 153. Take rice and seethe it in Cowe milk, and creeme some wheaten bread therein ; it must be such as is cleane without rie, and put into the said mylke Rome Fennel seed, beaten into fine powder, and a little sugar, to make it sweet, and this is known to be exceedingly good. 30. Ch. 154, p. 31 , b. Take a good quantity of greene wheute, which groweth between Michaelmas and Easter; you must take both of the blades and rootes, and stamp it very well, and ptraine it through a fine linen cloth into some posset ale, and put therein a little fine sugar, and this will encrease great store of mylke in woeman's breastes, within the space of three or four days. This hath been proved. 88 INFANT FEEDING AND ITS INFLUENCE ON LIFE. CHAPTER V. TREATMENT OP DEFECTIVE LACTATION CONTINUED MEDICAL. Medicinal Treatment. Remedies : Laver Borage Lettuce Sow-thistle Rocket Castor-oil Leaves Tapioca Partridge Berry Cytisus Milk-weed Mallow Gith Pulsatilla Common Salt Crystal Sakeik Fesire Iron and Cod-liver Oil. MEDICINAL TREATMENT. I now proceed to speak of those medicinal remedies which have been recommended. Paulus ^Egineta, in speaking of these, says, "That medicines for the formation of milk are possessed of some efficacy, I am well aware, and yet I do not recommend them in all cases, for they greatly waste the body." This opinion seems to have been very generally acted upon in modern times by those who were ac- quainted with such remedies; but the fact is, by far the majority of prac- titioners make no use of galactagogues; not because they fear that it may injure the comeliness of the body, but because galactagogues are not usually described in books on materia medica, and so many neither know nor believe in their existence. I think the consideration of these different remedies is best taken ac- cording to their natural orders. I should premise, however, by saying, that my experience is necessarily limited to a few of these only; I have not been able as yet to try all, nor even the majority; and from the diffi- culty of identifying plants spoken of by different authors of past centu- ries, with those under a different name in the present day, the experiments may in some cases have been conducted with the wrong plant. Again, preference has generally been given to those which were found most effi- cacious and most frequently named, and unmistakably defined by ancient as well as modern authors. All, however, I have met with, are here sub- joined in a tabular form: 1. Alga. Porphyra lacciniata, laver (Galen). 2. Boraginacfce. Echium vulgare, bugloss. Borago, borage. 3. CaryophUleae. Saponaria vaccaria, cow basil (Redwood). 4. Composite?. Lactuca sativa. lettuce; eonchus arvensis, common sow-thistle. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 89 5. CrucifercB. Eruca sativa, garden-rocket (English Phys. enlarged). 6. Euphorbiacect. Ricinus communis, castor-oil plant ; Jatropha curcaa. Jatropba manihot, Tapioca, or cassova plant. 7. EricaccB. Gaultheria procumbcns, winter green-box berry. 8. Labiate. Ocymum (basilicum) ? Melissa asinos, basil thyme. 9. LeguminoscB. Cytisum scoparium. Coronilla juncca (milch vetch). Cioer. 10. Maivacece. Malva sylrestris, marsh mallow. 11. RosacecB. Quinquefolium vnlgare, or Potentilla, creeping cinquefoil. 12. Ranunculacea. Nigella sativa, or melanthium (Gith) ; Anemone pratensis, pulsatilla. 13. Umbelliferas. Pimpinella anisum, aniseed ; Anethum fceniculum, fennel ; Anethum dulce, dill Apium sativum, parsley ; Daucus carota, carrot (Galen). Common salt, sarkeik, fesire, iron, and cod-liver oil. BORAGINACE^E. Echium Vulgare. Viper's bugloss. Flowers blue; July; biennial; found on sandy and chalky soils. Roots opening, and said to be slightly astringent. (Redwood.) " The seed drunk in wine procureth abundance of milk in women's breasts." ' I have tried this remedy in the shape of a strong infusion; but I could not trace in any of the cases any effect as a galactagogue. Borago Officinalis. Common borage. Flowers blue; June and July. Biennial. Borage and bugloss. " The seeds and leaves are good to in- crease milk in women's breasts." ' Of this plant I have no experience. CABYOPHYLLE^B. Saponaria Vaccaria. Cow basil, vaccaria. Seed heating, diuretic. This plant is said to increase lacteal secretion in cows fed upon it. (Red- wood.) Galen speaks very favorably of it. 1 Culpepper's English Phyt., p. 868. 90 INFANT FEEDING AND ITS INFLUENCE ON LIFE. I have tried this remedy in a few cases only as a strong infusion, and I think I can speak favorably of its effects. In my hands the patients seem to have remarked that the quantity of milk produced under its em- ployment was materially increased. COMPOSITE. Lactuca Sativa. There are many varieties. Has been substituted for opium, to check diarhosa; allays cough and diminishes rheumatic pains. Leaves refreshing, slightly anodyne, laxative, anaphrodisiac. The milk it yields constitutes, when inspissated, lettuce opium, or lactu- carium. (Redwood.) "The juyce of lettice increaseth milk in nurses." 1 I have no experience of this drug. Sonchus Arvensis. There are several varieties of this plant. The corn sow-thistle, sonchus ciliatus, or oleraceus, common sow-thistle; S. la?vis, or smooth sow-thistle; S. asper, or prickly sow-thistle. In their effects they are described as possessing properties like those of lettuce. Culpepper speaks of the plant as follows: " The decoction of the leaves and stalks causeth abundance of milk in nurses, and their children to be well colored. It is good for those whose milk doth curdle in their breast." * I have also used this remedy in a few cases, and in my results I should place it in the same category with saponaria, which it closely resembles in its action. CEUCIFER^E. Eruca Sativa. Rocket. South of Europe; said to be antiscorbutic, diuretic, flatulent; seeds acrid, stimulant, exciting the stomach, and a good substitute for mustard. Culpepper speaks of it: "The seed also taken in drink taketh away the ill scent from the armpits, increaseth milk in nurses, and wasteth the spleen." Of this plant also I have no experience. Avicenna states there are two varieties, one wild, and the other culti- vated. When the seed is boiled into a decoction, and put, instead of mustard, as a poultice, it causes the milk to abound. Bum ORB1ACE.*. Ricinus Communis, Oil-bush, Palma Christi. Castor-oil plant. India. Seeds are purgative, yield oil by boiling and expression. Root in decoction diuretic; leaves with lard used externally as an emollient poultice. 1 Culpepper' s English Phys., p. 142. 1 Op. tit., p. 344. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 91 The galactagogue properties of castor-oil leaves were known to the Spaniards of Peru and Chili. M. Frezier, engineer in ordinary to the French king, in his narrative of a voyage to those parts, performed dur- ing the years 1712-13-14, stopped for some days at San Vincente, one of the Cape de Verde Islands. In his description of that island he states, that among other plants he saw there the palma Christi, or ricinus icanus, by the Spaniards in Peru called Poterilla / and they affirm that the leaf of it applied to the breasts of the nurses brings milk into them, and applied to the loins draws it away. 1 The employment of castor-oil leaves as a galactagogue in this country dates since 1850. In a paper read before the British Association, at Edinburgh, in 1850, and afterwards published in the Lancet of same year, 3 Dr. Me William brought the effects of this plant before the profes- sion. " The leaves of this plant in Bonavista in the Cape de Verde Isl- ands are known as the bofareira, which is in reality the ricinus commu- nis of botanists, and occasionally the leaves of the Jatropha curcas, both belonging to the natural order of Euphorbiaceae. Two kinds are known in these islands, the red and the white. They are both varieties of the same plant, but the red is avoided by the natives, the former being said to be galactagogue in its properties, the latter eminently emmenagogue. In cases of childbirth, where the appearance of the milk is delayed (a circumstance of not unfrequent occurrence in those islands), a decoction is made by boiling well a handful of the white bofareira in six or eight pints of spring water. The breasts are* bathed with this decoction for fifteen or twenty minutes. Part of the boiled leaves are then thinly spread over the breast, and allowed to remain until all moisture has been removed from them by evaporation, and probably, in some measure, by absorption. This operation of fomenting with the decoction, and apply- ing the leaves, is repeated at short intervals until the milk flows upon suction by the child, which it usually does in the course of a few hours. On occasions where milk is required to be produced in the breasts of women who have not given birth to or suckled a child for years, the mode of treatment adopted is as follows: Two or three handfuls of the leaves of the ricinus are taken and treated as before. The decoction is poured, while yet boiling, into a large vessel, over which the woman sits, so as to receive the vapor over her thighs and generative organs, cloths being care- fully tucked around her so as to prevent the escape of the steam. In this position she remains for ten or twelve minutes, or until the decoction cooling a little, she is enabled to bathe the parts with it, which she does for fifteen or twenty minutes more. The breasts are then similarly bathed, and gently rubbed with the hands; and the leaves are afterwards applied to them in the manner already described. These several operations are repeated three times during the first ,day; on the second day the woman 1 Dr. McWflliam's Letter, p. 488, ToL ii., 1850. *VoL ii., 1850, p. 294. 92 INFANT FEEDING AND ITS INFLUENCE ON LIFE. has her breasts bathed, the leaves applied, and the rubbing repeated three or four times. On the third day, the sitting over the steam, the rubbing, and the application of the leaves too, with the fomentation of the breasts, are again had recourse to. A child is now put to the nipple; and, in the majority of instances, it finds an abundant supply of milk. In the event of milk not being secreted on the third day, the same treatment is con- tinued for another day; and if then there still be want of success, the case is abandoned, as the person is supposed not to be susceptible to the influence of the bofareira. " Women with well-developed breasts are most easily affected by the bofareira. When the breasts are small and shrivelled the plant then is said to act more on the uterine system, bringing on the menses, if their period be distant, or causing their immoderate flow, if their advent be near." Dr. McWilliam gives the cases of three women (occurring under the notice of Drs. Almuda, Sir George Miller, and Consul-General Kendall) in whose breasts milk was induced by the employment of the bofareira. In all these cases pregnancy had occurred some years previously. The late Dr. Tyler Smith also made some experiments upon the use of this plant. He tried the effects of the leaves in five cases, in three of which it proved successful. In one it produced a copious flow of the ca- tamenia, in another of leucorrhosa. From his experiments he believes that the castor-oil leaves, applied externally, have distinct galactagogue effects. He followed out in his experiments the description given and quoted above from Dr. McWilliam's paper, but did not apply the steam of the decoction to the generative organs ; nor does he appear to have given it internally. 1 I believe I am the first who has used castor-oil leaves and stalks inter- nally as a decoction in this country. I was led to do so from having fre- quently observed that suckling women, after taking a dose of castor-oil, noticed that they secreted a larger quantity of milk a result which I cer- tainly cannot entirely attribute to the removal of accumulated faecal mat- ters; because I have not seen the same full effect from the use of other purgatives. Dr. Tyler Smith * had alluded to this effect as having been noticed by others, although, he believed, it might do this by moderating febrile excitement. It occurred to me, therefore, that in defective lacta- tion, the exhibition of castor-oil leaves and stalks in a decoction might pro- duce, or more directly cause a flow of milk. I have now given the rem- edy in several cases, and I must say I have not been disappointed. The flow has been remarkably increased. Four objections against its use, however, should be mentioned. 1st. Some patients complain while taking it of a sensation in the eyes, not exactly amounting to pain, but accompanied with dimness of sight. I do not think this effect, however, is due to any 1 London Journal of Medicine, vol. ii., 1850, p. 951. Ibid., 954 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 93 peculiar effect of the castor-oil plant. I have only noticed the symptom in weak women; and I rather attribute it to the forced flow of the secre- tion, an effect exactly analogous to that which is observed in nurses who have suckled too long, when the child takes the breast. 2d. A second is, that the dose after a time requires to be much increased, as the remedy appears to lose its effect. A temporary suspension, and the substitution of another galactagogue, remedies this inconvenience. 3d. The third objection is a more serious one, but one which I hope in time will be rem- edied the difficulty of procuring the leaves or stalks in sufficient quantity. Until very lately they were not imported into the country, and all those that could be obtained were produced in botanical gardens, the larger number coming from the gardens of Mr. Butler, of Covent Garden. The supply was therefore but small. It is due, however, to the public spirit of my friend, Mr. Thomas Greenish, Sen., that we can now rely upon a regular supply. Part has been imported from Australia, part from the East Indies, and part from Sierra Leone; and an excellent preparation made in the shape of a liquor, which he has named the " Liquor Palmas Christi." In doses of one to two teaspoonfuls three times a day, it is most effective. Indeed, it is a remedy so important as a galactagogue, that I hope ere long it will be used much more extensively. The last objection applies to an occasional effect observed after its ad- ministration. The roots in decoction were before said to be diuretic. The leaves in decoction are occasionally so also. I have heard of two examples. In the one, so far as I could hear, a large quantity of water was daily passed under its influence, and it did not appear to produce any increase of the secretion of milk. In this case, however, I am not aware if the breasts were kept warm. If not, it is conceivable that an effect simi- lar to that observed with diaphoretics should occur. These remedies, it is known, will not act as sudorifics if the surface of the skin is kept cool, but as diuretics. If an analogous explanation applies to galactagogues, it points out the importance of keeping the breasts very warm when the decoction of castor-oil leaves is given internally. Moreover, we are led to this mode of management by noting the manner in which the remedy is employed in Bonavista. Hot fomentations of the leaves are there always applied locally to the breast. Where this diuretic effect is produced, it is well therefore to smear the extract of the leaves over the breast in the same manner as belladonna extract is sometimes used, with a warm ordi- nary poultice outside it, and this combination will probably fulfil all the indications in the treatment. In the second case, both the secretion of the kidney and the milk were much increased, and to such an extent as to make it obligatory, for the sake of the patient's strength, to discontinue it. I am not aware (as both of these cases occurred in the practice of others) whether hot fomentations were also applied to the breasts. But clearly the breasts, as a rule, should always be kept warm when this rem- edy is given; and when the diuretic effect is produced, not only kept warm with poultices, but well smeared over with the extract. <)4 INFANT FEEDING AND ITS INFLUENCE ON LIFE. When the castor-oil leaves are given as an infusion to women who are not suckling, I have observed two effects, both of which seem to denote its specific action. First, it produces internal pain in the breasts, which lasts for three or four days. Then, secondly, a copious leucorrhoeal dis- charge takes place, after which the effect on the breasts entirely disap- pears. During the existence of the pain at the breast I make no doubt that if a child had been applied, the suction would have determined the lacteal secretion. This, however, is an experiment to which I have never found a patient willing to submit herself, and so have not been able to prove it. 1 In two instances only have I seen anything like emmenagogue effects upon women. One was a hospital case, in which intense uterine conges- tion existed, and in which, with a view of deriving to the breasts, I ad- ministered the remedy. In this case, after giving the liquor for two or three days in 3 ij- doses, an attack of menorrhagia supervened. I may say that the patient had been laboring under uterine disease for years. The menorrhagia soon ceased after the remedy was suspended. My friend, Mr. Robinson, of Devonshire Street, had another case in which he ir;i\e the remedy. Mrs. E. M., ret. 31, was confined October 2d, 1862, after eighteen hours' labor, of a moderately sized female child, healthy, etc., and without any unusual symptoms. At the end of two weeks, finding there was but very slight flow of milk, after regulating the bowels and using a moderately generous diet, he prescribed for her 3 j- of the liquor palmse Christi three times a day. The fourth day after taking it she com- plained of bearing-down pains in the womb, loins, and thighs, and very considerable haemorrhage. The remedy was therefore suspended, a slight aperient was given, and the symptoms subsided in three or four days. The remedy was then again given, and the haemorrhage again recurred. It was now attributed to the palma Christi, and astringents with sedatives substituted with good effect. At the end of another eight days, the pal- ma Christi was again given, but only twice a day; but in three days he was again obliged to suspend its use for the same symptom. The patient ultimately got well on tinctura ferri sesquichloridi. These cases prove that the remedy should not be given in cases where there is disease or irritation of the womb. In a class of cases of an oppo- site character, chlorosis and anaemia, in both of which there was a wish to provoke the catamenial flow, the remedy failed altogether. Except pains in the breast, as before stated, and an occasional leucorrheal flow, these 1 Avicenna mentions a particular plant, under the name of Albetaflores palmarium, or Albata, which, when taken, causes the secretion of milk to be much increased. Is this the Palma Christi? It is also spoken of by him as Bussura, i.e. (Palma) Besser and Bed a, which he has not further described, because, he adds, "they are well known." It appears to have been a plant in his time in very common use. This remedy is prepared and sold by Mr. Greenish, 20 New Street, Dorset Square, W. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 95 were the only symptoms observed. Nothing like a sanguineous discharge was ever noticed. The palma Christi acts in an energetic manner in many instances. The following, however, may be taken as a good typical example of the mode in which the liquor palmae Christi usually acts in ordinary cases. A lady had seven children. For the fifth she had so little milk that she was obliged to give the child up entirely to a wet nurse. With all the others, however, the milk had disappeared after the second month, and generally the quantity of milk secreted was very small. She was recommended to take the liquor palmae Christi. It was soon found to act specifically on her mamma?. If she missed a dose or two there was a sensible decrease in the quantity of milk secreted. By x its continued employment, however, in doses of a dessert spoonful three times a day the quantity of milk needed was maintained. She had suckled her present child for the last eleven months, and had all along continued to have a sufficient supply of milk for it. Further, experience of its use proves that its action is remarkable in three respects: 1st. It is in no way restricted to any particular portion of the suckling period. 2d. Its action may be immediate, that is, within twelve hours; seldom, if ever, need it be tried for a longer period than one week before its galactagogue effects will be observed. And, lastly, its good results in increasing the flow of milk do not seem to wear off even after a protracted continuance of the remedy, but its omission will often lead to a diminution if not cessation of the secretion. These results may be exemplified by the following short abstract of cases, which I think it well to give here in confirmation. In one case of a lady in whom, after five months, the milk in the breasts became insufficient, after taking the liquor three days, the quan- tity of milk instantly increased, and a dose at night would ensure a full supply the next morning. In another case where the child was only three months old and the mother's milk failed, its employment brought about a plentiful supply within a week. In another case where the mother had vi TV little milk, the exhibition of the liquor brought about within twelve hours so copious a flow that the breast-pump had to be used to relieve the patient of the excess secreted. In another case it seemed to act as a charm, the patient indeed could not do without it. Another patient used it with two of her children the third and the sixth. In the former case six weeks, in the latter ten days after the birth of the child, the milk had almost entirely ceased. She then took the remedy. In about twelve hours in each case the milk returned in great abundance and continued so. One bottle of the liquor was found sufficient to determine this happy result. In the case of another lady who, having had three children pre- viously, and with all had suffered from deficiency of milk, three weeks after the delivery of her fourth child, and beginning to suffer from the same deficiency, she took the remedy. In three days a plentiful supply 96 INFANT FEEDING AND ITS INFLUENCE ON LIFE. was brought about. In the case of another lady, six weeks after her con- iiiu-inent deficiency of milk was so marked that the child had to be fed artificially. In a very few days after taking the remedy there was such an increase in the quantity that the child was satisfied and throve upon the breast milk alone, so that all hand-feeding was omitted. Lastly, in the case of a lady who had had four children previously, none of which she had been able to suckle, two months after the birth of her fifth baby she began taking the remedy. The very next day she was able to suckle the baby entirely. She found her milk to be thoroughly good, and felt much stronger herself from the moment she took the medicine. In none of these cases did it appear to act in any way injuriously either upon mother or child. Both, on the contrary, appeared part passu to improve in health and strength. Another plant, belonging to the order Euphorbiaceae, is the Jatropha Jfitni/tot, the tapioca or cassava plant. I extract the following account of it from Livingstone: ' " There are two varieties of the manioc or cassava, one sweet and wholesome, the other bitter and somewhat poisonous. The latter is more speedy in its growth than the former. Very little labor is required for its cultivation. The earth is thrown up into oblong beds about three feet wide and one foot high, in which pieces of the manioc stalk are planted at intervals of four feet. In from ten to fifteen months the roots are fit for food, but there is no necessity for raising them at once, as the roots do not become dry and bitter till three years. When the roots are taken up, a piece or two of the upper stalks are replaced in the hole and a new crop is thereby begun. The plant grows to a height of six feet. In a dry soil it takes two years to come to perfection, requiring during that time one weeding only. It bears drought well and never shrivels up under it as other plants do. When planted, however, in low alluvial soils and well watered, it will come to perfection in twelve or even ten months. Every part of the plant is eatable, even the leaves may be cooked as a vege- table. When the bitter plant is used, the people get rid of the poison by steeping the root four days in water, when it becomes partially decom- posed. It is then stripped of its skin, dried in the sun, and pounded into fine white meal, closely resembling starch. This meal is mixed with as much boiling water as it will absorb, and in this state forms the ordinary porridge of the country. It is, however, both unsatisfying and unsavory; no matter how much a man may eat, two hours after he is as hungry as ever, while in point of flavor I can only compare it to starch made of dis- eased potatoes. The well-known substance tapioca, is extracted from the plant by pouring water over the grated root, and this disengages the starch from it, which subsides, and is then dried over a slow fire, the mass being kept in motion during the process and thus forming itself into globules with which we are familiar. It is the staple article of food in 1 Pages 207 and 286. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 97 Africa, and is sold at the rate of 10 Ibs. for Id. throughout the interior of Angola." The leaves of this plant are given to milch goats, and their milk is thereby much increased. This, like the palma Christi, is another plant the leaves of which should be imported to enable us to judge of its galac- tagogue effects. Of the various plants which succeed in my list, except those mentioned among the umbelli ferae, I have no experience. One only I have tried, the cytixns; but my trials have been so limited that 1 cannot speak of its ef- fects at present. I shall content myself, therefore, with their mere enu- meration, and the properties they are alleged to possess. ERICACE^. Gaultheria Procumbent. Winter green box berry, chequer berry, partridge berry, mountain tea. North America. Leaves, Gaultheria, Ph. United States, used for tea. Fruit contains an aromatic, sweet, highly pungent volatile oil, which is antispasmodic and diuretic; a tincture has been useful in diarrhosa. Coxe states that the infusion is useful in asthma. It is used in North America as tea. The brandy in which the fruit has been steeped is taken in small quantities in the same way as common bit- ters. It has been employed as an emmenagogue, and with the view of increasing the secretion of milk; but its chief use is to impart an agree- able flavor to mixtures and other infusions. It is employed as an infusion, and also in the form of an oil, which is more used in regular practice than the leaves. Instances are on record of deaths resulting from the use of the oil by mistake in the dose of one ounce. On examination after death, there were strong evidences of gastritis. LABIATE. Ocy >/"'/>>/>'. There are several varieties. Album, Toolsie tea, dried leaves used as a substitute for tea. Juice in one-drachm doses given for colds. O. basilicum, basilicum; sweet basil, strong scented, emmena- gogue, gives the peculiar flavor to Fetter-lane sausages. According to Anstie, assuages childbirth pains. O. cavum, sudorific, anti-gonorrhceal. O. cuspum, anti-rheumatic remedy, etc. It is probably the O. basilicum \\hu-h has been ; by some believed to be the basil spoken of as a galactagogue. ima speaks of this plant as the Bedareng, which is known as well as its oil to be the beneficial ingredient of oil of marjoram. Its water and leaves increase the secretion of milk. MelliMa Acinos. Syn. Acinos vulgaris, basil thymo, and mellissa chenopodium, wild basil; supposed also by some to be the basil meant by older authors as a galactagogue. 7 98 INFANT FEEDING AND ITS INFLUENCE ON LIFE. LEGUMIXOSJE. Cytisus. A large number of ancient authors speak of this remedy as an effective galactagogue. 1 do not find the variety, however, further specified. " A decoction of the young tops of cytisus scoparius is said to be diuretic and cathartic, even to animals who browse upon them. The flowers and seeds, used as a pickle for table, are cathartic, and are some- times roasted as coffee. C. laburnum, seed and bark poisonous, narcotic, acrid, leaves diuretic, resolvent." ' Johann Xardius speaks of the cytisus as a galactagogue, if given in the food of animals. The remedy, indeed, is as old as Hippocrates. I have used the cytisus scoparius once or twice. I cannot say I have noticed galactagogue results. It is not impossible, however, that the cytisus that is here meant is in reality altogether a different plant from the cytisus we now know. The following passage from Aetius Tetrabiblos * seems to favor this view: " Tythymalli and those medicines that are called galactides, or galac- tagogues. " Jfalimon sive Halmyris. Some eat the seeds of the fruit of hali- mon, and having cooked them serve them. The plant gives strength to milk and to the seminal secretion. A drachm of the root drank out of water quiets convulsions and tormina, and both attracts and increases milk." The dictionaries give the following meaning to halimon: "Hali- mon i. n. oAi/iov; some kind of marine fruit : ab oXt/ios maritimus." ' " Et cytisiis necatur eo, quod halimon vocant Graecii. Alii halimon (lege halimon) olus maritimum esse dixere soldum, et unde nomen aX/itpos, sal- sus, genus nitri." It may be that some kind of sargossum or sea laver perhaps the nlva lactuca, sea lettuce, or lettuce green lavcr, both edible varieties of sea-weed is meant. It is remarkable, too, that the author of Gynoeci- orum enumerates among his recipes to increase the secretion of milk " Lac vaccinium bibat; aqua salsa valida vel marinae fomenta et post vino calido." 4 Avicenna has likewise alluded to this plant under the name of " Melha." " This," he states, " is the halimus which resembles hauserigi; its leaves, like olive leaves, only wider, are eaten as vegetables. The ex- pressed juice causes milk to abound." Coronilla Juncia. Syn. poly gala vera. Milk vetch. This herb in decoction increases milk. I believe this is the same plant which is known and sought for in Lon- don by many suckling mothers indeed it is kept for that purpose by 1 Redwood. Page 71. 8 Plin., 1. 17, c. 24, ad fini ex Theophrast Hist. Plant., 1. 4, c. 24 4 Page 78. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 99 herbalists. It is usually obtained from Gravesend, and known more popularly as the milk weed. I have used it largely, and I must also speak very favorably of it. Second only to castor-oil, and of about the same efficacy as the fennel, it is more readily available for most persons. I have also used the leaves of this remedy as a decoction, and have found it very efficacious. I have not tried the roots or the seeds. Probably the medicinal effects of these parts of the plant would be even more marked, and in winter they would be more readily procurable than the fresh leaves. Cicer Arictinum has been said by some to exert a galactagogue effect. "The seeds are heavy, but wholesome, and may be roasted for coffee; farina resolvent." MALVACEAE. Malva Sylvestris. This plant, so commonly known, marsh mallow, is stated by Culpepper to be a galactagogue : "The leaves boiled, used by nurses, procureth them abundance of milk." ' This effect, I presume, is due to its nutrient qualities, rather than to any peculiar medicinal effect. Avicenna speaks of a variety of Jlfalva as a galactagogue under the name of cubeze, " which is a wild kind of malva, as the muluchia is a domestic variety. Cubeze, he adds, is a species which is known as the muluchia arbaca / and this is the althcea, popularly the Jewish vegetable, not the luxinquum, which is a different species, and is red. The leaves and flowers make the milk to abound." ROSACE^E. Quinquefolium Vulgaris, or potentilla reptans. Creeping cinquefoil, five-leaved grass, said to be a galactagogue. RANUNCULACE^B. X> ' : /' !'! >'/'/. Gith, fennel flowers, devil in a bush. Nigella arven- sis, or melanthium sylvestra. Seeds acrid, oily, attenuant, used as a spice. Paulus /Egineta recommends sweet gith as a galactagogue. Anemone Pratensis. Pulsatilla. This plant has been recommended by Avicenna. UMBKM-IKER.E. Five plants in this order are commonly recommended: The Pimpi- iiill-i Anitnm ; Aiutlnnn /' nicidum, or fennel; Anethum IHilce, or ' '' raveolens, dill; Apium /Sativum, or parsley; and Daucnu Carota. 1 Op. crt., p. 150. 100 INFANT FEEDING AND ITS INFLUENCE ON LIFE. All these plants are too well known to require description. All older authors, from Hippocrates down wards, speak of them. The fennel (mara- thron of the Greeks), indeed, seems to be the staple ingredient of most of the remedies employed to promote secretion of milk. .^Egineta rec- ommends the root and fruit of the fennel boiled in ptisan. Aetius rec- ommends the leaves of the dill. ^Egincta also directs that the fruit of the carrot should be given in such cases. My experience of these several plants has been confined, in a medicinal point of view, to the fennel. I have used rather extensively the infusion of fennel seeds, and of all those plants which I have tried, I consider it as second only to the rici- nus. It is remarkable how materially it increases the flow of milk in those who take it, sensibly producing the draught in many women who have been strangers to this sensation to any extent for weeks. In one re- spect it differs, not producing the same amount of dimness of sight which the castor-oil leaves do ; at least patients have not complained to me of this effect when taking it. The appearance of the children has been also particularly good under its influence. There are two other specific galactagogues which must here be allud- ed to. One is common salt. The other is a substance spoken of by au- thors of the last century as chrystal. Common Salt. We are pretty well aware of the effects of common salt upon the body in proper quantities : one of the most important of these, according to Liebig and Boussingault, is to improve the glossy and smooth appearance of the coats of animals. Nardius, in his Analy- sis of Milk* has the following remarks on it : " Albertus says that in- sular cattle are larger because of the saltness of their pastures ; the salt, moreover, having a quieting (taming) effect upon them, so that they yield an abundance of milk. Whence it happens that in seaside places, where cattle feed on salt pasturages, they are more prolific; their flesh is more tender; their milk more abundant, and richer in cheese. The learned Mercurialis, it is true, controverts this opinion; but still he ad- mits that a moderate use of salt does increase milk." Moreover he adds, "that sheep will fatten upon salt drinks; and that, for this reason, it is customary to give to them, every fifth day, salt, in the proportion of about 200 pints for every 100 sheep." So also th*e poet testifies: "Let the lover of milk bring frequently to the managers of his cows cytisus, lotus, and salt herbs. These last they love best, and the effect will be to swell out their breasts. Moreover, having partaken of these they will drink more, and so a larger flow of milk will be provoked." * The last substance to be mentioned is Chrystall, differently spelt as Christal or Crystall. I find this substance used in several receipts of old farmers and numerous works of the last century, and then much in 1 Op. cit. * Nardius, Analytit de LacU, p. 153. Collection of Pamphlets, 1650-1652, Brit, Mus.: Rich Storehouse Treat, far Hie Diseased. By A, T. 1596, chap. 155, pp. 31-36. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 101 vogue as a galactagogue. " Take crystal!, and beat it into fine powder, and mingle it with as much fennel-seed, likewise beaten in fine powder, and a little fine sugar. Let the woman use to drink hereof somewhat warm, with a little white wine, and this will cause great store of milk to increase in her breasts: yea, it will restore her milk again, though it be clean gone from her." ' Whether, from what has been premised on com- mon salt, it may be supposed Rock Crystal is meant, I do not know. In some of the old medical dictionaries the crystallus is further designated as " crystallus mineralis, potassse nitras fusus sulphuris paucillo mixtus." Also, as "sal prunellne." Nicholson, in his Dictionary of Chemistry, describes the Crystal Mineral as follows: "In the ancient dispensatories we find a formula for making a salt of this name by fusing nitre, pro- jecting a little sulphur thereon, and afterwards casting it into little cakes."* On this supposition, nitre would possess properties not at pres- ent attributed to it. I have not, however, with the view of testing this surmise, tried the remedy. Two other plants, used as galactagogues by the Arabians, are men- tioned by Avicenna, Sakeik and Fesire. " Sakeik, called Sakaik (alnaman), is a rose, vehemently red. If its flowers and stalks are boiled with decoction of barley and eaten, they make the milk to abound. " Fesire is the hezargiesum or hezar chasen, otherwise the vitis alba. The juice of this drunk with a decoction of wheat insures the flow of milk." I cannot close the category of medicines to be given to a suckling woman without referring to two other remedies in more common vogue iron and cod-liver oil. I have already shown that in reference to the first of these many learned writers 3 have asserted that iron often exerts a repressive influence upon the lacteal secretion, and facts apparently in confirmation of this opinion, chiefly occurring when patients take chaly- beate waters, have been given. However, I have explained this error at page 69, and that these effects are rather due to ill-timed administration, or to the preparation of iron given. Any remedy which will be likely to induce constriction generally of the system, we should d priori expect to be detrimental. Besides, if we look to the appearance of a woman who has long nursed, and may be said to be exhausted by the process, we shall notice some well-marked symptoms which indicate at once the reme- dies to be employed: general pallor, amounting often to anaemia, de- bility, languor, copious Ieucorrho3a, pain in the back, headache, increased by the erect and relieved by the recumbent position, and general emacia- tion. All those symptoms are clearly those of want of red globules in the blood, and precisely those which experience proves most readily sub- 1 See note on previous papre. ' Nicholnon's Dictionary of Chmitry. 1808. t BulL de Ttiirap., Dec., p. 554; Med. Timet and <7ot., January 23, 1858, p. 96, 102 INFANT FEEDING AND ITS INFLUENCE ON LIFE. side under the exhibition of iron. Few having to treat such a case would hesitate to give it. The use of iron here, if given pari passu with the nursing, would have prevented, or at any rate delayed, the occurrence of exhaustive disease. So also the emaciation is often painfully remark- able after nursing. In milch cows (as I have before said) ' it is this very emaciation which deteriorates the value of the animal so much after two or three months, as to make it a losing concern for a farmer to keep a milch cow at all. Among milch cows, it is only by giving highly com- bustible food (oil cake) that this result is obviated. Why not apply the same rule to the human female? It is with the intention of fulfilling this indication that I have given cod-liver oil. Of the preparations of iron I usually give the iodide, especially when there is any strumous dis- position to contend against, or the syrup of the superphosphate, which from the excess of phosphoric acid, so important to both mother and child, is peculiarly applicable; sometimes, where there is excess of acid, or gastrodynia, present, the sesquioxide or carbonate the more astrin- gent preparations I entirely discard. In addition, I give a teaspoonful dose of cod-liver oil twice a day after breakfast and dinner. Indeed, the usefulness of these two remedies, as ascertained by observation in cases where intense debility and anaemic symptoms with emaciation were wont always to make their appearance from the third to the seventh month of suckling, cannot be doubted. Having on subsequent pregnancies attended such cases, and given them during their suckling periods both iron and cod-liver oil, beginning as early as the sixth week after delivery, and sometimes even earlier, and continuing the remedies up to the period of weaning, I have been grati- fied on finding at the end of that period that these distressing symptoms of debility and emaciation never recurred: on the contrary, the patients were unimpaired in health, strength, and looks, and the children were far stronger and larger than those which preceded them. Perhaps it is the dread of physic and a disregard to the artificial life women lead in towns which are, in great measure, the causes of the common prevalence of symptoms of hyperlactation. As a resume of the foregoing remarks, it may be concluded that de- fective lactation is in many cases a curable affection, and that under proper treatment the mother may be enabled to fulfil her maternal duties, not only without injury to herself, but with great advantage to her off- spring. These results, if fully carried out by future experiment which may be looked for with great interest, and I must also say, with full con- fidence are of great importance. 'Page 84. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 103 CHAPTER VI. Circumstances under which a Mother should not Suckle. Specific Disease in the Mother When the Mother's Milk disagrees When the Mother can only Suckle with one Breast When the Milk in both Breasts is Diseased In Exhaustion from Hyperlactation Sore Nipples. FROM what has been said it will be gathered that, in many cases, a mother may be so treated by hygienic, dietetic, and medicinal means as to be put into a condition favorable to suckle her infant. But it cannot be too strongly stated, as the refusal to make the experiment is in most cases not only an error, but I should almost say a criminal decision, that if she cannot do so entirely, she may be assisted by artificial food, judiciously selected and yiven to the child. The principles of alimentation in such cases, i.e., the rules which should guide us in bringing up a child by hand, either entirely or when it depends in some measure upon a small quantity of breast milk from its mother, belongs to the third part of this work. We have now to consider under what circumstances a mother should not suckle her infant. 1. Specific Disease in the Mother. It is stated that where disease of the parent exists, such as scrofula, to an unusual degree, consumption, mania, cancer, syphilis, and other dangerous hereditary diseases, it is not wise to let a child derive its nourishment from this source of contamina- tion. I am bound to admit the full force of this objection, which is doubtless valid in the greater number of cases. Consumption is so prevalent a disease, and one so likely to be increased by oversuckling, that for the mother's sake it is well not to allow her to suckle to the same extent as a healthy mother, both for her own and for the child's good. Yet even in such cases we must not lose sight of the healthy influence of suckling, to which I referred (at pp. 13 and 40); and if it be her own child a mother has to suckle, it may, after all, be better to let her do so if it be done within reasonable limits, and especially if she be assisted by artificial food also given to the child. To a maniacal patient, or one likely to have a violent paroxysm, no one would think of trusting a child. But too little attention is, perhaps, paid to the existence of cancer in a family as a drawback to a mother siK-kling her child. In the year I860, 2,100 men and 4,857 women died of this disease in England, and the malady seems on the increase. The proportion of deaths from cancer to deaths from all other specified dis- eases was, in I860, 1.3 per cent. In 1841 it was only .8 per cent., show- ing a very material increase which bears no proportion to the increase of 104 INFANT FEEDING AND ITS INFLUENCE ON LIFE. population. In scrofula and syphilis, perhaps (both of which diseases are often very amenable to treatment), the objection to suckling does not al- ways hold. The mother must be treated, and the remedies which cure her will equally cure the child. This is especially true in the case of the syphilitic taint; for it should also be remembered that in putting such a child to a wet nurse, we must of necessity also contaminate her, and she will in a little while be scarcely in a better condition than the parent her- self. Then, again, if the mother be found diseased, the child will most assuredly manifest symptoms of the disease, if not diseased already, and will need treatment; and this is, perhaps, best carried out through the mother. The case of scrofula is precisely one of those in which the child, in addition to the breast milk it receives from its mother, can be also artifi- cially but judiciously fed; and the mother, thus enabled to rally in her own health, because the drain upon her is diminished, can be so cared for as to produce, if not a large quantity, at least a sufficiency, of good and wholesome milk for her infant. 2. Evidence that the Mother's Milk does not agree with a Child. In some cases the milk of the mother disagrees with the child. It may pro- duce diarrhoea, insomnia, it may be convulsions. This is more especially the case in very impressionable women. In some, as we have seen before, 1 it will produce death. In the Vienna puerperal fever, the death of the child was often the first indication that the mother was about to sicken with the fever. But commonly, other unhappy effects, although fortu- nately very short of those before mentioned, will be produced. We have seen a in Drs. Merei and Whitehead's tables that 24 per cent, of the chil- dren who received abundant breast-milk alone, to fifteen, eighteen, and even fourteen months, were badly developed, and did not thrive well; as many as 23.3 per cent, having only a medium development. No doubt, therefore, if it be clearly shown that the mother's milk dis- agrees, this is a legitimate reason for not allowing her to suckle her child; but this conclusion must not be arrived at hastily, for even here treatment sometimes will effect a good deal. Change of air, change of food on the part of the mother, wine, some artificial food, or medicine to the child, will often prove beneficial; a week or two of perseverance and attention in these respects will frequently remove all source of irritation. Those cases, I must say, which have resisted such measures, have occurred either in a very early or a very late period of nursing. In the former instances, the simple substitution of a wet nurse seldom suffices alone. So much treatment is required besides, that it is often a difficult question to deter- mine how much is due to treatment, and how much to the wet nurse. Still, I must admit, that in a few cases the salutary effect of the change is very obvious. In later periods of suckling, i.e., after eight months, wean- ing often proves as effective as the adoption of another wet nurse. 1 Page 73. * Pages 13 and 14. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 105 3. Where a mother can only nurse with one breast, either because the nipple in one is defective, or from one breast having been the seat of ab- scess, some have maintained that the mother is wiser not to suckle her own child. This, I believe, is altogether an error. The one breast which remains healthy performs all the duty, and the amount secreted is fully equal to the requirements of the child. Sometimes, without known cause, a child refuses to take the breast of one side. The mother frets, and is unhappy, imagines it to be perverseness in the infant, and probably fears an abscess in the neglected breast. Only the last of these contingencies requires attention, and will, no doubt, if treated upon the principles be- fore laid down when speaking of galactorrhoea, 1 soon pass away. The mother should not fret. Let the secretion of the full breast be drawn by a pump, or by some kind Samaritan, and after a few days, if the child be applied, it will often take it readily. It sometimes occurs that there is a peculiar taste in the milk of one side as compared with the other, which explains the dislike on the part of the infant. Dr. Hartman instances a case where this anomalous lactation occurred: "An infant, whose mother was in good health and had borne several children, exhibited a healthy appearance for the first five weeks after its birth. The alvine evacuations then became copious, fluid, and discolored, and the child lost flesh and strength. After the usual remedies had been vainly administered for a fortnight, the mother remarked that the child did not take the right breast willingly, and so much did the unwillingness increase, that at length the mere application of the nipple to the infant's lips occasioned loud crying. On examination, it was found that the milk of the right breast had a distinctly salt taste, whereas the milk of the opposite breast was of the ordinary sweetness: no difference of consist- ence or color was discoverable. From that time the child was only al- lowed to suck the left breast, and in a few days all diarrhoea and sickli- ness of appearance vanished. It is not a little singular that while the mammary secretion was thus unnatural, the health of the mother re- mained unimpaired."* 4. Sometimes the milk is diseased not only in one, but in both breasts. The nature of this disease has been ably ventilated in a paper on " Sac- charine Fermentation in Milk within the Breast of the Mother," by the late Sir Duncan Gibb, from which I here epitomize." Vogel announced the discovery of vtbriones, a species of animalcule, in human milk, in 1830. These he clearly proved were developed within the mammary gland itself. He believed it to be due to fermentation in the milk, by general congestion and increased heat in the breasts, con- nected with general excitt inrnt of the sexual system. This view was dis- 1 Pages 66 and 67. * British and Foreign M> */>, vol. xii.. p. 4::0. 1 Archive* of Medicine, vol. ii., No. 3, 1801; Banking's Half- Yearly Abstract, voL xixiv., p. 254. 106 INFANT FEEDING AND ITS INFLUENCE ON LIFE. proved, because the milk was neutral, not acid, and it was argued that the fermentation evolving lactic acid would immediately destroy these in- fusoria. Sir Duncan Gibb's attention was first called to this disease from the circumstance of an infant, aged seven weeks, being brought to him in an extreme state of emaciation, although the mother herself was the very belle ideale of a healthy nurse. The child had been healthy and plump at birth, but was now never satisfied with its mother's milk, and was rave- nous, though spoon-fed besides. In other respects, no active disease, such as diarrhoea, diuresis, or diaphoresis, could be found about it to account for the atrophy present. The mother's milk was therefore examined. It had a specific gravity 1032, was rich in cream, and neutral, with a large quantity of sugar. So far it seemed normal. Examined, however, micro- scopically, seven hours after withdrawal, it revealed myriads of living ani- malcuhr, ribrioncs 1>liiliti<', phthisical, cancerous, epileptic, weak women, as well as those in whose parents insanity or any other mental eccentricities exist, or have existed. Unfortunately, however, the history of these cases, at least in London, is almost always obtained from the applicant herself. Now it is manifest that an adept in such cases (particularly if the disease be only latent) may deceive any medical man. He asks if she has had sy- philis. She denies it. Yet she may have uterine syphilis, so well de- scribed by Mr. Langston Parker. Delicacy forbids a more complete investigation. Moreover, external examination in most of these cases is limited to the breast, which may, even in a case of uterine syphilis, ap- pear quite healthy. To prove that this is not merely a theoretical opinion, but one founded on fact, I will relate a case: A woman became a patient of mine. She represented herself as married. I found out subsequently that she was single. She denied having ever had syphilis. Atrophy came on in her infant, and a very suspicious roseolar eruption around the thighs. I demanded an exami- nation, and found an indurated uterus and a specific ulcer within the os, extending towards the external os uteri. The child died; but there can be no doubt that had I not trusted her, and had she been properly ex- amined, and that at an early period, the child's life might have been saved. But fallen women may also deceive you in a host of other ways. A common deception relates to the age of their milk. On one occasion, when I was seeking for a wet nurso, a woman pre- sented herself to me; she had, she said, been confined throe months, was married, and had had two children before. The milk appeared good, and I select ft I her. It turned out .she was unmarried, had not had a child for a twelvemonth, and to keep the infant now in her charge quiet drugged :. Another woman, who had just been delivered, stated she had only been seduced some ten months back. I found out she had cohabited with a rouk for two years, and had had two miscarriages previously, and so on. These examples are suggestive, and prove how small is the dependence 110 INFANT FEEDING AND ITS INFLUENCE ON LIFE. that can be placed in the class of women we are alluding to; and if they are deceitful as to present faults, why should we trust them as to their antecedents, and immunity from disease acquired in earii r life ? Thirdly. The influence of a wet nurse upon a household is another reason why a fallen woman should not be selected. If it may be opera- tive for good sometimes in reclaiming her, it may, if the woman be a bad character at heart, be operative also for evil on the mistress, the master, but particularly on the other servants, especially so if in the principles of any there are sympathizing dispositions. These women often " speak unadvisedly with their lips," and have frequently doubtful peculiarities. As to the effect upon a mistress of a household in a country where the purity of our wives is unimpeachable, and their virtue proverbial, the tendency to corruption by conversation with such women is fortunately very rare, and I believe that it seldom, if ever, occurs. To dwell on this point is therefore unnecessary. Still all will admit that too frequent as- sociation and companionship of the better classes, even with virtuous domestic servants, is nearly always prejudicial. A lover of low company in our ranks of life is soon regarded as an interloper in better company, and one to be avoided. Let us also bear in mind that the intimacy of a mistress with her child's wet nurse is of no ordinary kind. It is close, and for the time, constant. It is fostered in great measure (at least in the beginning), by the maternal love which overflows with gratitude when she beholds her once weakly child thriving upon the milk of the hired wet nurse. Such alliances (more dangerous where the nurse is the only nursery attendant, as in the case of newly married couples with small means) are, to say the least, an unfortunate contingency. And surely, if it be right to prevent our wives from visiting ladies of doubtful reputa- tion, it cannot be right to admit fallen women to their intimacy, and this in their very houses. If it be true that " ce n'est que le premier pas qui coute," surely it is better to avoid taking it. The same reasons apply, although less forcibly, when we come to speak of the masters of households. Not to allude to those endless petty annoyances which so commonly arise in connection with hired wet nurses of this class, it may suffice to remark that the records of medicine, the annals of our Divorce Courts, and the history of the social evil, prove that married men are not exempt from error in this direction. But it is chiefly amongst the women servants in an establishment, those who in their station are on equality with the wet nurse, that the danger is greatest. In the Dublin Quarterly there is a review of Dr. Stranger's book. 1 From this review I epitomize the following sad story. It is the case of an honest, hard-working, but poor servant, attracted by the splendor of a passing courtesan on horseback. She is sad, not, alas ! at beholding a fallen creature, but because she compares her own com- parative poverty, and unassuming garments, and hard toil, with the cour- 1 On the History of Prostitution in New York. INFANT FEEDING AND ITS INFLUENCE ON LIFE. Ill tesan's gay habiliments and luxurious mode of life. Gently chided by her mistress, who has also been a silent spectator of the scene, she acknowl- edges her error with tears. Yet in a year or two that misguided girl has launched into a similar course of vice in New York. A little while longer she is placed prematurely on her death-bed. One look has sufficed to tempt her from the right path ! But the wet nurse, in her favored position, is a daily and more lasting picture. Covetous people there are, and not a few have strong passions. " What a difference of wages ! what superior food is given to her ! She rides in the carnage as a lady visitor. She is more considered than any other servant in the establishment. What prevents my doing likewise ?" True religion and innate modesty will triumph, it is true, over these whis- perings of the Evil One; but all have not these, and ours is the guilt in putting the stumbling-block before them. I trust I am not misunderstood. I make these observations entirely believing that the worst effects produced are only of very exceptional occurrence. I know that nowhere in this world is the purity of the do- mestic home so great as in these realms. But it is because faithfulness and virtue are so estimated among English women, and because vices such as those alluded to are held aloof from and reprobated; because, as yet, no looseness of morals, as on some parts of the Continent, is tolerated in good society, that I speak. I would pity, I would relieve, and I would let the good and strong-minded of both sexes do their best to reclaim these poor fallen sisters, nay, 1 would bless them for doing so; but let it be done by seeking for them other employment less dangerous and ob- jectionable, and not in employing them as wet nurses, and familiarizing our households with the spectacle of vice rewarded. Fourthly. What holds for the household applies equally to the com- munity. It is an incentive to crime. If fallen women are preferred to married, if we give better wages to them than to other virtuous female servants, if we pass over their fault lightly, and allow them to occupy a superior position in households, we ma}- rest assured we are only add- ing fuel to fire; we are favoring the passions of the frail sisterhood; and l>v Diving lucrative employment to some who may be willing victims, we are encouraging the base seducer in his course of infamy. Already some of the advertisements in our daily papers where women hold out their shame to a premium, prove that it is an incentive even now in full operation. Let us take, as a confirmation of this point, the following return from our workhouses, extracted from the Times of June 11, 18G2: " /-emale A'hilt lumpers. Yesterday morning the following curious return was issued of the female adult paupers in the workhouses of the :1 unions and parishes of England and Wales, classified according to character: Single women pn-irnant with their first child, . r >09; singh* women who have lia-I one child, 2,847; single women who have had one child and are pregnant again, 202; single women who have had two chil- dren, 1 ," 1 1 ; single women who have had three children, 877; single women 112 INFANT FEEDING AND ITS INFLUENCE ON LIFE. who have had four or more children, 782; idiotic or weak-minded single women with one or more children, 470: total, 7,548. Women whose out- relief has been taken off on account of misconduct, 327; women incapa- ble, from syphilis, of getting their own living, 543; prostitutes, 790; girls who have been out at service, but do not keep their places on account of misconduct, 383; girls brought up in the workhouse, and who have been out at service, but have returned on account of misconduct, 373; widows who have had one or more illegitimate children during their wid- owhood, 680; married women with husbands in the workhouse, 1,698; married women with husbands transported or in gaol, 258; married women deserted by their husbands, 2, 131 ; imbecile, idiotic, or weak-minded women and irirls, 5,160; respectable women and girls incapable of getting their living on account of illness or other bodily defect or infirmity, 5,300; respectable able-bodied women and girls, 2,267; respectable aged women, 11,615: total, 39,073." From this table, if we include the widows of immoral character, we have as many as 8,220 women of bad character, or 21 per cent, of the whole number, or nearly one-fourth of all our female paupers. Is this not retribution ? and has it not arisen from our not sufficiently discour- aging immorality ? Fifthly. But we are doing worse. We are, perhaps, encouraging murder, at least, authorizing the death of the nurse's child. Upon this point let us hear Dr. Bachhoffner. He is reported to have spoken before a meeting of the Vestry of St. Marylebone as follows: " He had already said, that of 1,109 illegitimate children born in the rec- tory district, 820 had been born in that house; and of that number there had been 516 deaths of illegitimate children registered during the same period, or 46 per cent. In St. Mary's district there had been registered 592. In this district Queen Charlotte's Hospital was situated. The num- ber of deaths had been 109 children, or 18 per cent. In All Souls' dis- trict, out of 145 illegitimate children born, there had been 87 deaths, or 53 per cent. Out of the 592 illegitimate children, nearly 400 had been born in Queen Charlotte's Hospital. In Christchurch the case was worse: of 223 births of illegitimate children, there had been in the same period 209 deaths, or 93.7 per cent., up to the age of three years. In St. John's, out of 140 births there had been 129 deaths, or 87 per cent. These last two were the 'dry-nursing districts;' and speaking from sixteen years' experience as district registrar, it was a remarkable fact, that usually within three or four weeks of the registration of the birth they were called upon to register the death of the same children, the cause being mesen- teric disease, diarrhoea, inanition, and other diseases resulting from the mode of feeding and deficient attention to the children. In the Cavendish Square district (a moral district), there were 40 births and 36 deaths, or 90 per cent., the worst of the whole. 1 But when we speak 1 Lancet, vol. iL, pp. 415-416, 1859. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 113 of stillborn children, returned as such, the case may even be more horrible." It is known that in some parts of the immoral community of this pro- fessedly Christian land, the mere existence of burial clubs proves a suffi- cient inducement to heartless parents to sacrifice, by poison or otherwise, their infant children, whom perhaps they have known for a few years and actually loved. It is manifest that when an infant is in the way it may as easily, and perhaps more easily, be got rid of by neglect as by more direct measures. For stillborn is often only another word for infanticide, since so many infants are returned under that title to avoid registration. " Who is there," as the Lancet remarks in a leading article for Oct. 22, "that having any experience of the society in which we live, will not ask with a shudder, what security our laws or our administration provide against the concealment of infanticide, under the word stillborn f How do we know that these illegitimate children have died without foul play ? " In a letter from Mr. Costen he writes me, that " in the St. Pancras Infirmary out of 200, which is the average number of women confined there yearly, about 174, or 87 per cent., of these are unmarried, including prostitutes suffering from syphilis and its effects, servants, etc., 8 per cent, of the children are stillborn; 5 per cent, die before they are one month old." Now the usual number of stillborn in a population is much less. From Dr. Barnes's London Maternity Reports we find that the normal proportion of stillborn births, out of 10,561 labors, was 308, or only 2.9 per cent. Now why this disparity ? As the women leave the workhouse after the month, no further details as to these children could be supplied to me by Mr. Costen. Several of the more healthy women go out as wet nurses, but their children do not remain in the Infirmary. In fine, all vital statisticians Burdach, Farr, Qtidtelet agree as to this greater mortality among illegitimate children. ' of experience and dry nursing will explain part of this mortality; but to be accurate, we must put down a large figure to infanticide. It was the opinion of Mr. \\'akley, the late coroner for Middlesex, that at least 200 infanticides in London annually escape detection. If so, why hold out greater incentive to the crime? The opinion of the late Mr. Acton, however, should be remembered upon this point also. He gives us a table of deaths of children under one year of age returned as having occurred in England and Wales in 1856 from violent causes: Injury at birth 104 Poison not distinguishable. 7 Opium 18 Laudanum 40 Godfrey's Cordial 19 Drowned 16 " fonnd 48 Strangled 14 8 114 INFANT FEEDING AND ITS INFLUENCE ON LIFE. Suffocated 223 " by food 8 41 by bedclothes 206 " overlaid 69 Murder 5 Manslaughter 2 Accident 6 Injury 14 Infanticide 52 846 Now note here Mr. Acton's remarks: "It is a frightful list; no less than 846 babies are recorded officially as hanged, strangled, poisoned, suf- focated, and so forth, during the year 1856. The great majority of these we are justified in assuming were the illegitimate offerings of first falls in virtue" Is it possible ? and yet we can recommend those who may be murderesses as wet nurses in virtuous families! I am not inclined to go the whole length with Mr. Acton; yet infanti- cide has a fearful reality in this country. Here, again, let us quote the Times : " Infanticide in London. Infancy in London has to creep into life in the midst of foes. We hear often of the impoverished or poisoned air of close alleys and rooms unfit for habitation, and now the coroners have just told us in their official returns that sixty-seven infants under two years of age were murdered last year in the metropolis. 150 more were ' found dead,' a large proportion of them left exposed in the streets; how many of these were ' persuaded not to live,' must remain a secret till the disclosure of all secrets. Of above fifty others we learn that they either lost their lives through the misconduct of those who should have tended them, or that their deaths are attributable, wholly or in part, to neglect, want, cold, or exposure; the mother of one was only thirteen and a half years old. More than 250 infants were suffocated, very generally in bed, and in upwards of half these cases there was no evidence how the suffo- cation was caused, or the juries did not state in their verdict that it was accidental. 1,104 deaths of infants in London in 1861 under two years old were such as to demand a coroner's inquest, upon them. The age is the same as in the massacre which Christendom annually remembers, but the size of this great metropolis causes it to out-Herod Herod." The Registrar-General's returns for 1860, quoted elsewhere, 1 in Lon- don, tell the same tale in another way. Taking deaths from poison, suffocation, and homicide, there died 1,678 persons; but of these 1,030, or 61.5 per cent., were under one year old, and on all ages under five 1,156, or 68.8 per cent. Nor do we appear to improve in these respects at the later date of 1872. The Registrar-General furnishes us with a table, setting forth the 1 See Appendix A. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 115 number of deaths at different periods of life from under one month to under five years, returned as having- occurred from murder and infanticide in England in the year 1872. Out of 237 murders and infanticides, of all ages, 130 were committed on children under one month old, ten on others extending over the period under one year. The total for under one year amounting to 140 or 59.3 per cent. The total under five years, amount- ing to 153. This mortality is the result of blows, throat-cutting, poison, drowning, suffocation, strangling, and other modes of violence. These numbers, of course, only refer to the cases so returned. But, including all, the violent deaths occurring to children under five years, are given by the Registrar-General as follows, for the same year. We find that out of 17,257 of deaths of all ages, 719 occurred to children under one month; 1,047 to others under one year old; and 3,805 to children under five years. From the first return of 1872 it is clear the mortality from violence is greatest for the first year of life, i.e., 59.3 per cent.; in other words, that the majority of children that die are precisely those who need wet nursing. Why this great difference ? Has hiring wet nurses not a good deal to do with it ? In justice, however, to Mr. Acton, I should say, that he believes it is because these women, so long as they are burdened with their children, cannot find employment, that infanticide among them is so common; that if they were more generally employed as wet nurses the crime would no longer occur so frequently, because the motive for it would be removed. This is, however, a mere gratuitous assumption. Have they not all the employment, according to the demand in the way which can be given to them already ? Are not they, as a class, already employed and recom- mended by all the faculty? unless, indeed, it is wished to oblige our wives not to suckle our children, purposely to give these women greater oppor- tunities of employment. But suppose we did, and the infanticides did not occur so frequently (which position, however, remains to be proved), if a woman is abandoned enough to commit infanticide what other crime will she not be ready to commit so soon as a temptation sufficiently pow- erful occurs ? and if so, where is the security in confiding our children to such women ? I believe but few of these frail sisters are bad enough to commit infanticide. Those that are, are criminals, and dangerous in more ways than one. They must be dealt with as such, and not put in posi- tions of trust. The larger majority of them, if their antecedents are known to be good, may be employed, but not as wet nurses. It is not lawful to do evil in order that good may come. Sixthly. There are dangers to the foster-child itself, which may be classed under three heads. The first applies even to the best of wet nurses, viz., that the mere substitution of a wet nurse for the mother of the child increases the chance of its death. The second, to the inexperi- ence of all women with th ir first children. The third, to the great fear of misconduct of many of these fallen WUIIK-M. 116 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 1. Themere Substitution of a hired Wet Nurse increases the Mortality. This point has already been referred to (p. 16), and I therefore need not do more than mention it here. 2. There is Danger from, the Wet Niirsds Inexperience. It may be urged that when we are quite certain that a woman has fallen but once, and that she has previously borne a good character, and that her antecedents are well known, the objections above made do not apply, particularly if full medical examination be made before the engagement. True; but then with delicate children and these are generally the class which re- quire suckling by a hired wet nurse it is important that the nurse should have experience in the management of children. Women who have fallen for the first time, in most instances, have none. Nothing can be more amusing than to see a man, who is quite ignorant and unaccustomed to children, take up a child and nurse it. But among women a novice is equally uncomfortable to look at; and the result, unfortunately, is far more sad to the infant. I remember meeting an example which made a great impression upon me. A lady was very ill, and the child had to be taken away from her and from the care of the monthly nurse. It was given into the charge of a married woman, but who had herself had no children, and was, therefore, inexperienced. The child began to droop, and became ill and thin to a degree. The moment, however, the monthly nurse was able to resume her attention to it, the circumstances of food, lodging, clothing, etc., being the same, the child began to thrive, and eventually did very well. A woman upon her first fall is not likely to understand the management of children, unless she has been a nurse be- fore a rare exception. If employed at all, she must be as carefully looked after as the child, by the mother, or by another nurse. It may be urged, in reply, that the same objection applies to the employment of a married woman with her first child, and the objection is a valid one; but then the fallen woman is selected because she is a first transgressor, the married woman should be chosen among mothers of many children. In- deed, all who have had much to do with delicate infants must be conscious how exceedingly important it is to have a good nurse, and one who un- derstands children well. It is by far the most important element in bringing up a child. 3. There is Danger from Misconduct on the Part of the Wet N-urse her- self. There are some faults which women of this class are especially lia- ble to commit. One is drugging; either the nurse herself is a dram drink- er or opium eater, and so far affects her milk by the pernicious habit, or, secondly, she drugs the child. Another equally cruel practice is to starve the wretched infant. The quantity of opium which is consumed by the working classes, and specially in our manufacturing districts, passes general belief. If the public-house is much frequented, so is the chemist's shop, especially on a Saturday night, by men and women seeking for their ordinary opiate, firallons of laudanum, soothing syrups, Dalby's carminative, paregoric, INFANT FEEDING AND ITS INFLUENCE ON LIFE. 117 disappear. The publican drives scarcely a brisker business. And the ef- fect on a mother's milk is very pernicious. The following- is a case of bad effect of opium on the child through the mother's milk. A lady, about to undergo an operation, took twenty-five drops of Battley's solution at 10 a.m., and repeated it at 2 p.m. on same day. At 8 o'clock p.m. she took five centigrammes of opium in a pill. Her child, a strong boy, seven weeks old, was restless throughout the day. At midnight he took the breast and suddenly fell into a deep sleep, in which he remained for six hours. On awaking, he sucked a little, and again slept throughout the day. At 2 p.m. respiration diminished in frequency and became less deep and jerking. At 6 p.m. the pupil was contracted, respiration imperfect, jorking, irregular, but in frequence nearly normal. It was with great difficulty that he could be aroused. Coffee was administered by the mouth and rectum, and the little patient was exposed to the draught from an open window, and in about an hour he seemed better. About an hour later respiration ceased for a while and he appeared dead. Life, however, returned, and the following day by 2 a.m. he was out of danger. The two points to be noticed here are (1st), the duration of the symp- toms (twenty-six hours), and (2d) that the mother's milk was the vehicle of the poison. A great number of women do not like to lose a good place, and they have often so little morality, that sooner than lose their situations, or in the hope of keeping them as long as possible, they will not hesitate to en- danger the life of the child. It is a comfortable way of doing it, and as the child sleeps well and cries but little while so drugged, risk of discov- ery is not so great and the fears of the relatives are disarmed. And yet the effect of opium on infants is very marked and pernicious. A case is mentioned in which an infant of some months of age, suffering from diar- rhoea, was ordered one drop of laudanum every three hours. After the first drop the diarrhoea ceased. After the second convulsions came on. After the third the child died (Presse Medicate Beige, July, 1875). I myself have seen a baby killed outright by the administration of two drops only of laudanum. Then, again, some women, in the wish to keep their place, do not hesi- tate to starve the little child. I will cite a case. I engaged a wet nurse for a child about six weeks old. The woman's milk was, from her account, about six weeks older. The breasts appeared full; the milk itself was rich in milk globules, and an- swered to the usual tests it was pronounced good. I subsequently found that this woman had had two illegitimate children, and that she had very little milk. The deceit practised by her when she appeared for examina- tion before me was similar to that adopted by dealers with the cows they wi.sh to sell, /./'., not milking them for some twenty-four hours before sale, so that the udders shall appear full. To keep the child easy it was regu- larly drugged with some opiate after the breast had been given. The parents were deceived; milk upon which the baby slept so well was sup- 118 INFANT FEEDING AND ITS INFLUENCE ON LIFE. posed to suit it. The child, however, began and continued to lose flesh, till in fact it was reduced to so great a state of weakness that it became questionable whether it could live many minutes. The nurse was changed, and after some time it did recover, but with difficulty. llrre is another instance. A gentleman selected, under medical ad- vice, a fallen woman as a wet nurse for his weakly child. After some days she disappeared. He set off to seek the fugitive, and found she had gone back to the man with whom she had formerly cohabited. However, as her milk agreed well with what had been before a weakly child, he pre- vailed upon her to come back. Some months afterwards he found out that every night she used to spend her time with the cabmen of a stand in the neighborhood. A more common fault is illustrated by the following case. I engaged a wet nurse, also a fallen woman. The milk suited in every way at first. Subsequently the child did not seem to thrive. It was always crying, al- though pacified when put to the breast, but apparently never satisfied. I examined the milk frequently, microscopically and chemically. I always found it good, nay, even unusually rich; but I soon discovered it was in- sufficient in quantity. This was detected by offering the child food imme- diately after it had been suckled, and finding that it partook of it with avidity. Had this not been found out the child would have died of star- vation. These are only a few of the tricks practised by wet nurses se- lected because of their want of morality. But there are various accidents of a similar nature likely to occur when infants are given into the charge of women without principle. But, again, as a justification of their employment, it has been averred that, first, many married women are quite as bad. Secondly, it is said that many of these fallen women are persons of good constitution, and of favorable age and previous excellent character; and it is conceived that if proper care be taken to select those free from disease, in the great major- ity of instances they would be found very suitable wet nurses, and very good domestic servants. Upon the first of these points I am not ready to cavil. It is some- times a true proposition, but then their shame is not openly and unblush- ingly proclaimed; the example offered is not the same glaring encourage- ment of vice; the evil is not prominently displayed. Still, if we know a married woman to be vicious, who could recommend her engagement ? The possibility of doing harm by employing a married woman is no reason for doing more harm by engaging a fallen woman. Secondly. It is all very well to talk of fallen women being excellent characters, save and except in the one sin by which they fell. This may be true for small towns and country places, where everybody's antece- dents are known. It is only true for London and very large towns as an exception. For how are wet nurses procured ? They are generally wanted in a hurry; application is made at a lying-in hospital, and the matron kindly furnishes the names of several, one of whom is usually se- INFANT FEEDING AND ITS INFLUENCE ON LIFE. 119 lected. But these are not generally women whose antecedents she knows. They are persons who apply to her for a wet nurse's situation, and whom she recommends in consideration of a small fee, because the age of the milk suits. But she is very often deceived. Some of these women are found on subsequent inquiry to have fallen more than once (p. 109), and to have had much experience in evil ways, although they may not have been upon the streets. Many of these have at one time or other of their lives suffered from those syphilitic diseases peculiar to their class. A few may have contracted habits of swearing, intoxication, and dishonesty; and there are some who, if the occasion again offered and proved remu- nerative, would gladly revert to their bad habits. What dependence could any one have on such a woman that she would care properly for a child ? It is true that sometimes even the most degraded may be restrained in their vicious course by strong affection for the little innocents that hang upon their breasts; and the power of religion can even soften the heart of the most depraved creature upon earth. But to hold out a premium for crime upon the bare chance of such a conversion is fraught with the greatest danger, and is only, after all, doing evil palpably, in order that good may come out of it possibly. Except, therefore, in a case of extreme necessity, and where the life of the child can only be saved by employing a wet nurse, and where none other can be found but a fallen woman, I hold it is a gross moral and social wrong to employ such a woman as a wet nurse. I would not, however, in regard to this unfortunate class, wish my words to be misconstrued. Woman is to me always an object of interest; and even in her most degraded state she is an object for Christian pity and reformation. Many are rather sinned against than sinning the vic- tims of villains who have deceived their too confiding love. If we are assured of this, if the woman be one of a class not previously depraved, the peculiar circumstances of the case may be taken into account, and it may be allowable to select her as a wet nurse; and then if she is carefully watched while attending to the child, and her own child is also well looked after, we are giving that woman an opportunity of gaining an honest livelihood, and once more reclaiming a lost position in society. But I know from experience, that where you have to do with a woman of bad character (particularly if she has been confirmed in her vicious habits if she be a harlot in taste and habit), do what you will, you can- not obtain from her reliable information, either as to her own antece- dents or those of her family, or as to any peculiar taint with which she may have become infected: and thus you may be doing irretrievable in- jury to the little babe which you require her to suckle. It is not likely that a woman who has obtained her livelihood by the sacrifice of every principle of virtue will hesitate to assert the most delib- erate falsehoods, when by so doing she will obtain a remunerative occu- pation, and one which may place her (although nominally a servant of a wealthy establishment), in the highest possible position to which a woman 120 INFANT FEEDING AND ITS INFLUENCE ON LIFE. in her station of life can hope to attain. If this be so, it only points out the immense importance of selecting a wet nurse who shall be as healthy in muni ;is she is in body. If, therefore, fallen women are to be employ- ed as nurses at all, let them do the menial work in large hospitals or pris- ons, under proper kind surveillance; but a virtuous household is not their proper domicile. A curious point here presents itself for inquiry, Are mental peculiari- ties of a good or bad kind transmitted through the milk of a wet nurse, as well as bodily infirmities ? This is an all-important inquiry. As it borders, however, on the metaphysical, and is extremely difficult or doubt- ful of proof, I think it wise not to discuss it here. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 121 CHAPTER VIII. The Physical Qualifications of a Wet Nurse to be Selected 1. Should have Good Milk : Characters of Good Human Milk 2. Hereditary Predisposition Good 3. Age not to exceed 30 4. Near the Age of Milk of Mother 5. Melancholic Temperament (5. Milk in Sufficient Quantity. THERE may be a state of health present in the mother which renders the selection of a wet nurse essential. If she is weak or pale, or hysterical to a degree; if there be copious leucorrhrea, but particularly if there be headache and a sensation of sinking at the epigastrium, or if the sight be- come impaired, the mother should desist. This defect in the sight will become blindness if the nursing is prolonged a blindness often persist- ent and the least curable. Moreover, as shown by Drs. Merei and White- head, such milk is not only injurious to the child at the time, but does not contain sufficient nutriment for its proper development. As such, it is noxious. Then, again, the child's mother may be dead. Or, lastly, the child, after an abortive attempt to bring it up by hand has been made, is in a state of dangerous atrophy, diarrhoea, etc. In such a case there must be a change, and we may have to select a wet nurse. In this choice we must have due regard, lest we injure the child to be nursed, to her physical as well as mental qualifications. To the latter, however, I do not here recur. But in reference to the former, I believe that to make a judicious selection is one of the greatest difficulties which a medical man has to encounter, because so very much depends upon the person chosen. The physical qualifications of a wet nurse may be summed up under the following heads: 1. She should have good milk. 2. Her hereditary predisposition should be good 3. Her age should not exceed thirty. 4. She should not have been confined many weeks before or after the child's mother. 5. She should be of the melancholic temperament. 6. She should have not only a good quality, but also a sufficient quan- tity of milk. As a corollary, we may add, that when a wet nurse cannot be given to a child exclusively, a married woman suckling another child may be employed to assist the artificial feeding. 1. She should have Good Milk. This point will be best treated by considering what the characters of good human milk are. One of the INFANT FEEDING AND ITS INFLUENCE ON LIFE. best evidences of a wet nurse's good physical constitution is, the secre- tion of an abundance of healthy and nutritious milk. Good human milk has an average specific gravity of 1032, varying from 1030 to 1034. It is always strongly alkaline; this alkalinity it usually retains from five to six days, after which it becomes acid. To the taste it is sweet, much more so than cow's milk. When allowed to stand, it will be seen to sepa- rate into two portions. The superficial very white substance, known familiarly as cream, consists chiefly of the oil-globules, which, being of a lower specific gravity than the other portions of the milk, rise to the sur- face. The more transparent subjacent liquid, known popularly by the name of skim milk, when the cream has been removed from its surface, consists of casein, sugar, and salts, held in suspension or solution in a white, opaque liquor. The agitation of the superficial portion, or cream, breaks asunder the oil-globules, which in this state constitute butter. If the subjacent por- tion, after the cream has separated from it, be kept any time, the sugar contained in it becomes converted into lactic acid, which gradually pre- cipitates the casein as a curd. Rennet, or the mucous membrane of the stomach, and most acids, have the same effect. The fluid which now re- mains, technically called whey, contains still in solution a large quantity of sugar and the salts of milk, which are readily separated by evapora- tion. When looked at through the microscope, milk is found to consist of a colorless fluid, the liquor lactis, in which are floating a number of bodies: (a) oil-globules, similar to those found in all parts of the body. (b) The proper milk- globules, smaller in size, varying from l-9500th to l-700th of an inch. These also appear to be oil-globules, from the fact that they reflect light strongly; but, from the difficulty experienced in dissolving them in ether, they are evidently covered with a layer of some- thing else, which surrounds them as a capsule, (c) There are a great multitude of small granules, or granulated corpuscles, floating amongst the milk-globules, most abundant in milk secreted at a very early period. The liquor lactis holds in solution the casein, though some observers be- lieve that the external layer of the milk-globules is also made up of casein. Years ago, M. Devergie devised a rough way of testing the quality of milk by the quantity of these large globules. He found that milk might be divided into three classes: 1st, that having large globuled milk; 2d, that having small globuled or pulverulent milk; 3d, that having milk of medium-sized globules. Out of 100 women, seventeen had the first variety of globules, and in ten of these seventeen, lactation increased their number. Twenty-two had the second variety, and out of these twenty-two, seventeen had the richness of their milk increased by lacta- tion. In his opinion the more numerous the large-sized globules, the richer the milk. 1 1 " Snr la valeur de 1'examen microscopique du lait dans le choix d'une nourrice." Britith and Foreign Review, 1844. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 123 According to the latest analyses by Becquerel and Rodier, the com- position of human milk may be stated as follows: ' Mean. Maximum. Minimum. Specific gravity 1032.67 1046.48 1025.61 Water 889.08 999.98 832.30 Solid constituents. . . 110.92 147.70 83.33 Sugar 43.64 59.55 25.22 Casein and extractive matters 39.24 70.92 19.32 Butter. 20.66 56.42 6.66 Salts by incineration 1.38 3.38 0.55 1000.00 1000.00 1000.00 There exist, in addition, certain volatile principles, which may be ob- tained by the evaporation or distillation of milk, and to which, in great measure, is probably due the odor of new milk. I shall have occasion again in the sequel to refer to these several principles in detail. It may suffice here to make a remark in reference to two of these principles, the extractive matters and the volatile principles of milk. Of the first, it may be stated here, that most of those peculiar changes which render milk so detrimental do not occur so much in the casein, sugar, butter, or salts, as in the extractive matters, concerning which, to our regret, it must be added, in the emphatic words of Lehmann, so aptly used by Becquerel and Vernois, " we know absolutely nothing." The same is true with regard to the volatile principles, the nature of which has not yet been determined by chemical inquiry, although several experiments for that object have been made. It will be seen that the extreme limits of health exhibit a very marked difference, and hence one great difficulty in selecting a wet nurse. 2. Hereditary Predisposition. In the inquiry made as to the heredi- tary predisposition of a wet nurse, the greatest care is required. iical men are, in this situation, invariably guided by the principle, that diseases which are known to be hereditary from parent to child, can be also conveyed to a suckling through a wet nurse's milk. Hence, it is usually the custom to reject those affected with any taint of consumption or tubercular disease, syphilis, or other similarly communicable maladirs. The great extent to which the former of these affections prevails may be gathered from the fact that the proportion of deaths from it, to 1,000 (i.-jitlis from all diseases, is 154.5 for males, 172.3 for females, and 163.4 for all persons. Syphilis is not generally fatal to the mother, but its con- sequences on the life of a child are very deplorable. It is known that a woman thus tainted will consecutively bring forth stillborn children, or have a succession of miscarriages; but it is not as generally known, or at 1 Becquerel and Rodier, Chimie Pathologiqut, p. 397. 124 INFANT FEEDING AND ITS INFLUENCE ON LIFE. least enforced, that even the healthiest children will, if they partake of this milk from a syphilitic nurse, gradually become atrophied, and die. Simon mentions a case of a young woman who contracted this disease after the birth of her first child, and who, in consequence of improper medical treatment, c,irrl> ! the disease about her for years. Her children continued pretty well till they reached the age of six months, then be- came highly scrofulous, and died in a state of general marasmus; and yet this woman's milk, when analyzed, appeared to be quite healthy, and even rich. Donne-, from several examinations of the milk of syphilitic women, concluded that no difference could be found in either the chemical or microscopical characters of such milk. Meggenhofen, however, found that it was acid in reaction. It is sometimes, as I have before said, very difficult to make out syphilitic disease, although present. I have already alluded to Mr. Lang- ston Parker's opinion, and given a case as an example (p. 109). This points out the necessity of full examination wherever the slightest sus- picion of contamination exists. Again, sufficient caution is not usually taken in the case of cancer. I have before said, that of late years cancer has been on the increase (p. 103). The disease is known to be hereditary; and therefore it is neces- sary to be doubly cautious in making a selection where any blood relative of the nurse has labored under the malady. What is true of cancer I would equally apply to insanity. This is also an hereditary disease, the taint of which, even if not actually transmitted as insanity, often develops itself in after life, in analogous, although milder, affections. Extra- ordinary peculiarities, eccentricities, strong dispositions to crime or sexual indulgences, more frequently a deficiency in intellectual power, are apt to follow evils greatly to be deplored, and therefore, if practi- cable, to be avoided. 3. Tlie Age of a Nurse should not exceed TJdrty. I would further ven- ture to state that it should not be much under twenty-five. I have al- ready shown elsewhere, 1 that the age of the highest sexual development in a female is twenty-six, at which age she is in the best condition to ful- fil her maternal duties. After thirty this power slowly deteriorates; and before twenty-five she can scarcely be said to have completely acquired that physical health, which has been weakened during the progress of puberty and the changed position which she has been made to occupy in society. It is but right to add, however, that we do not find the milk itself very much altered, chemically or microscopically, between the ages of fifteen and forty. Still, at the extremities of the scale, the differences are obvious. In the very young, the butter, casein, and solid matters generally excepting the sugar, which exists in diminished quantity are on the increase; in the older women there is a larger proportion of water and sugar; the amount of butter and casein is diminished, although the 1 On " Procreative Power." London Journal of Medicine, 1850. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 123 latter is still in excess as compared with the normal condition; from which it may be inferred, that the milk of a very young person is less digestible, and therefore less to be recommended for a delicate infant. i. It is usually said that t/te wet nurse selected should have been con- fined as nearly as possible about the same time as the mother of the child for whom the milk !< ri aired. Too much stress, however, should not be laid on this contingency; for it should not be forgotten that the con- stituents of milk not only vary in relative quantities in different animals, but even in the same. So liable are they to vary, that the different cir- cumstances of life may materially affect them in the same individual. Indeed, Parmentier and Deyeux have shown that the milk of women of the same age, confined at the same time, and submitted to the same in- fluences, was always different in fine, that the milk of the same animal, obtained at different times, varied greatly. 1 All that we should look to is, that the milk be good, and that the age of it be not too far removed from what the child's mother's milk was; for milk materially changes in its composition as the period of lactation is prolonged; and thus the fe- male, although possessing very excellent milk, may yet supply a fluid which will prove injurious to the suckling. The effects of age on milk are summed up as follows by Becquerel and Kodier. The specific gravity varies much. The proportion of water increases from the fifth to the sixth month, and from the eleventh to the twelfth; it diminishes from the first to the second, and from the eigh- teenth to the twenty-fourth. The solid matters increase in a marked de- gree from the first to the third. The sugar decreases during the first month, but increases from the eighth to the tenth month. The butter in- creases considerably up to the sixth month, and then considerably de- creases from the fifth to the sixth, and from the tenth to the eleventh month. The salts undergo a slight increase in quantity from the first to the fifth month, then correspondingly decrease. These changes are really most important to trace, because they are indices as to the substitute which, bearing a proper proportion to the amount and quality of nutritive matter required, is best fitted for a child whom it becomes obligatory to wean, or for whom another diet is imperatively called. It must be con- fessed, however, that the constituents of milk vary so much, that it is very difficult readily to estimate its goodness from their present quantity. Its composition varies also, within the limits of health, so much, that we have often no better method of testing it than triul with the child, when, if it agrees with it, we may conclude it is good. " It may, however, be stated as a rule, that if the butter is in excess, the milk is poor in quality, ex- cepting in syphilis and phthisis, particularly when the latter is accompa- nied with diarrhoea, and in mental disturbance. In the former it may fall to 9.12 per cent.; in the second, to 12.7; in the latter, to 5.14; the normal proportion being 26.6. Thus in acute diseases the mean is 29.8; 1 Burdacb, PhytMogu, a. 520, p. 356. 126 INFANT FEEDING AND ITS INFLUENCE ON LIFE. in chronic, 32.6; in acute enteritis, 31.5; in acute pleurisy, 54.2; in acute colitis, 54.2. In nurses of feeble constitution it is 28.78, as compared to 25.96 in those of robust constitution. In very young nurses it varies from 15 to 20, 37.8, and so on." ' 5. A Wet Nurse of a Melancholic Temperament should be preferred. The milk of a brunette is generally richer in solid constituents than that of a blonde; for which reason the former are preferred as wet nurses. The following analyses, quoted from Simon, were made by L'Heritier: * Blonde, aged 22. Brunette, aged 22. 12 12 Water 892. ... 881.5 853.3 .... 853. Solid constituents 108. ... 118.5 14C.7 147. Butter 35.5 ... 40.5 54.8 .... 56.3 Casein 10. ... 9.5 16.2 17. Sugar of milk 58.5... 64 71.2.... 70. Salts... 4.0 . 4.5 . 4.5 . 4.5 1000.0 1000.0 1000.0 1000.0 These are extreme cases; but the average ratio of solid constituents lies from 120 for a blonde to 130 for a brunette. There is yet another reason why a brunette is to be preferred. Blondes usually belong to the sanguine or scrofulous temperament. A fair skin, with brilliant color, light blue eyes, very light or red hair, are usually present in such cases. The digestive powers are weak, and an unusually irritable manner is a frequent accompaniment. As a consequence of this sanguine and more passionate character, the milk of blondes is very apt to become altered under mental excitement. In extreme cases it has been known to pro- duce the death of the infant; but it almost always produces serious re- sults. In the case of a recently delivered woman, who was in a state of considerable fever induced by a fit of passion, the child after partaking of her milk was seized with vomiting, diarrhoea, and convulsions. This milk was examined by Simon ; it had an alkaline reaction and a strong animal odor, when boiled. After twelve hours it developed a large quan- tity of sulphuretted hydrogen; and yet the casein, sugar, and butter had not undergone any change in quantity or quality. Brunettes usually belong to the bilious or melancholic temperament. In disposition they are more gloomy and dull than blondes. The milk is richer, and a precocious child is, as it were, restrained by this milk from over-excitement in its mental manifestations. Its body has time to be formed and to develop itself before it is exhausted by undue psychical excitement, and a stronger child is the result. Among the brunettes there is to be found another variety, closely connected with the sanguine. The eyes may be very dark, even black; 1 Op. tit. * Simon's Chemistry, ii., 54. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 127 the complexion also dark; but with this there is a transparency in the look; the eye is unusually bright; the veins appear vividly blue through the skin. Such persons have all the vivacity of character common to the sanguine, and are to be avoided for similar reasons. Intermediate between the sanguine and melancholic is the lymphatic or phlegmatic temperament. It is the reverse of the sanguine. It is ac- companied with weak pulse, languid circulation, cold extremities, and pallid skin. 1 There is deficiency of red blood, of vascular action, of tone; and the proclivity is to watery fluxes and other chronic affections. Such persons are not calculated to make good nurses, and should therefore be scrupulously avoided. 1 Lastly, the nervous temperament is to be rejected. This is character- ized by agitation and trepidation of manner. There is an exaltation in the nervous phenomena, and a general tendency to nervous and hysteri- cal diseases. 5 AVhen we remember that a child is eminently impression- able, and has to go through an excitable period in teething, to exalt a ner- vous tendency cannot be wise. Deyeux examined the milk of a woman who was liable to frequent nervous attacks. He found that, simultane- ously with these attacks the milk became transparent and viscid, like albu- men, and did not resume its normal condition till some time afterwards. To expose a child to such variations is most injudicious. 6. >'/,<' sltAos- phates and uric acid. Generally speaking, however, this ulceration was not common. In combination with other aliments, excess of oleaginous food appears to exert a beneficial effect, particularly in cold countries. In. Iceland, where all circumstances considered usually favorable to the devel- opment of the scrofulous diathesis are present, the inhabitants enjoy a remarkable immunity from it, without any other assignable cause than the peculiarly oleaginous character of the diet usually employed.* Fatty matters are occasionally accumulated in the blood. Several cases are on record in which the blood was quite white, in consequence of excess of fat. In some cases it was chyle, unchanged. Short of this, milky serum is not very unusual from this cause. The face and general appearance of such persons are very greasy and oily looking, quite the character of what Sir Duncan Gibb has termed " the atheromatous consti- tution." The proportion of butter required for an infant, taking human milk as the average, is 1 part iif 2.8; or, taking solid constituents, as much as 1 in 3. 2. Sugar exists in the body in two forms First, as sugar of liver, or diabetic sugar, which is identical with the grape sugar, as it occurs in the grape; and second, as ttuyar of milk. It is of the last only we have to speak particularly, and it has several very important bearings. In alkaline blood it certainly assists to dissolve the carbonate and phosphate of lime. Kven if some salt of lime bo present, the sugar may, as in the chick, com- bine with the alkali or lime in the alkaline fluid, and then dissolve the car- 1 See remarks on Mineral Ingredients, p. 134. 1 Carpenter's Physiology, p. 883. 132 INFANT FEEDING AND ITS INFLUENCE ON LIFE. bonate of lime as a compound of sugar with lime or soda. This was shown by Barreswill. 1 But sugar is capable of being transformed into fat in two ways: first, by undergoing a kind of vinous fermentation, the atom of sugar being decomposed into carbonic acid and a substance poor in oxygen; or, sec- ondly, by a kind of butyric fermentation, hydrogen, carbonic acid, and a compound poor in oxygen being found, which last is one of the known fattv acids. In all these cases a peculiar ferment is developed, which is capable of separating the oxygen from the hydrogen. The lactic precedes the butyric fermentation, and of all nitrogenous bodies it is with casein especially that this change is effected. This, doubtless, is one of the rea- sons why casein is the nitrogenous aliment found in milk. The butyric fermentation, like the lactic, requires the addition of equivalent quantities of alkalies for its perfect accomplishment.* "But in every case the deposition of fat within the animal body betrays a certain deficiency of oxygen, showing that the amount of oxy- gen respired is insufficient to allow the complete separation of the sugar into water and carbonic acid." 8 Another important use of sugar is, that it is essential to the forma- tion of milk. Sugar is not secreted by the mammary gland. The sugar is probably merely separated by the gland from the blood in which it exists. It is not readily detected in the blood; but this is probably due to the rapid manner in which it is excreted. Certain it is, if an animal is fed on starchy or saccharine matters, the quantity of sugar is consider- ably increased. It is upon these grounds that a milk containing more sugar and more closely resembling human milk can be obtained from a cow or goat, if either be fed on beet-root in excess. Allusion has been already made to the effects of a diet exclusively saccharine. Magendie fed dogs exclusively on sugar and distilled water. During the first seven or eight days they were sufficiently brisk and ac- tive; in the second week they began to lose flesh, although all along the appetite continued good; in the third week they became feeble and lost their appetite. Films also appeared in the eye, followed by an escape of its humors. From six to eight ounces of sugar could up to this time be taken; now, however, they could only consume* three or four. Debility increased till voluntary movement was impossible, and death resulted from the thirty-first to the thirty-fourth day. General atrophy of mus- cular structure, and signs of inanition in the intestines, which were pale, empty, and contracted, were well marked on a post-mortem examination. These results may be expected in a minor degree where children have their food either too much sweetened, or if the breast milk contains too large a proportion of saccharine matter compared to the other ingredients a state which I have detected in some wet nurses with very thin milk. 1 Day's Lehmann, chap. iii. , 220. * Ibid., i., p. 282. 1 IbuL, iii., p. 221. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 133 The proper proportion of sugar in milk should be 1 part in about 2.3, or, taking solid constituents only, 1 in 2.6. II. T/ie Nitrogenous Aliment. Liebig states, " In the same way as in the egg, the albumen of the blood holds the first place in the powers of formation of the fcetus, to which it is conveyed from without. By its elements it takes a share in all processes, it determines growth, and also the production and amount of all organized tissues in the young as well as in the adult frame. . . . Only those substances are, in a strict sense of the word, nutritious articles of food which contain either albumen or a substance capable of being converted into albumen." In milk " we find it in the shape of casein, a substance which, like albumen, contains sulphur and nitrogen, and the absence of every other nitrogenous compound in milk renders it perfectly certain that from casein alone the chief constituent of the young animal's blood, as well as its muscular fibres, membranes, etc., are formed in the first stage of its life." 1 From the experiments of Guillot and Leblanc it appears to be a nor- mal constituent of blood in man and other animals, at least so far as the examination of seventy specimens of blood in men, women, oxen, cows, rams, sheep, etc., justifies the inference; but the quantity is notably in- creased during pregnancy. 1 Casein differs from albumen in not being coagulable by heat, but it is precipitated by all acids, even acetic and lactic acids, which have no effect upon albumen. The addition of water to milk favors the separa- tion of the casein, and renders it harder and less digestible. One advantage, however, which casein has over albumen, among many others we have dwelt upon, is that it facilitates more readily than any other nitrogenous body, the butyric fermentation of milk where the lactic fermentation has been already induced. It is doubtless in assimi- lation converted into albumen and fibrine wherever so required; for in- stance, the albumen which accumulates around the fatty nucleus of the cell-growth. 1 )ogs fed on casein exclusively live for a long time, but become weak and thin, and lose their hair. Its quantity in human milk varies, e.>/., ;!<) to 40 per cent, in 1,000 parts, or in reference to solid constituents, 1 part in 5 to 1 part in 10. In sj aking of these several alimentary substances, it may be stated, that "afu-r an animal has been fed for a long period on one kind of ali- . which, if long continued, will not support life, allowing him his customary food will not then save him, but he will die as soon as if he had continued to be restricted to the one article of food which was first given."' A variety is therefore essential to the maintenance of ht-altli. Letters pp. 247-248. Cmnptet Rendut, 1850. xxxi., pp. 520-585. Mttller's Physiology. 134 INFANT FEEDING AND ITS INFLUENCE ON LIFE. It is perhaps because in artificial feeding due regard is not paid to this variety that the third stage of defective assimilation is induced, from which recovery very rarely, if ever, occurs. It follows as mi important corollary from the foregoing general re- mark, that if inferior milk be given, or if artificial animal food be pre- pared from milk in an improper manner, the same evil results will follow, because excess or defect in one or more of the ingredients will be given. It becomes, therefore, important to look at the question in the point of view of the proper and wholesome admixture of food. III. The Saline Ingredients. Their due appreciation will set forth some very important principles in alimentation, and also give us a key to the quality of substitutes required when artificial food is given. The salts of milk are not the least important of its constituents. They are stated in the annexed table for human and cow's milk: Cow's MILK. Mean of Two Experiments. HUMAN MILK. (Hardlen.) Phosphate of lime 2.87 0.706 Phosphate of magnesia 53 Carbonate of lime 0.009 Phosphate of peroxide of iron 07 Chloride of potassium 1.63 Other salts 0.053 Chloride of sodium 29 0.09S Soda 43 Sulphate of soda 0.074 Total salts in 1,000 parts of milk.. 5.82' In 1,000 salts 1.000 Schwartz, in his Journal* enumerates the following salts in 100 parts of human milk. Soda, resulting from the decomposition of lactate of soda, 0.03; chloride of potassium, 0.07; phosphate of soda, 0.04; phosphate of lime, 0.25; phosphate of magnesia, 0.05; phosphate of iron, 0.001. First, of the phosphate of lime. This salt, especially when combined with carbonate of lime, is most useful in the process of alimentation. It is on their combined agency that the solidity of the skeleton depends. Moreover, it is a peculiar property of phosphate of lime to make carbonic acid more soluble in the blood. Its administration, whether in a separate form or in aliment to a growing animal, is thus peculiarly indicated. Deformity of every kind in the skeleton may depend on an insufficient quantity of this salt in the blood; for it should be remarked, first, that not only is it useful because it is itself appropriated to the system; but, secondly, phosphate of lime when present in a fluid (which in the present case is milk, and by subsequent assimilation becomes blood) has the prop- erty of enabling that fluid to take up more carbonic acid. Now when carbonic acid in its turn is in excess, it dissolves carbonate of lime. Hence, the quantity of carbonate of lime held in solution in the blood is thereby made greater, and is in this way from time to time more easily and largely deposited in bone. Chalk, or carbonate of lime, is insoluble in 'Simon's Chemistry, ii., 63. *VoL viii, p. 270. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 135 distilled water; but in proportion as this becomes saturated with carbonic acid, so a larger quantity of the chalk is taken up a property never to be lost sight of when it is wished to strengthen a growing child. Secondly, the phosphate of soda has an alkaline taste and reaction like the carbonate, and its solution in the presence of free carbonic acid takes up as much of that acid as carbonate of soda does; and, like it, only more easily, gives it off by agitation in vacua, or by evaporation, without losing its power of again absorbing carbonic acid. Hence it fol- lows, that in adults the change of carbonic acid combined with alkali by phosphoric acid, which occurs when animal food is taken in lieu of vege- table food, and vice versa, has no pernicious influence, because it gives rise to no alteration in the essential properties of the blood. The process of sanguification, of the production of heat, and of secretion, are carried on alike under the influence of the predominating alkali, as before stated. 1 But phosphate of soda seems to possess another useful property in the economy. The fatty acids, stearic and margaric, are converted into emulsions in the chyle through its agency, so as to allow of their easy assimilation in the system. This peculiar property, discovered by Dr. Marcet and lately exemplified by Dr. Thudichum before the Medical Society of London, is of immense importance in the explanation of the digestion of fatty matters, and is another reason for supplying food rich in phos- phoric acid and soda, which is especially the case with animal aliments, to growing and weakly children; fat, as before stated, being the nucleus around which albuminous matters are deposited. Thirdly. In the uses of phosphoric acid, viewed particularly as an acid, and in regard to alimentation, there are several very interesting points. The blood is alkaline, and, as opposed to this, flesh is tvV, tin' acidity being due to phosphoric acid; and this is true for other solid por- tions of animal food, but for muscle especially, which contains an excess of phosphoric acid. Fourthly. In muscle, and in soup made from muscle, we have also excess of chloride of potassium in lieu of chloride of sodium. X<>\\- there is considerable analogy in this respect to milk which contains an excess of chloride of potassium, although it also contains some chloride of sodium.* 1 Liebig's Lettert. 1 Competition qfattiet When boiled Compoxttion ofatkat ti/Jtetti. there enter qfmlU: into the soup. (Keller.) (Com.) Phosphoric acid 88.60 '2C..-2 1 Phosphate of lime 50.7 Potash 40.20 :!"'.4^ Phosphate of magnesia 9.5 Earths and oxide of iron. . 5.69 3.15 Phosphate of poroxide of iron . 1.0 Sulphuric acid 2.96 'J !C> Chloride of sodium 5.0 Chloride of potass. 14.81 14.81 Chloride of potassium. -J7. 1 Bod*., , 6.7 100.25 82.57 100. (Ibid., p. 428.) loO INFANT FEEDING AND ITS INFLUENCE ON LIFE. No doubt this large excess of the potash salt in milk answers many of the purposes of chloride of sodium in the economy. But chloride of potassium enjoys the peculiar property, in common with carbonic acid, of dissolving carbonate of lime, or chalk. The advantage, therefore, of giving to the infant this salt for the purposes of the skeleton, and in sup- plying to the muscular system a salt essential to that structure, must ap- pear at once obvious. The excess of potash salts generally, but of chloride of potassium especially, which last, as in muscular flesh and milk, so greatly exceeds in quantity the chloride of sodium, is very remarkable. Dr. Andrew Clark has also informed me that potash salts are always in excess in cell- developments, even when the growths are morbid a fact of grent impor- tance, although often overlooked, as showing that those animal foods which contain an excess of potash salts should be preferred as aliments for growing children. While, however, these facts are admitted, it is important to oppose a mistake usually made, in speaking of chloride of potassium. Robin and Verdeuil have properly insisted upon the impropriety of confounding this salt with chloride of sodium, or common salt, in all its agencies upon the animal economy. Although it is true that they may mutually be substituted for each other in plants, they cannot always be similarly sub- stituted in the animal body, particularly in the young animal. We have said that chloride of potassium exists in large quantity in muscle; it is found also in small quantity in blood. The reverse is true as regards chloride of sodium. This proves a peculiar antagonistic power in these two salts. But more than this, life is inconsistent when this relative quantity is not maintained in the blood. It is well known that in certain cases of Asiatic cholera large quantities of a solution of chloride of sodium have been transfused in the blood with the happiest results. And in the same disease it is found that the alvine evacuations con- sist almost exclusively of a solution of chloride of potassium. Yet when any attempt has been made to inject a potash salt into the blood, death has invariably resulted. The two salts, therefore, cannot be inter- changed. It is remarkable also to notice, in connection with this opposite action, the fact that muscular tissue which contains a large excess of chloride of potassium has an acid reaction, whereas blood which contains a large ex- cess of chloride of sodium has an nlkuliiie reaction. Now this correlative antagonism cannot be purely accidental. Nay, its constant occurrence proves that it is intended to fulfil some wise purpose, although we may not fully appreciate it. It is also curious to note that the potash salt, so needful to cell-growth, is in milk (the food par excellence for babies, in whom growth is so rapid and continuous) conveyed not as a sulphate, phosphate, or carbonate, but as a chloride. This preponderance of chloride of potassium and phosphoric acid in milk is also remarkable in a portion of the blood. I allude to the blood-globules; a coincidence the INFANT FEEDING AND ITS INFLUENCE ON LIFE. 137 more remarkable, as the blood-globules are eminently concerned in nutri- tion. Upon this point I quote Lehmann's remarks. "Although we are able to calculate the quantity of the mineral con- stituents in the blood-cells, the questions still remain to be answered, whether there are certain salts which especially accumulate in the cells, and if so, which they are. These questions have also been answered by C. Schmidt, for he has discovered that the fluid of the blood-cells (i.e., the water contained within the blood-corpuscles) contains in addition to the organic matters a preponderance of phosphate and potash salts; so that, consequently, the phosphate of potash and the greater part of chlo- ride of potassium pertain to the blood-cells, whilst the chloride of sodium, with a little chloride of potassium and phosphate of soda, is found in the plasma, i.e., the serum and fibrine. In the plasma the organic materials are combined only with soda; while in the blood-cells the fatty acids and the globules are combined both with potash and soda. " C. Schmidt, in analyzing a specimen of food which contained 396.24 p. m. of blood-cells and 603.76 p. m. of intercellular fluid, found 1.353 of chloride of potassium and 0.835 of phosphate of potash in the for- mer, while there were 3.417 parts of chloride of sodium, besides 0.267 of phosphate of soda and 0.270 of chloride of potassium, in the latter. Schmidt has examined and tabulated the relations between potassium and sodium and between phosphoric acid and chlorine in the blood-cells, and in the intercellular fluid in several of the mammalia. (See table below. 1 ) " These results coincide with those of Nasse, who found most phos- phates in the blood of those animals which were distinguished for the abundance of their blood-corpuscles, namely, swine, geese, and hens; in sheep and goats, on the other hand, in whoso blood he found compara- tively few corpuscles, he also found the least phosphates. On another occasion Nasse has expressed the opinion that the phosphates must be principally contained in the blood-corpuscles."* It is also worthy of remark, that as metallic chlorides exist in ex- traordinary quantity in the gastric juice, and in the saliva also, as chlo- rides of sodium, but especially of potassium, this may be probably another 1 100 PARTS OP INORGANIC MATTER. Blood-cell*. Planma. Blood cells. riama. Ontu. Potiu.- rinm. Sodium. Potaa- MIITII. Sodium. P. 0. Chlorine. P. O. Chlorine. Mean of eight ex- perimentfl. 40.89 6.07 7.85 U.57 37.41 9.71 85.08 8N.07 14.08 .-, 1!) :{.-.'-. 5.17 r. -,<; ::..v, 37.74 87.74 n ->', :;? . MI 17 fit J', I',' 13. 2 8.95 9.41 21. ' t . s* j: i 6.03 <; .;:, :,!<(> -jo. os ::? ::i 41.70 10 Ml 40.41 Dosr. . . Cat Sheep Goat 1 Luhmann, translated by Day, ii. , p. 188. 138 INFANT FEEDING AND ITS INFLUENCE ON LIFE. reason why chloride of potassium is provided in excess in milk, which is the natural food of young 1 infants, in some measure to compensate for the absence of saliva, usually present in adults. " When, however, the functions of the blood-globules are considered, it is manifest that as in their constitution they on the one hand possess a remarkable correspondence with muscle in the large quantity of potash salts, especially chloride of potassium, and on the other hand a like corre- spondence to nervous matters in the large quantity of phosphuretted fat contained within them, it appears reasonable to conclude that they are especially destined to elaborate materials for the nervous and muscular tissues, whereby the fleshy organism and vital activity of the nervous and muscular systems are strengthened. Coupling this fact with the larger quantity of blood-globules in animals of high animal heat and in youth, their excess in dynamic fevers and plethora, their diminution in weak persons and low fevers, and generally in all cases where the system is badly nourished, we cannot fail to perceive how intimate is the relation between the process of nutrition and the quantity of blood-globules, and as a consequence the important relation in this process of phosphates and chloride of potassium." ' These are all reasons why chloride of potas- sium should exist in such large quantities in milk to supply an ingre- dient so much needed by a young and growing animal. But, 2dly, what do we learn from the changes observed in the milk taken after it has undergone digestion by a healthy child, and all that is good and nutritive in it has been assimilated ? In other words, what les- son does the appearance of the healthy fasces teach ? Much every way. To prove which I cannot do better than to quote an article in the Medical Times of March 25, 1876, p. 339, which very succinctly describes them : " The Normal Digestion of Infants. An essav by Dr. Wegscheider, of Berlin (vide Centralblatt, No. 3, 187G), based on the microscopical and chemical examination of the faeces of a number of healthy infants between two and three months old, whose diet consisted entirely of breast milk, reveals some interesting facts with regard to the various changes which go on in the digestive tract at that early period of life. The faeces were simply scraped from the napkins, and then preserved, without the addition of water, in well-stoppered bottles. "The color of the motions of healthy infants varies between that of yolk of egg and greenish-yellow; their reaction is always acid. Their consistence is very variable, and ranges from an almost complete!} 7 - dry to a thin liquid character. Their smell is never offensive, but resembles that of sour milk. The faeces always contain whitish fibrinous-looking flakes, which are proved to consist of fat, with probably some intestinal epithe- lium. The fats consist of palmitin, stearin, and olein. Besides fat, the fasces appear to contain traces of peptones. Sugar was not found in any appreciable quantity. 1 Op. cit. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 139 "The remains of the secretions of the digestive tract are found in the faeces in considerable quantity. Mucin is present in variable amount, and its presence can be chemically proved by the precipitate, insoluble in ex- cess, which acetic acid produces in an aqueous solution. Bile pii>'in -nt exists, both free and also in combination with bases. Choleic acid tan be detected in a free state in a solution made by extracting the fa?ces with alcohol. Cholesterin occurs in considerable quantity, but Dr. \Vegschei- der does not consider that it is entirely derived from the constituents of the bile. With regard to those bodies which are the products of trans- formation of the food and of the digestive secretions, neither leucin nor tyrosin can be chemically detected in the fasces. On the other hand, large quantities of saponified fats, in combination with lime and magne- sia, are present, and are thus wasted for nutritive purposes. In a watery extract of the faeces Dr. AVegscheider found traces of diastatic and pan- creatic ferments, but no pepsine. In consequence of the difficulty of keeping the faeces free from admixture with urine, he did not examine them for urea. " The most important conclusions which Dr. Wegscheider draws from his researches on the faeces of infants, in relation to their digestive func- tions, are the following: (1), The albuminous constituents of the milk are completely absorbed ; (2), the white residue which is found in the faeces and is usually regarded as casein, is not casein, but chiefly fat, with some admixture of intestinal epithelium; (3), the unabsorbed fats leave the bowel partly as soaps, partly as free fatty acids, and perhaps partly as unaltered fat; (4), urobilin and unaltered bilirubin occur in the faeces, and biliverdin is also found in diarrhoeal stools. " It is clear, therefore, from these products expelled, that all the casein is absorbed, also nearly all the sugar; and, third, a large proportion of the fats. These, therefore, are essentially the ingredients required in any healthy food for infants." no INFANT FEEDING AXD ITS INFLUENCE ON LIFE. CHAPTER II. Of the various Kinds of Animal Milks to be substituted for Human Milk. Composi- tion of Human Milk at different Ages. Ass's Milk. Goat's Milk. Cow's Milk. Difference of Milk, Town and Country, Summer and Winter, Morning and Even- ing. Results of various Foods in ita Composition. THK preceding remarks place us in a better position to consider the effi- c-acv and nutritive qualities of substitutes for human milk, by which it is wished to maintain the functional integrity and growing powers of a child, (a.) The simplest of these is clearly milk from another animal. Of this fluid three kinds are usually spoken of : ass's milk, which is said to come nearest to human milk; cow's milk; and goatfs milk. I will speak of each of these varieties seriatim. Before doing so, however, it will be well to set forth in a tabular form the relative quantities of the solid ingredients and the water contained in human milk, at periods of three months for the first year, and of six months for the second year: so that we may be enabled thereby to judge of the amount up to which each of these ingredients should be brought, and which is best adapted to the age of a child, when we substitute for its mother's milk that of the ass, the cow, or the goat. 1 1 COMPOSITION OP HUMAN MILK. Table calculated from one given by Becqwrel and Rodier. Specific gravity. Water. Solid con- stituents. Sugar. Casein with extractive matter. Butter. Incinerated salts. 1st Quarter. 1032.50 877.33 122.67 42.30 33.39 34.94 1.73 2d " 1031.81 893.14 106.80 43.71 87.95 23.89 1.37 8d " 1033.07 890.83 109.17 48.87 40.89 23.40 1.21 4th " 1031.24 892.98 107.03 4"). 79 36.89 23.03 1.29 12tol8mhs. 1032.05 891.34 108.66 43.92 3G.98 26.44 1.32 18to24 " 1030.81 876.55 123.45 41.33 37.32 43.47 1.33 COMPOSITION OP Ass's MILK. Simon. Milklyr. old. Peligot. Mean of BCV. anal. Chevalier and Henri. Lehmann. Vernois and Bccquercl. Human milk. Water 907 00 904 7 916 3 795 to 789 1 890 12 889 08 Solid constit. 91 05 95 3 83.5 205 to 210 9 109 88 110 92 Butter 12 10 12 9 1 1 . to 12.9 18 50 34 61 Casein 16 74 19 5 18 2 16 to 19 35 65 39 24 Sugar, with ex- tractive matter and salts 62 31 62 9 (with extractives) Sugar 60 8 60 8 to 62 9 50 46 26 fifi Salts. 3.4 5 24 1 38 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 141 Ass's Milk. It has usually been said that ass's milk is the nearest to a woman's milk; but 1 believe this to be an error. It contains, certainly, more water, but only about half as much casein and butter, about twice as much sugar and salts. In the Appendix I have given five analyses of ass's milk, of specific gravity from 1023 to 1039. I shall endeavor to show in the sequel how it is that this milk so often disagrees. Goafs Milk. In many parts of the world the goat is the substitute for the cow as the provider of milk to the population. The objection usually made to it is its disagreeable odor, from the presence of hircic acid. Observers differ greatly as to its composition, as may be seen from the table at p. 143, partly given by Simon. 1 The analysis by Boysson gives a composition not unlike human milk. Mayor, indeed, says that goat's milk is preferable to cow's milk, because it resembles more than any other milk that of a woman; and this is doubtless true, particularly if we compare with it the milk of very young women. It is certain that many children thrive very well on it in Ire- land, Malta, Switzerland, and other mountainous countries. One advan- tage which the goat possesses over other animals that yield milk, " is the greater impunity with which she sustains the various vicissitudes of the weather. She will sleep readily under a powerful sun, without suffering; she will remain unaffected, if exposed to rain or storm; she will bear a great amount of cold, although to this last she is more susceptible. Ex- perience, however, has proved that the goat, as well as the cow, will yield a larger flow of milk if fed in stables upon proper fodder; but then great attention should be paid to the cleanliness of the stable, and the removal of all offensive matters. The best milk afforded by the goat is that which it yields about two months after kidding. The peculiar odor and taste of goat's milk, from the presence of hircic acid, and which is not always very agreeable to those who taste it for the first time, is an objection; but persons soon get accustomed to it, and come to like it. This smell, however, is not essential to goat's milk, being chiefly present, and then most strongly, when the goat is allowed to associate with the ram; and is greatly diminished if the animals are kept clean, and especially if washed from time to time. It is also far less marked in those goats which have no horns: in the milk of these there is little more odor than in that of the cow."* It is interesting to notice here a fact established by Becquerel and Vernois; that is, that the character of the goat's milk, like that of the cow, may be regulated by the ijimlih/ of the food supplied. If a highly nourishing and rich milk is desired, it is best to feed the animal on straw and trefoil; but if a light milk is required, beet-root is preferable. This difference is set forth in the table, p. 142, to which I have also appended the composition of human milk, for comparison. 1 Simon's Animal CJumiitry, *oL ii., p. 65. * Pannentier. 142 INFANT FEEDING AND ITS INFLUENCE ON LIFE. INFLUENCE OF KINDS OF FOOD ON GOAT'S MILK. Fed on Btraw and trefoil. Fed on beet- root. Normal (mean). Human milk (normal). 1031.10 1026.85 1033.53 1032.67 858.68 888.77 844.90 889.08 Solid constituents 141.32 111.23 155.10 110.92 Butter 52.54 33.68 56.87 34.61 Casein and extractive 47.38 33.81 55.14 39.24 35.47 38.02 36.90 26.66 Salts 5.93 5.72 6.18 1.38 Cow's Milk. This is the substitute for human milk best known in these regions. The absence of unpleasant odor, and the greater ease with which it is obtained in Great Britain, are advantages in its favor. In appearance it is of a bluish white color, almost tasteless, specific gravity varying from 1030 to 1035. Its microscopical characters are about the same as those of human milk, excepting that the milk-globules are more abundant. Its chemical composition is given on the oppo- site page. Now it is clear, comparing this with human milk, that 1. The quan- tity of water is less in that of the cow; 2. The solid matters are in greater quantity; 3. The sugar is less in amount; 4. There is more casein; 5. And more butter ; 6. The salts are also in excess. It is quite manifest that, if the above analyses are to be depended upon, a simple dilution of this milk will not suffice. Water may be added, to diminish the relative quantity of casein and butter to the nor- mal figure it attains in human milk; but it will also reduce unduly the amount of sugar; and thus, at the outset, we meet with a difficulty in its employment. As with the goat, however, so with the cow, the food supplied, and the circumstances under which it is given, will, in great measure, modify the character of the milk yielded; and there are also some other differ- ences quite compatible with health, referring to the circumstances in which cows are placed, which materially affect the nature and yield of milk. 1 (a) Country Milk and Town Milk. The former is stated to be prefer- able to the latter. The reason is, no doubt, that the cows are less crowded together, and the milk is less watered. Becquerel and Vernois have also proved the truth of this popular 1 Page 145. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 143 K *j cp GO c ^ - > pr-_C = - ?sp c <; !||1i|l|i as?? ? P ?r CB ! . 2- 00 . . x x : : : s: : j: : : . . . 3 . . PS . . . .....&... ...<..< oo 1 O*O -3 4* Ot f-i: 00 ' ' 4O O -2 00 . 40 CO 05 . H- co oo oo i-i on I 00 . (_ Oi Ci Ct 4O . CO h-i -3 O O5 00 to c; co ct . ~3 - CD 00 CO a O CO OO CD O 1 oo to . o co -3 OS ~2 -3 4* \ \ 40 co o en o 00 -u Cn CO O O Ci Ci 00 Lecono. 00 . O CO CO - O 4O Ot CO cn *-> 4O O 00 CO 2 ~ -. . 40 H-> Ci co co oo CD 4" CO l" : CO Ci 00 Ci 40 Ci O 4 H- 00 r s O O 144 INFANT FEEDING AND ITS INFLUENCE ON LIFE, opinion from their experiments. See table below. (The mean figures only are given. 1 ) This difference is not, however, due to the mere exposure to country air, because experiments have proved that when cows are fed on hay, 'with oats or barley-straw, or the ordinary culinary roots with a certain quantity of wet bran, a similar milk is obtained from them in towns. (b) Summer and Winter Milk. Owing to the difference of nutri- ment given, the composition of these two milks is not the same. The principal difference observed in winter is a diminution of the water, and among the solid constituents an increase of the butter only; both the casein and sugar are slightly diminished. In summer there is more water; but what is remarkable is, that among the solid constituents the casein, sugar, and salts are diminished, and the butter is considerably increased. (c) Morning and Evening Milk. Milk, however, does not vary ac- cording to the season only, but according to the period of the day during which it is secreted. In 1851, Dr. Hassall, in his report on the adulteration of milk, proved this. While ten samples of morning milk from different cows yielded collectively 77 per cent, of cream, or an average of 7 for each cow, the same number of samples of afternoon milk yielded 9G per cent., the aver- age being 9. The curd amounting in the first case to G93, in the second to 810 grains. But milk varies more during the same milking, that last drawn being much richer than that first drawn, the latter yielding Clip- per cent, against 141 per cent, of the former. 9 More lately, Professor Boedecker, however, has completed a series of experiments, to elucidate this point, and he has arrived at the result that the milk of the evening is richer by 3 per cent, than that of the morning, the latter containing only 10 per cent, of solid matter, and the former 13 per cent. On the other hand, the water contained in milk diminishes by 3 per cent, in the course of the day; in the morning it contains 89 per cent, of water, and only 86 per cent, in the evening. The fatty particles increase gradually as the day wears on. In the morning they amount to 3.17 per cent.; at noon to 2.63, and in the evening to 3.42 per cent. This circumstance, if true, would be very important in a practical point of view. Let us sup- pose two pounds of milk to yield only the sixth part of its own weight 1 Influence of Season. COMPOSITION OP Cows' MILK. Paris. Country. Specific gravity 1033.10 1033.72 Water. 869.78 857.80 Solid constituents 130.42 142.20 Butter 33.66 38.85 Casein and extractive matters 53.86 57.00 Sugar 37.07 38.99 Salts 6.03 7.36 1 Lancet, 1851, pp. 322 and 258. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 145 of butter; then the milk of the evening may yield double that quantity. The caseous particles are also more abundant in the evening than in the morning from 2.24 they increase to 2.70 per cent., but the quantity of albumen diminishes from 0.44 to 0.31. The serum is less abundant at midnight than at noon, being 4.19 per cent, in the former case and 4.72 in the last. (d) Results obtained by various Kinds of Food, and by Beet-root in particular. Dr. Play fair adduces an example of a cow fed on much nitrogenous matter, in which not only was the amount of nitrogenous matter or casein in the milk increased, but also the butter. Certainly the yield of milk is increased by much of that stimulant diet which is occasionally administered after a time to cows, such as refuse slop from whiskey distillers, and which is known to be given largely in America, and fi>r \vliich cows acquire so depraved an appetite, that they will not after- wards take their ordinary food. 1 Other less exciting food has the same result. Thus, Parmentier and Deyeux found that cows fed on the leaves and stalks of maize yielded more milk than when fed on ordinary fodder. Moreover, the milk was extremely sweet. The milk obtained from cows fed on potatoes and common grass was much more serous and insipid. That from cows fed on cabbage was disagreeable to the taste. Herman- stadt found also that fresh aliments caused a larger quantity of sugar to appear in the milk than dry food. Mr. Curwin found* that coleseed when given to a cow was far the most productive of milk (Jiritssi'-tr WapUS.Jfape)j and in this respect was superior to Swedish cabbages and Kohl-rabbi. Among the most approved fodders for cows are sainfoin, Spanish, and ordinary trefoil; but there are a vast number of other annual plants among the graminaceae or leguminosa?, which, if cultivated and given to the cows, would prove exceedingly useful. Indeed, Anderson assures us that cows fed upon trefoil, in addition to grass, yielded a superior kind of butter to that afforded by cows fed upon this famed pasture only. The ancient faculty of medicine in Paris appointed a commission in 1771 to trace the effects of various roots on the milk of cows. These reported the potato to be particularly useful in increasing the quality and the flow of milk; also, that its administration to the mothers of thin, weakly children, had led to the rapid improvement of these latter in every respect. The effect of several varieties of food is set forth in figures in the table given below, 1 compiled from one quoted by Dr. Hassall from Che- HaasaU. Treatise on Milk, 1825. * After Chcva&er and Henri. Ordinary fodder. Boot. Carrota. Water 870.3 868.8 866.7 Casein 44.S :57.r> 42.1 Sugar of milk 81.3 27.5 80.8 IJiitt-r 47.7 5!>.r, :,::.n Salt* C.O G.b 7.5 10 146 INFANT FEEDING AND ITS INFLUENCE ON LIFE. vallier and Henri, and from another given by Becquerel and Vernois. Chevallier and Henri's cows were fed on the ordinary fodder beet-root and carrots. The winter food of those referred to by Becquerel and Vernois was daily one bundle and a half of trefoil or lucern, weighing from twelve to thirteen pounds; half a bundle of oat-straw, weighing from nine to ten pounds; and at the rate of fifty -five pounds of beet-root per week, half in the morning and half at night, with two buckets of water daily for drink. The summer food was green trefoil and lucern, Indian corn, barley, grass, in no fixed quantity in amount, however, estimated at from 99 to 100 pounds per week. At night, on returning from the field, the cows were given in the stable from eleven to thirteen pounds of grass daily. Drink as in winter. These tables prove that if cows be fed on carrots, the casein and but- ter are diminished, but the sugar increased in quantity; whereas, if fed on beet-root, both the casein and butter are much diminished, and the sugar is much increased. Here, as in the case of the goat, a milk is pro- duced, which, except in the excess of the salts, is very like woman's milk. It is manifest, therefore, that a great deal depends upon the manner in which cows are fed. Generally this is done in the cheapest possible way, because milching cows so deteriorate in value after eight or nine months' use as such. I am told that cows purchased for 18 to 20 at the beginning of a season, will sell at a loss of from 6 to 8 at the end of it ; they look so small and meagre. This mode of feeding cows is, after all, only evidence of great shortsightedness in the owner, since the deteri- oration may be easily prevented. A very intelligent gentleman in Not- tinghamshire has informed me, that if the cows are fed upon a steamed food composed of chopped hay, bran, malt culms, and rape-cake, not only will they produce an extra quantity of milk, but keep throughout the milching period in first-rate condition; in fact, they will, at the end of the six or nine months, look as well as they ever did. It is seldom that the milk of other animals is tried or is substituted for these three. Yet mare's milk has occasionally been tried successfully, although, according to Dr. Cameron, of Dublin, its composition is very different from human milk. In mare's milk, with about the same quan- tity of water, we have about one-third more sugar, but one-third less butter, less than half the cheese, and twice as much mineral matter. In tow's milk, with less water, we have about the same quantity of sugar, After Vernois and Becquerel. Summer Winter Normal food. food. human milk. Water 859.56 871.26 889. Casein and extractive matters. 54.7 47.81 39.24 Sugar of milk 36.38 33.47 26.66 Butter 42.76 42.07 34.61 Salts 6.80 ., 5.34 . 1.38 INFANT FEEDING AND ITS INFLUENCE ON LIFE. 147 more than double the quantity of butter and cheese, and nearly six times as much salts. 1 1 Milk. Water. 89 Sugar. Butter. Cheese. 43 24 33 Salts. 1 7 Mare's 90 .67 .90 ..193 40 Sow's. 81.7 46 56.6 70 9.6 Medical Press and Circular, Feb. 3, 1875. 148 INFANT FEEDING AND ITS INFLUENCE ON LIFE. CHAPTER III. ON SOME OF THE OBJECTIONS TO THE USE OP ANIMAL MILKS. Asa's Milk : Excess of Sugar and Salts. Goat's Milk: Advantages from its Employ- ment. Cow's Milk : Difficulties in its Employment Adulteration chiefly with Water Acidity. Meyer's Experiments. Unhealthy Sheds for Cows. Revolting Filthiness of some in London. Necessity for Parliamentary Interference. Ass's MILK. To the excess of salts is probably due the purgative effect of ass's milk occasionally noticed in adults who take it. The saline matter amounts as a minimum to twice, as a maximum to four times, as much as in human milk. Now if it be a fact, as is usually stated in books, that ass's milk is the best substitute for woman's milk (but there are no con- clusive experiments to prove it), do children fed on it exclusively invari- ably thrive ? Answers to these questions are important desiderata; but till the problem is solved, the substitution of ass's milk cannot be urged merely because it contains more sugar than cow's milk, or because it proves wholesome food to invalid adults. In many adults, cow's milk in any quantity produces nausea and vomiting. It is usually well borne on the stomachs of infants, although it may disagree otherwise. But to make up the requisite quantity of casein and butter, twice as much of ass's milk would be needed. The quantity of sugar, as well as the salts thus taken, would be greatly in excess. Would not scrofula be developed as a result ? And what good effect on the brain and bones would the ex- cess of the salts produce ? We know that sugar is not of itself capable of supporting life when it is given singly. Besides the debility which supervenes, abscesses form on the cornea, which penetrate internally, so as to let the humors escape. Finally death occurs. The post-mortem ap- pearances are general atrophy of the muscles, contraction of the stom- ach and intestines, etc. These experiments, chiefly instituted by Magen- die, however cruel and revolting, are not without their practical impor- tance. Although it may be urged that no children are fed exclusively upon sugar, and that therefore the objection does not apply, still we often meet with a class of cachectic patients, eminently scrofulous, with morbid tastes for sweets. In these, strumous ophthalmia, with ulcers on the cor- nea, make their appearance. Is it not reasonable to conclude that these morbid products are due to a diet too exclusively saccharine ? and have we not some grounds for fearing that very similar results would occur if we ventured to bring up children exclusively upon ass's milk ? But more than this : it has been shown by Lehmann and Elsasser, INFANT FEEDING AND ITS INFLUENCE ON LIFE. 149 i\iai fat exists in most of the fluids secreted by the body, and assists diges- tion along the whole course of the alimentary canal. 1 The solution of food, although delayed by excess, is hastened by a moderate quantity of fat. So also, in early or foetal development, it is the fat-globule which attracts, as it were, the albumen or nitrogenous elements around it, acting in the cell-growth as the nucleus around which parts grow. Moreover, the fats of the blood are also deposited in the blood-globule the portion in the blood generally admitted as most concerned in the nutrition of the body ; and this is doubtless one of the reasons why cod-liver oil proves often so useful. To attempt, therefore, to feed a child exclusively on food poor in fatty matters, as ass's milk, is evidently unphilosophical. It has been stated by Mr. Lobb, that, by adding ty per cent, of cream to ass's milk, a very good substitute for human milk would be procured with great ease. " The expense of ass's milk," remarks Mr. Lobb, " would put it out of the reach of the poor." He might have added, the expense of cream in towns would have the same effect. The suggestion, however, is a good one, because in the country it might be easily procured. In many parts of Great Britain, asses are to be obtained at a very cheap rate. I am told five shillings are in some places, in winter, gladly accepted; and I believe thirty shillings is the usual price. If, therefore, ass's milk can be successfully modified by the addition of cream, a herd of these animals would prove most useful to a foundling hospital, not only in providing milk for the infants, but in affording a ready method of exercise; while as beasts of burden they would prove valuable, particu- larly if situated in a country neighborhood or by the sea-side. To deter- mine, therefore, the practical usefulness of ass's milk, in combination with cream, would be no small matter, and would be fraught with immense advantages. Theory, on the other hand, condemns its use when given on scientific grounds, and, until its usefulness is proved by practice, I feel bound to oppose the popular prejudice. t;,it\t Milk. The table given at p. 142 shows that the milk from a goat, if she has been fed upon beet-root, very closely resembles in chemi- cal composition that of a woman, only that it is richer in sugar and salts. It certainly comes much nearer to human milk than ass's milk. Indeed, as evidence that practice confirms theory in this instance, I may cite ex- perience in Ireland. In that country, I am informed, the foundlings of Dublin were very many years back sent to the mountains of Wicklow, to upon the goats' milk. As the children grew older, the goats came to know them, and became very tame; so that the infant could go to the goat to be suckled by it, as it would to a humajn wet nurse. The children throve, I am told, remarkably well. The same results, I am informed, have been observed in Malta. It is therefore much to be regretted that an animal so easily kept and obtained should not be more generally employed. If our foundling hos- 1 Page 130. 150 INFANT FEEDING AND ITS INFLUENCE ON LIFE. pitals were to have establishments in the country, where goats might be kept in numbers, there would be no need for exclusiveness in admitting cases, infanticide might cease, and the hundreds of babies now sacrificed to the murderous system of dry-nursing might be saved to their parents and the nation. (7oto' Milk. The disadvantages met with in the employment of this variety of milk are well known to most of us; they are disadvantages dependent upon its bad quality, and are very serious in their results, and very difficult to overcome. A few of these I will consider seriatim. They are 1. Adulteration of cow's milk. 2. Its acidity, dependent upon stall-feeding. 3. The effect upon milk produced by keeping cows in unhealthy sheds. 1. Adulteration. The most painful part of our experience in towns is that pure milk cannot be procured; it is almost always adulterated. In the excellent work of Becquerel and Vernois, the Annales (VHygibne, it is said to be adulterated in Paris by the following substances : water, glucose, flour, starch, dextrine, infusion of amylaceous matters (rice, barley, bran), yolk of egg and white of egg, sugar, gelatine, liquorice, boiled carrots, broken-down calves' brains, serum of blood, several salts, bicar- bonate of soda, chalk, turmeric, emulsion of hemp or almond seeds, etc. We do not, however, find that in England these are commonly employed, but adulteration by water is extensively practised. Dr. Hassall, out of twenty-six samples of milk, found that eleven were adulterated with water in the proportion of from 10 to 50 per cent. Dr. Sanderson, the medical officer of health for Paddington, found out of thirty-two specimens of the milk examined by himself and Dr. Alfred Bernays, of St. Mary's Hospital, that in all, except one, the quantity of water was greater than it was in pure milk. In twelve instances the quantity of solid constituents was only half as great as it ought to have been, in a few only one-fourth; many specimens contained less than 6.5 or 5.8 per cent., a few, 3.5 instead of 12.98, as in pure healthy milk. The late Dr. Hillier, when medical officer of St. Pancras, examined twenty specimens of milk, and found that the quantity of water added varied from 25 to 50 per cent. That supplied to the workhouse was one of the poorest. Instead of a gallon containing nearly 9,000 grains of solid matter, it contained only 5,425 grains, or two-thirds the proper quantity. The late Dr. R. D. Thompson also found in Marvlebone, that the gallon of milk, in seven samples, weighed, as a mean, 71,680 instead of 72,415 grains, which amounts to the withdrawal of 1.44 oz. of solid matter, well calculated to nourish the body, and substituting for it water. The late Dr. Hyde Salter also, and Mr. Hunt, from the confessions made to them by milkwomen, their patients, state the quantity of water usually added is one gallon of water to two of milk. What sort of food can this be for an infant, especially if diluted, as it almost invariably is, by the purchaser, INFANT FEEDING AND ITS INFLUENCE ON LIFE. 151 and often afterwards by medical direction ? Is it to be wondered at that children fed on such weak milk do not thrive ? But this admixture of water has other disadvantages. The danger of the admixture of water to milk has been lately sadly displayed, and fully justifies the most severe measures of repression which any Government could well enact. It is in the wholesale poisoning of infants through milk diseased with typhoid poison. In 1870 Dr. Ballard, while officer of health for Islington, was able to show that an outbreak of enteric fever, which had attacked in ten weeks 7G families and 175 persons in part of his district, coincided with the use of milk from a particular dairy, where shortly before there had been cases of enteric fever, and where apparently the infected house-drainage must have had easy access to an underground water-tank in the premises. The same thing was traced by Dr. Ballard, in 1872, at Arnley, in the borough of Leeds, where 107 cases occurred, and where, out of G8 houses invaded, 51, including that of the milk-seller himself, were supplied with milk by the said dairyman. In this case contaminated water was used to clean out the milk-pans from a well on the premises. Again, a similar outbreak of enteric fever occurring at Moseley and Balsall Heath, near Birmingham, in 1873, was traced by Dr. Ballard to similar contamination. Here 50 families were invaded, and of these 47 obtained their milk supply from two milk-sellers whose dairies were situated close together in a street in Balsall Heath, and water from a con- taminated well in the neighborhood of both these dairymen was added to the milk, whether intentionally or accidentally, and so carried infection to the families. The epidemic of typhoid fever which broke out in Marylebone in July and August, 1873, is well known. Full inquiries were made upon the subject by Drs. Murchison and Whitmore, and again by Messrs. Rad- cliffe and Power. The cases here occurred in 143 households, and the number of cases inquired upon were 244. Of these 26 died. Here also the milk was traced to have come mainly from one dairy. Of the 244 cases 9-10ths i. e., 218, were in households which consumed milk from a particular service of a particular dairy. It was clearly shown that the water used for the dairy purposes, and which came from a particular farm, contained excrementitial matters from a patient suffering from enteric fever immediately before and at the time of the outbreak. A later epidemic occurring at Crossbells, in January, 1875, may be mentioned, whore milk was brought from Eaglesham infected with enteric frvt-r poison, derived from a water supply which was contaminated with i from patients affected with the fever. Amongst 42 families sup- plied with this milk 1H cases of fever occurred, wliilo amon^r 40 families who u-ed condensed milk, or had no milk supply, not even a solitary cnso of fever occurred. The latest epidemic of enteric fever at Keagley dates from a similar 152 INFANT FEEDING AND ITS INFLUENCE ON LIFE. admixture, and has brought about the same fatal results, and so will continue until severer measures are adopted. Summonses were lately taken out (Medical Times, May 13, 1876, p. 527) at the Worship Street Police Court, against several dairymen and cow-keepers in Shoreditch, for having on the premises a foul well con- taining water in such a state as to be a nuisance and injurious to health. Drs. Stevenson and Wanklyn had examined specimens of this water, and found it to be diluted sewage. And, indeed, milk appears to possess a peculiar aptitude for the re- tention of certain poisonous ingredients. In the Lancet of April 29, 1876, we read: " Milk brought from the country in cans by the night trains is carried by the retailers to their own premises, where it often remains for five or six hours. These premises are often little dirty shops or kitchens close to the rooms in which the families live. There is no security whatever that epidemic disease may not be raging in the place, that vessels con- taminated in the worst possible way may not be used to contain the milk, or, except in the places where the Adulteration Act is rigidly en- forced, that the milk may not be adulterated with foul water ...... But the last few years have brought a flood of new light to bear on the peculiarities of milk. We now know at the cost of many serious epi- demics how peculiarly sensitive to noxious influences is the fluid which forms so important a part of the national food supply. If clothing will spread the infection of fever, so, when once infected, will milk, and that in a far more insidious and extensive manner; for with milk it is impos- sible to say how widely or how far the disease may be carried. If water will carry the germs of cholera and enteric fever, so will milk, and with milk there is the added danger not, indeed, demonstrated, but suspected by many that the highly complex organic constituents so closely analo- gous to those of the body, which are present in it, may serve as a pabulum for the development and indefinite multiplication of disease germs. Re- cent experience seems to show that milk-spread epidemics are particularly virulent, and the observation tallies, though, of course, it cannot be said to establish the last-named theory. The ease with which milk receives and carries infection is illustrated by the absolute and well-known neces- sity for purity of air and perfect cleanliness in dairy operations." These remarks of this periodical are very suggestive. It may be stated, in addition, that a moderate temperature, such as blood heat, favors fermentation and decomposition. The milk, for some time at least after it is drawn, and especially in summer, is in a tepid state. The changes thus begin at once, so that when some time afterwards the milk is taken, it is in an eminently favorable condition for rapid ami ulterior progressive changes, to the immense detriment of those who drink it. 2. Acidity. Cow's milk, except the animal has been fed exclusively upon grass, is almost always acid in stall-fed cows; human milk is always INFANT FEEDING AND ITS INFLUENCE ON LIFE. 153 alkaline; hence another reason why cow's milk disagrees with many children. The experiments of Dr. Mayer, of Berlin, are particularly conclusive upon this point. He says that for a considerable time he had been in the habit of examining the milk supplied to householders in Berlin, and testing it by litmus paper, according as the cows were fed from brewery slops or brandy lees, gardeners' produce, or in the country. In every instance, except one, he had found the milk decidedly sour. ('/.) Of cows fed with brewers' lees, red potatoes, rye bran, and wild hay, in five instances the milk was slightly sour, in one very much so. (b.) Of forty cows fed with potato mash, barley husk, and clover and barley straw, in ten examined, the milk was sour, in. three very sour. (o.) From among fifty cows, fed on potato husks, barley husks, and wild hay, five were examined, and in all the fresh milk was sour. (/.) From fifty-two cows, fed on potato mash, husks, wild hay, and rye straw, out of twelve selected for examination, the fresh milk of all was sour. (e.) From six cows, fed by a chief gardener on coarse beet-root, red potato, bran mash, and hay, the fresh milk was slightly sour. (y.) From five cows, fed by a cow-feeder on lukewarm bran mash and hay, in four the fresh milk was quite neutral, in one it was decidedly al- kaline. The whole of these experiments were made in the winter season, when the cows were necessarily stall-fed, and they confirm the truth of the gen- eral opinion, that the fresh milk of stall-fed cows is almost invariably acid. Dr. Mayer does not believe that this acidity is due to want of exercise, so much as to the unscientific manner in which the cows are fed; and he par- ticularly objects to the potato mash, which he considers the cause of the acidity. The milk of the cows of gardeners and cow-feeders is usually praised by the Berlin women as being particularly good. But Dr. Mayer has observed that it often gives rise to diarrhoea and cutaneous eruptions in children; which, he supposes, is due to the cows being fed with the cabbage, turnip, and potato refuse. The very worst milk is that supplied by cows fed (in potato refuse from brandy distillers; the best among the stall-fed being that obtained from the cows of cow fattoners, which feed on hay and grass in stalls. By substituting the milk of the latter for tho former, he was oft<-n enabled to arrest at onco the intestinal derangements previously referred to. ::. l\i';'. >( on Milk j>rn< J />>/ /.>,//',,; but it may be flavored by a few drops of essence of celery, or celery salt, cinnamon syrup, two or three drops of spice brandy, dill water; in fact, any flavor peculiarly agreeable to the infant for which it is intended and to which it may be most accustomed to take with its milk, so that it may form a pleasant drink. It is best to give it to an older patient in a dark-colored claret- glass, so as to hide the blood-red color. Pepsinized Raic Juice or Beef-essence. Having prepared the minced raw meat as before, and filled the tumbler with water, which in this case should be cold, some of Long's prepared glycerinized gastric juice ' should be added, one dessert spoonful, and stirred up as before. A considerable portion of the fibrine is thereby taken up, and the juice therefore made by it so much more nutritious. It is estimated that one teaspoonful of this juice dissolves one ounce and a half of lean meat. If kept at a temperature of 90 deg. Fahr., it will dissolve the meat moro rapidly. It is obvious if the ordinary beef-essence preparation be compared with ordinary beef-tea, it is eminently more nutritious. It contains all 1 This may be procured at Messrs. Young & Poetons', chemist*. Baker-street 11 162 INFANT FEEDING AND ITS INFLUENCE ON LIFK. the albumen, casein, osmazone, and all the salts of flesh: viz., creatine, creatinin, inosinic and lactic acids, volatile acids, inosate, phosphates of potash and magnesia, and, in the case of the pepsinized juice, a great deal of the fibrine. But one of the most useful ingredients in it perhaps is the coloring matter of the blood. I reckon that three wineglassfuls are equivalent to a chop. This pepsinized raw beef-juice does undoubtedly possess some advan- tages over the simple beef-essence. We are all aware that the digestion of nitrogenous matters is chiefly effected in the stomach, and this through the instrumentality of " the gastric juice " which possesses the peculiar property of dissolving very speedily all azotized aliments. But circumstances may occur where the gastric juice before mentioned is not procurable. It may, therefore, be as well to indicate here how artificial gastric juice can be made. It can be readily prepared by digesting the mucous membrane of the stomach of any animal in dilute hydrochloric acid. The best proportion for making the latter is three drops of the strong acid to one ounce of water. By exposing this mixture to a gentle temperature of 70 Fahr., we obtain a fluid possessing all the properties of gastric juice. If beef- tea be first prepared on Liebig's plan, and then after a few hours' macera- tion in cold water the artificial gastric juice be added, and the tempera- ture raised to 70 Fahr., some of the fibrine will be taken up as well as the albuminous matters before in solution in the supernatant water; and a beef-tea much richer in azotized food in fact, an artificial chyme will be obtained. Pej>sine, the active principle which exists in the gastric juice, used singly, acts upon fibrine but slowly. But, as before stated, the juice of meat contains lactic acid. When pepsine and lactic acid are conjoined the solution of the fibrine takes place very quickly. For cases of defective or weak assimilation, the advantages of such a beef-tea are very obvious. The same result can be obtained by addition of the liquor pepsinii, or the essence of rennet, in both of which we have the principal ingredient of gastric juice, which in cases of defective assimilation is so much re- quired. More lately, Dr. Archer Farre has advised the employment of an arti- ficial gastric juice, in which to the pepsine is added not hydrochloric acid, but lime-juice. After five years' experience of its use, he concludes it is most effective as a food solvent. 1 Another method, of which I have no experience, yet which theoreti- cally appears very plausible, would be the addition to beaf-tea, or to milk, of a solution of sweet-bread, or a pancreatic tea, or some of Dobell's pan- creatic emulsion, or broken-down pieces of the sweet-bread itself. It is known that fatty matters are saponified by the secretion of this gland, 1 Prepared by Westwood and Hopkins, London. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 163 which is always contained in some proportion in the substance of the gland itself, which may therefore be substituted for it. The secretion also con- verts starch into sugar, and probably also exerts a solvent action upon azotized matters. I shall, however, again refer to this point in the sequel. The extract prepared by Mr. Roberton, of Manchester, and obtained in the form of a dry powder, is the best I am acquainted with. How- ever, except in cases where haste is required, there is scarcely any need of using any extract, since the beef-tea itself, prepared by lixiviation in water over night, is more easily obtained. This, also, should not be heated above 120 to 130; nor even boiled. HogartKs Essence, of Meat. Of the composition of this material I can say nothing, except that I believe it is a concentrated solution of meat-tea in fact, a meat-tea reduced by the evaporation of its watery ingredients to the consistence of a syrup. I can, however, confidently speak from experience of its utility. It is certain that children who have been reduced to a state of great weakness by hand-feeding, or im- proper diet, occasionally recover, and that almost marvellously, under its influence. I have used principally the essence of beef. Its taste is much liked; and in doses of five or six teaspoonfuls daily, with a very little water, it is well digested by children. Indeed, it is often borne in infants affected with exhaustive diarrhoea from weaning, when milk and farina- ceous food disagree. Hogarth's essence 6f meat is, I regret to say, not to be had at present as easily as in former periods. It has, I fear, been beaten out of the market by the other extracts of meat now in more, extensive use. I re- gret it, because it was more nutritious and preferred by infants. Brand & Co.'s essence of meat, however, seems a very good substitute, both for invalids of a larger growth as well as children. That in most common use is the essence of beef, but similar preparations are also made from mutton, from veal, and from chicken. This essence consists solely of the juice of the finest meat, extracted by a gentle heat, without the addition of water or of any other substance whatever. It contains, therefore, the most stimulating and exhilarating properties of the meat, calculated to invigorate the heart and brain immediately, without any fatty or other elements which require solution in the stomach. It has been introduced into medical practice as a stimulant, after loss of blood from any cause, and in cases of nervous exhaustion and enfeebled digestion. In instances of extreme exhaustion or urgent danger, one teaspoonful may be admin- istered as often as the patient can take it; in less urgent cases one may be taken three times daily, with a small piece of bread and a little wine. It should be kept previous to use in a cool place if possible, on ice. If in bottle, the cork should be taken out, and kept out. The cases should be opened at the smooth top, and when once opened the essence must be allowed to remain exposed to the air. The essence in bottles (and in case when once opened) will only keep good about two days. Of this remedy I can speak most highly, having used it on several occasions with 104 INFANT FEEDING AND ITS INFLUENCE ON LIFE. marked advantage. Other preparations are more or less allied to the foregoing, such as concentrated beef-tea. This article contains all the soluble ingredients of the best beef, and may be taken by the most deli- cate stomach. It will keep in any climate. It may be cut into pieces about an ounce (more or less, as circumstances require), and dissolved in half-a-pint of boiling water, with a little salt according to taste; re-boil- ing adds to the flavor. Similar concentrated chicken, mutton, and veal broths, may be made in the same manner. A beef-tea jelly, which con- sists of pure beef-tea of about three times the ordinary strength, and a fibrous extract of beef, containing all nutritious elements of meat (includ- ing most of the fibrine and a percentage of fat), are also supplied by the same firm; but my experience only allows me to speak definitely, and that most favorably of the essence of beef. 1 When, however, a meat-juice or beef-tea is distasteful to a child, we almost always find the substitution of a raw piece of meat itself, which is held so as to prevent the child swallowing it bodily, and is often eagerly taken by an infant, of great utility. The discovery was first made upon children suffering from diarrhoea. " In these circumstances," says Dr. West, 1 " there is still one article of food raw meat which, strange as it may seem, is often eagerly taken, and always perfectly well digested. Professor Weisse, of St. Petersburg,* first recommended its employment in children suffering from diarrhoea after weaning; and it has been since then frequently given by other phy- sicians in Germany in cases of long-standing diarrhoea. The lean either of beef or mutton rery finely shred may be given in quantities at first of not more than two teaspoonfuls four times a day to children of a year old, and afterwards, if they crave for more, a larger quantity may be al- lowed. I have seldom found any difficulty in getting children to take it: often, indeed, they are clamorous for it; it does not nauseate if given in small quantities, nor does it ever aggravate the diarrhoea; while, in some instances, it has appeared to have been the only means by which the life of the child has been preserved. With returning convalescence the de- sire for this food subsides, and the child can without difficulty be replaced on its ordinary diet." Upon this point more lately some very important facts have been re- corded by Dr. F. P. Leverett, of South Carolina, in an article reproduced as an abstract in the Dublin Medical Press.* As the subject is most im- portant, I may be pardoned for giving this abstract almost in full. " In the fall of 1854, Dr. Caspar Lewis introduced the use of raw beef into the children's ward of the Philadelphia Hospital, to which he was the attending physician and lecturer. He had the fillet of beef as free from 1 May be had at 11 Little Stanhope-street, Mayfair. ' Diseases of Children, p. 498. 1 Journal fur Kinderkrankheiten, voL iv., p. 99. 4 May 9, 1860; Charlettown Medical Journal, Sept., 1859. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 165 fat as possible, scraped with a knife, so as to obtain the pulp, as Weisse, of St. Petersburg,, recommended. This he seasoned generally with salt, sometimes with sugar, so as to tempt the children. He gave of this pulp at first a teaspoonful, three or four times a day, and gradually increased the amount as the child's fondness for it increased. It required but a few days in any case to get the child to take it with readiness, if not avidity; some even relished it from the first. Many of the students who attended Dr. Morris's clinical lecture in 1855, witnessed the great benefit which many of the children derived from this remedy, then new in our country. Weisse some years previously recommended its use in the diarrhoea of weaned children, but to the comparative inattention it received in Europe may be assigned the reason of its being almost unknown to us. Dr. Morris mentioned to Dr. Leverett, that it had been suggested to him by his friend, Professor Thomas, of Baltimore, who had used it with great benefit for one of his children suffering with chronic diarrhoea." There are several cases related in the paper above referred to, in which raw meat was given with the greatest advantage. Their consideration, however, more properly belongs to the treatment of defective assimilation, and will occupy our attention when we come to discuss that portion of our subject. It was necessary to mention this remedy -in this place, as a most important mode of cure, and one often eminently successful, when all other means have failed. The objection to it is one to which Dr. Leverett in the above paper also refers, namely, that raw meat, often at least on the Continent, contains the ova of tape-worm, and hence those who take it in this state become affected with this parasite. A case of this kind has lately occupied the attention of medical observers; and as raw meat is likely now to become from its manifold advantages a frequent remedy, it is as well to refer to it in this place by way of caution. " On January 12, 1860, a robust maid-servant was admitted into the Dresden Hospital. She had been indisposed since Christmas, and con- fined to bed since New Year's Day, complaining of depression, lassitude, sleeplessness, loss of appetite, and thirst. These symptoms persisted on her admission. There was considerable pyrexia; the abdomen was pain- ful and tympanitic, and although neither splenic tumor nor roseola was present, the case was put down as one of typhoid fever. A remarkable affection of the whole muscular system now rapidly supervened, consist- ing in extreme painfulness of the extremities, with contraction of knee and elbow joints, and oedematous swelling, particularly of the legs. The pain was so severe that the patient was continually moaning. Pneumonic symptoms now appeared, and death took place on the 27th inst., pre- ceded by an apathetic condition. The post-mortem examination showed in the internal organs merely an atelectatic condition of the left lung, with numerous small lobular infiltrations, bronchitis, and hyponrmia of the mucous lining of the ilium. The muscles, however, which showed a grayish red color and a slightly freckled appearance, were found, on microscopic examination, to harbor vast numbers of non-capitulated 166 INFANT FEEDING AND ITS INFLUENCE ON LIFE. trichinae. The parasites were living, some coiled in spirals, others with extended bodies, and all (as Professor Virchow was the first to show, in a fragment of muscle, which was forwarded him for examination) living in a sarcolemma of the primitive fibrils. They showed various stages of de- velopment. They were diffused over all the striated muscles of the body, with the exception of the heart, and that in such vast numbers that, under a small magnifying power, as many as twenty were counted in the field of vision simultaneously. The muscular substance was otherwise fragile', homogeneous, and non-striated, and showed numerous transverse fissures. The intestinal mucus was found to be swarming with mature trichinae of both sexes; and the remarkable fact was elucidated, that female trichinae are viviparous, the central portion of the bodies being observed to be full of well-developed embryos. " Inquiry being directed to the probable source of trichinatous infection, it was ascertained that on December 21, four days before the patient was taken ill, two pigs and an ox had been slaughtered on the establishment of her master. Some smoked ham and sausage, prepared from the meat of one of the pigs, were fortunately obtained, and on examination proved to be full of trichinae. The parasites had a shrunken appearance, other- wise unchanged; reassumed a normal appearance on addition of water, but showed no signs of vitality. It is particularly worthy of remark, that to the naked eye the ham appeared quite healthy. It is very likely that the deceased had partaken of some of the raw meat. The butcher of the establishment (butchers notoriously indulge in raw meat) had also been taken seriously ill a short time afterwards, and had been confined to his bed for three weeks with severe muscular pains, his whole body being semi-paralytic, etc. This complaint was ascribed to rheumatism at the time, but Professor Zenker correctly surmises that an immigration of trichinae not sufficiently extensive to prove fatal, may have been the cause of attack, and that capsulated trichinae would be very likely dis- cernible in his muscle." 1 It may be stated that muscles are liable to two kinds of parasitical in- fection commonly found in the abdominal muscles of sheep, and often present in the rabbits of London. One of these is the cysticercus. The muscle is covered by a number of small bladders. On opening one of these a small animal, bladder-shaped also, with a prolonged portion, at the extremity of which is the head, is observed. The other variety is the trichina spiralis, above alluded to. This creature is generally confined to the voluntary muscles, and is occasionally found in animals who dur- ing life have been apparently in good health. The muscles affected with this parasite are more fragile than usual; and to the naked eye, instead of looking red and clean, have a freckled appearance, or here and there a grayish aspect, which it is at once obvious is not due to an intermixture of fat. Looked at more closely, numerous transverse fissures are found 1 Medical Times, June, 1860. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 167 on the surface, together with a number of white spots or vesicles, which are oval-shaped, and opaque at each extremity. Within each vesicle is a worm coiled upon itself. This is the trichina. Meat about to be given raw should, therefore, from prudential rea- sons, be carefully examined: if it appear gray, and there are any spots on the surface, it is a suspicious specimen. A small magnifying power will at once, however, clear up the doubt. Fortunately in this country beef is seldom, if ever, infected with these parasites, and it is this variety of meat which is usually prescribed in a raw state. Raw meat-juice is thus preferable to raw meat, since, in the straining of the meat through a coarse sieve, and the squeezing of it in a press- strainer, the worm is excluded. It is with pork, after all, that the prin- cipal danger occurs when it is taken raw, not with beef. 168 INFANT FEEDING AND ITS INFLUENCE ON LIFE. CHAPTER V. Mode of Correction of Impure Milks, and of Preparation of Artificial Milks to Resem- ble Human Milk. IN the foregoing chapter sufficient has been said on the use of the vari- ous kinds of milk in their natural condition. Let us now consider the questions 1. The correction of inferior milks, so as to adapt them for the sustenance of infants; 2. The preparation from strong and rich milk of a compound resembling human milk. 1. Correction of Inferior Kinds of Milk. The correction of milk de- ponds, in the first place, on the means we have of determining its purity. Practically, however, except in the laboratory of the chemist, we can do no more than judge of the amount of its dilution with water, which is, after all, the usual adulteration practised in this country. To determine this amount of water, two ways, among many others, require mention here: that devised by Dr. Minchin, and that by Dr. Merei. 1 Dr. Minchin's method depends upon the translucency of the milk. A certain amount of transparency exists with the purest milk; but in pro- portion as it is more or less translucent, so in proportion are we able to test the amount of dilution. The instrument he has devised is made of brass, in the form of a shallow oblong vessel, capable of containing about an ounce of fluid; the depth of the vessel is made to increase gradually by means of a slab of white enamel, fixed in a gentle slope from one end to the other. The slab is graduated throughout its entire length. Upon this the milk is poured till the vessel is filled, and a cover of plate glass is then put on; this should be done by giving it a sliding motion to ex- clude air-bubbles. When the vessel full of milk is thus covered, the degree of dilution possessed by a sample under examination is estimated by the number of degrees on the enamel, which can be read through the glass cover; for the glass being in contact with the edge of the enamel plate at one end, and separated from it by a gradually increasing interval towards the other, the intervening stratum of milk is made to assume the form of a thin wedge. If the fluid under examination be of a rich quality, abounding in oily and caseous particles, it will possess such an amount of opacity that only a few degrees can be discovered on the subjacent enamel when the instrument is held opposite the light. If, on the contrary, the speci- men be of inferior quality, whether from innate poverty or the admixture 1 Dublin Medical Press, Aug. 8, I860 ; Ranking, vol. xxxii., p. 9. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 169 of water, the diminution of opacity thence resulting will be evinced by the enamel scale becoming visible through a deeper part of the fluid, or at a greater distance from the commencement of the scale-; the degree of transparency, therefore, can be measured by the number of lines visible through the fluid. The method of Dr. Merei is equally simple, and depends upon the quantity of cream that can be separated from a given quantity of milk. If we take a tube nine inches long by half an inch wide, graduated into sixteenth parts of an inch, and put into it about two ounces of milk and the same quantity of water, and expose it to a temperature of 50 to 60 Fahr. for about eighteen or twenty-four hours, the cream will be found to have separated, and will be observed as a whiter, more opaque substance, floating on the surface of the milk. If this stratum above the milk amounts to seven or eight of the graduated degrees, that milk is essen- tially good and rich, and contains about six and a half to seven and a half of butter. Medium milk will contain only five or six degrees; the worst kinds, only three degrees; and the inferior qualities supplied to the poor (skim milk), only two degrees. Here, then, is a ready means of measur- ing quality. Now, experience has shown that such poor milk causes more gastric disorders than rich milk; nay more, that to obviate this result it requires a greater dilution than rich milk, notwithstanding its poverty. Dr. Merei attributes this to the preponderance of casein, which is one of the chief causes of gastric disorder. This casein, it is observed, is both harder and coarser in cow's than in human milk. This is, no doubt, one cause; but there is another which, I think, applies, and which is mainly due to the dishonesty of milk-dealers. The cow-keeper has already watered his milk, to separate a certain amount of cream from it. The retail milk-seller has very frequently done the same. The butter has thus been already taken out. Lactic acid has formed, and what butter remains in the milk is scarcely now contained in perfect combination as an emulsion, but is dis- integrated, or, as it were, in imperfect mechanical suspension only. The casein is, perhaps, in the same state. Dr. Merei's experience in the method he adopts to improve inferior milks, seems to point also to this view of the case. In case of feeble children, with bowels previously deranged, he recom- mends that, instead of diluting the milk with water, we should add a de- coction of arrowroot, made with one teaspoonful of this substance to three- quarters of a pint of water, this quantity to serve for the admixture of the whole day's supply. In more severe cases, the arrowroot may be increased to two teaspoonfuls. This arrowroot is not given as an aliment, but as a softish substance to soothe mechanically the irritation of tin- intestinal mucous membrane. Langenbeck, indeed, believes that in such cases the granules of starch intersperse themselves between the particles of casein, and thus in great measure prevent the formation of hard indigestible curds. 170 INFANT FEEDING AND ITS INFLUENCE ON LIFE. The mixture Dr. Merei gives consists of three or four parts of this thin decoction of arrowroot to one part of new milk slightly boiled, and in the twenty-four hours' amount of food thus prepared he adds about one to two tablespoonfuls of cream. Children will digest well from a pint to a pint and a half of this mixture in twenty-four hours, according to age. As they grow older, he increases the proportion of milk, but not of the cream. If an infant be under four months of age, tolerably strong and regular in his bowels, and has to be bottle-fed, a mixture of first quality milk with water, in equal proportions, will suffice; after four months one part of water to two of milk, if given at a temperature of 90, agrees well. For children liable to diarrhoea, a very thin and weak infusion of aniseed tea, instead of water, may be substituted. Where the gripings and diarrhoea are severe, it is well to combine a teaspoonful, three or four times a day, of dill or peppermint-water and water in equal parts, with lime-water and a trace of opium to allay the irritation. 1 The above has been very generally the plan upon which I have acted in these cases, with two exceptions. The ease nowadays of giving cod- liver oil to infants, and its cheapness as compared to cream in towns, have led me usually to prefer the former, which doubtless acts in the same way as cream in supplying an oily but highly assimilable combusti- ble aliment. I have, also, usually combined sugar of milk, both because it exists in cow's milk in smaller quantity than in human milk, and be- cause it favors a butyric fermentation. The advantage of sugar of milk is not merely due to its sweetness, and because it is the sugar which sweetens milk in its normal state; but I have found on trial that it allays morbid irritation of the bowels, and will often check diarrhoea. I believe this is due chiefly to its undergoing fermentation less readily than ordinary sugar; and certainly alkalinity in milk, even when rich in sugar, as that of the woman, prevents it from becoming so readily acid as cow's milk. The acidity of milk is best corrected by lime-water, in the proportion of one to two tablespoonfuls of lime-water to the half-pint of milk. In cases of diarrhoea this quantity may be increased. The advantage of giving sugar of milk with the lime-water is further shown by its facilitat- ing the solution of lime, especially the hydrate, and so in this manner favoring assimilation. In cases where the bowels are constipated, the acidity is best corrected by magnesia, as much as will cover a fourpenny piece, or more, as the case may be, and in this way a purgative salt is produced which relieves them. If the gastric disturbance which a par- ticular milk induces, is very great, then chalk may be substituted for the lime-water, in five to ten grain doses. This will also be dissolved in the sugar of milk. "Where, however, the tongue is very red, and there are 1 Extract from a private letter. INFANT FEEDING AND ITS INFLUENCE ON LIFE. ll other evidences of gastritis, the carbonates of soda or potash are to be preferred. 2. Preparation from. Rich or Strong Milk of a Compound resembling Human Milk. My attention has been called to this preparation by Mr. Harry W. Lobb, a gentleman who for some time past has closely studied the subject. In p. 133, in his little brochure on Hygiene, originally read before the Harveian Society, he gives us the following method of prepar- ing Professor Falkland's milk for infants. I subjoin it here in full: " One third of a pint of new milk is allowed to stand until the cream has settled; the latter is removed, and to the blue milk thus obtained about a square inch of rennet is to be added, and the milk-vessel placed in warm water. In about five minutes the curd will have separated; and the rennet, which may again be repeatedly used, being removed, the whey is carefully poured off, and immediately heated to boiling, to prevent its becoming sour. A further quantity of curd separates, and must be re- moved by straining through calico. In one-quarter of a pint of this hot whey is to be dissolved three-eighths of an ounce of milk sugar; and this solution, along with the cream removed from the one-third of a pint of milk, must be added to half a pint of new milk. This will constitute the food for an infant of from five to eight months old for twelve hours; or, more correctly speaking, it will be one-half of the quantity required for twenty-four hours. It is absolutely necessary that a fresh quantity should be prepared every twelve hours; and it is scarcely necessary to add that the strictest cleanliness in all the vessels used is indispensable." The above is a very ingenious process, but it is open to objection in one or two particulars: (a.) Messrs. Parmentier and Deyeux have shown that there is a dis- advantage in boiling milk. When eight pounds of milk obtained from cows fed on grass, cabbage, potatoes, and maize, respectively, were dis- tilled, eight ounces of a colorless fluid were obtained. That from those fed on grass was aromatic; on cabbage, offensive; on maize and potatoes, quite inodorous. Hence they infer, that if this volatile principle forms in any way one of milk's constituent parts, it must be wrong to deprive milk of it, or to expose it to those circumstances which favor its separa- tion. Experience with infants has also shown me, that boiled milk is seldom so well borne as milk simply warmed by the addition of hot water. To this volatile principle I shall again recur. (b.) The objection has been made by Mr. Lobb, that in Dr. Falkland's process scarcely enough casein is removed. The former has another method of preparing this artificial human milk, which he calls mincasea, which I here subjoin: Half a pint of new milk is set aside for the cream to separate, which latter is removed; and to the blue milk half a teaspoonful of pre- pared rennet is added; this is placed over the fire, and heated until the curd has separated, when it is broken up with a spoon, and the whey poured off. In winter, three drachms of powdered sugar of milk aro 172 INFANT FEEDING AND ITS INFLUENCE ON LIFE. added to this warm whey; and the whole is mixed with half a pint of new milk. In summer, three drachms and a half of sugar of milk are added, and with the new milk are all boiled together." There is another formula given by Mr. Turner, a homoeopathic chem- ist, of Manchester. Although I disbelieve the dogma of homoeopathy, 1 am not above taking a lesson from an adversary. His formula is very simple. " Dissolve one ounce of sugar of milk in three-quarters of a pint of boiling water, and mix with an equal quantity of good fresh cow's milk." This process is simpler than Professor Falkland's and Mr. Lobb's, and, as such, I prefer it, and would fain recommend it, except that I should prefer water of a temperature of 160 Fahr. to the boiling water. The most ignorant nurse might prepare it easily in any part of the coun- try where good milk can be procured. The disadvantage which applies to this process in towns, as I have be- fore stated, is the difficulty which attends the procuring of good milk. The same objection applies to many other places, as on board a ship. In Appendix E, I have annexed a series of formulae which I have hitherto used in private practice and in the Cripples' Home Infant Nur- sery. These may be useful as a guide and reference, and, so far, as a means of preventing intestinal mischief. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 173 CHAPTER VL Vegetable Substitutes for Human Milk. Inferiority of the Vegetable as Aliment. Indigeetibility of Starch. Injurious Qualities of Arrowroot Of White Bread. Objections to White Bread Pap Generally contains Alum, and no Chloride of Potassium An Insufficiency of Phosphoric Acid. Advantages of Aerated Bread Is rich in Cerealin. Adulteration of Flour. Good Effects of Tea. Period when a Child should take Vegetable Food. HAVING now considered the animal substitutes for human milk, we have to consider another important class of substitutes, i.e., those from the vegetable kingdom, and at the outset two questions present themselves for considerstion, Is the chemical constitution of vegetable food such that we may safely employ it as a substitute for animal food? and if so, at what period should it be given ? As I have elsewhere said, animal food is, as it were, the essence of vege- table food, and far more digestible. But there is another peculiarity possessed by animal food. Liebig, as we have already stated, 1 has shown that the blood in the body is preserved alkaline in carnivorous animals through the agency of the subphosphate of soda ; whereas, in the case of herbivorous animals, the salt which maintains the alkalinity of the blood is the subcarbonate of soda. This last result, however, only applies in the case where the food consists exclusively of the lowest grains, roots, green vegetables, and fruits, the ashes of which contain carbonates; be- cause if lentils and the higher cerealia, as wheat, oats, etc., be employed, since their salts are nearly the same as the salts of blood, the subphos- phate of soda is also found in the blood. But more than this: in meat and the higher cerealia, not only have we a larger quantity of mineral ingredient, but we have also a large quantity of plastic or nitrogenous element. The hydrocarbonaceous, calorifiant, or combustible element contained is also in fair proportion, so that any of them may then be safely used. Still there is a very great disparity between these vegetable substances among themselves, and as compared with animal compounds. In order to make this clear, I have annexed the following table, compiled from Professor Liebig and Dr. R. D. Thompson, in which the amount of nitrogenous or plastic matter being expressed by 10 in all cases, the relative amount of combustible respiratory material ia given for purposes of comparison. 1 Page 186. 174 INFANT FEEDING AND ITS INFLUENCE ON LIFE. Proportion of ten plastic to the quantities of respiratory matters in the following articles of consumption: Veal 1 Eye flour 57 Hare 2 Barley 57 Beef 17 Maize 70 Lentils 21 j Potatoes, white 86 Beans . . ... 22 j East Indian rice 100 Peas 23 Fat mutton 27 Cow's milk 30 Linseed 30 Fat pork 30 Human milk 40 Wheat flour 46 Oatmeal . . .50 Dry Swedish turnips 110 Potatoes, blue 115 Rice 123 Buckwheat flour 130 Arrowroot 260 Tapioca 200 Sago 260 Wheat starch.. . 400 The respiratory ingredient in these vegetable substances with large figures being chiefly starch (such as if digested at all becomes converted into sugar), would, as proved by Magendie's experiments, lead to the de- velopment of scrofula, from deficiency of plastic or nutritive ingredient. But from the non-development of saliva at an early period, it is to be feared that even this change would not occur. And this seems, often at least, to be the case. In a paper published on the Diet of Infants, Dr. Stewart, of New York, in speaking of the Parisian hospitals, says " It is the custom at these and similar institutions, whenever an infant is sick, to withdraw him altogether from the breast, and to substitute for the milk some farinaceous substance, made fluid by boiling, arrowroot, gum, and rice-water, or a thickened preparation of rice, known as crtme de riz, and other preparations of a similar kind, forming the diet of a sick infant. In the reported cases of the Foundling Hospital, and those for the recep- tion of sick children, prescriptions of this nature form a very important part of the treatment, as will be seen by referring to the different trea- tises in French on the diseases of children." " The attention of M. Guil- lot having been directed to the changes which the food given to children underwent, and to the excessive mortality among them, he instituted a series of investigations in a number of cases of death, with special refer- ence to the state of the contents of the bowels. He was struck with the uniform similarity, a jelly-like substance being present in the bowels, and in some instances lining both the small and great intestines. This was subjected to the test of the tincture of iodine, which produced an in- tensely blue color, thus proving it to be starch." ' This proves that starch is not digestible as such, and does not appear to find material in very young infants for its conversion into digestible sugar a conclusion already forced upon us when speaking of the healthy faeces in a baby (p. 138). 1 Dr. Stewart on "Diet of Infanta," Dublin Journal, 1845, pp. 141-112. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 175 This jelly-like substance is sometimes tinged with blood. Its pres- ence, however, in the bowels of a child proves that starch is not digesti- ble, at least in the early periods of life, which is, in fact, what we might have anticipated. In adults it is converted into sugar; but if this change is not effected in the child, in whom one of the principal organs that bring this about does not act at all, or at least very imperfectly, the pres- ence of starch in the bowels in any excess must be detrimental and injuri- ous? But more than this. From the absence or great diminution of sugar, which assists, as before seen, in dissolving the carbonate and phosphate of lime, these ingredients are not taken up in sufficient quantities in the blood for the purposes of the economy. Hence a tendency to rickets is established. These ingredients are not assimilated. There is, moreover, a deficiency of sugar for the respiratory processes, and a loss of animal heat, the oily matters only remaining to supply this want by conversion into sugar. Whether this is easily accomplished in a child has not, so far as I know, been proved by experiment. Practically judging from the injurious effects of a diet too exclusively starchy, there is reason to doubt it. Yet how frequently, and even by medical men, is arrowroot ordered in cases of diarrhoea as the exclusive diet ! I cannot conceive anything more injurious than this popular arrow- root feeding. I believe it is a cause of the death of many infants. The following example, one out of many, received from an authentic source, will suffice to prove this. A poor woman had had five children; all had been brought up artificially on arrowroot, and all had died. A sixth in due time was born, and she was strongly urged by a kind friend to try nourishing food, such as milk, beef-tea, etc., instead of the arrowroot. This she agreed to do. Meeting her accidentally some time afterwards, this friend inquired about the infant. The reply was, "Oh ! it is dead; but it is no fault of mine, as I fed it on the best arrowroot that could be procured." So strongly rooted is the popular prejudice in favor of this starchy ingredient, which contains only 10 parts of plastic matter in 260 of combustible matter, instead of 10 in 40, as in human milk (see table, preceding page), and therefore never can suffice to nourish a child, especi- ally a weakly one. A favorite substitute, also, for human milk is barley or more prop- erly what is known as patent barley. Here, again, we have a flour com- paratively poor in nitrogenous material. But, besides this, it contains dextrine, a substance which even in the adult is difficult of digestion, and d fortiori, must be so in an infant. Its starch corpuscles are less soluble in the gastric juice, the food made with it is slightly acrid, and somewhat laxative. 1 When barley paste is washed, the milky fluid deposits not only the starch, but also a protein matter, supposed to be insoluble casein. 1 Hawaii on Food. 176 INFANT FEEDING AND ITS INFLUENCE ON LIFE. Next in esteem with the public is pap. Now pap is given very early. 1 have seen it given to a child from birth. It seemed to thrive upon it at first; but in about a month's time the child, which was of enormous size, sickened, and recovered only after much difficulty. Unfortunately the popular prejudice in favor of white bread proves often a cause of death. Magendie's experiments made with dogs have set this point at rest. A dog fed on white bread, wheat, and water, did not live more than fifty days, whereas a dog kept on soldiers' broicn bread did not suf- fer. The explanation in this case can be satisfactorily given. It is to be found chiefly in the relative differences of the saline constituents of wheat, as compared with those of milk. The objections to pap may be classed under three heads 1. The disadvantage of wheat-flour, given in bread, is due to the ab- sence of two salts, both of which, as we have already seen, are very aux- iliary to nutrition (pp. 134 and 135) (a) to a marked deficiency in chlo- ride of potassium; (b) to the decomposition of the free phosphoric acid, and, perhaps, the phosphates, into insoluble and therefore useless salts to the economy; (c) and to its mechanically distending the stomach. 2. To a diminution of the quantity of cerealin contained, and which thus interferes with the proper digestion of the grain. 3. To the adulteration of bread with inferior kinds of grain. 1. (a) If we except those of the pea and bean tribes, most of the edible flours are deficient in the same way. There is no chloride of potassium in wheat, etc., and consequently in bread. But, more than this, the phos- phoric acid is partly, often considerably, neutralized in its effects. (See note below. 1 ) Englishmen like to use white bread, which, independently of containing less nutritive matter than brown bread, as I have fully shown elsewhere, contains alum. This adulteration is known to make inferior flour, and flours generally of a bad color, white, and equal in appearance to flour of superior quality; and, secondly, it enables flour to retain a larger quantity of water, by which means the loaf is made to weigh heavier. 1 The bread is also less liable to crumble as it gets stale. Accum, quoted by Hassall, states the smallest quantity of alum that can be employed to produce this white appearance is four ounces to a sack of 240 Ibs. Dr. P. Markham states eight ounces to be the usual quantity employed, and Mitchell found that in the 4-lb. loaves he examined the amount of alum varied from 34^ to 116 grains in each. 114 grains would amount to 20 ounces to the sack. 3 Out of twenty-eight samples of Lon- 1 Composition of ashes of wheat by Erdmann, exclusive of peroxide of iron, 1.33 per cent., and silica and sand, 3.37 per cent. Alkaline phosphates for 2 mo 49. 18 Earthy for 2 mo 23.13 Free phosphoric acid 27.69 100 4 H assail 3 Ibid. INFANT FEEDING AXD ITS INFLUENCE ON LIFE. 177 don bread examined by Dr. Hassall, in all alum was found in smaller or larger quantities. The injurious effects of alum cannot be too strongly urged. Alum forms with phosphoric acid, as Liebig has shown, an in- soluble salt, and so prevents the phosphoric acid from being appropriated to the economy. The blood becomes incapable of performing its dutv, and hence children fed on it deteriorate, and in the end will die. AIM; herein is the explanation of the frightful amount of disease observed in pap-fed babies. The phosphoric acid, so essential to them, is in groat measure lost. The brain and nervous system and the bones are arrested in their development; and hence also one reason for the great comparative success in bringing up children by hand in the country on home-baked bread, which contains no alum, and which, although of darker color, pro- vides phosphoric acid in an assimilable state to the child. 1 (b) It is not necessary, however, that the whole phosphoric acid should be lost in order that the white bread pap should disagree. The experi- ment of Magendic, before alluded to, proves that a dog fed on white bread did not live longer than fifty days, dying at the end of this period with all the signs of inanition; and we must expect that the same rule, before quoted, which applies to other animals, will hold good here; namely, that after continued restriction to any one kind of aliment which cannot singly support life, a return to ordinary food will not save life. The power of general assimilation has been lost. Moreover, a pap-fed child, because obliged to use the spoon, cannot be brought again to suck the bottle or the breast. It has lost the instinctive power of suction from want of habit. So the habit of digestion of particular kinds of food cnce com- pletely lost is never again acquired. I believe one reason that many pap- fed children among the lower classes live in spite of the pap they take is this : The little infants, fortunately for themselves, are often spoilt; they keep asking for what they see on the table, and besides the pap, pieces of meat, herring, cheese, etc., which form the usual food of the parent <. are given to them; and so that which in the better ranks of life would 1 From an analysis by Enlmonn. given below, it would appear that 100 Ibs. of ashes of wheat contain Alkaline phosphates 46.48 Earthy ' 21.87 Free phosphoric acid 26. 19 Bnt M 100 Ibs. of wheat only contain 1.83 Ib. of salts, and since 80 Ibs. of floor will make 100 Ibs. of bread, the 100 Ibs. of bread will contain Ibn. Avoir, gm. Troy. Alkaline phosphates 69 4s:M fhy 319 phosphoric aoid Bnt ns a sack of 240 Ibs. contains from 4 to 20 rnnros of alnm. i>., from 1.7 743.7 grains, to $.3 or or :;c.2l.2 grains, it will rnnt.-ii:. '1.3 grains of alnminn. Looking now to the composition of phosphate of alnmina. AUO,PO i.e. (I 44) = 317.2 we have enough alumina to saturate 184.1 to 858.6 grains of phi s phoric acid. 11 178 INFANT FEEDING AND ITS INFLUENCE ON LIFE. be considered unwholesome, and therefore would be withheld, is the provi- dential means of saving their lives, because the food is then not exclusively pap, and the phosphoric acid needed is obtained from other sources. Again, the reason why some kinds of baked flour agree so well is, that phosphate of soda is added, and so in the excess of phosphoric acid given the bad effects of the alum are neutralized. (c) But there is another way in which pap proves injurious. It more often, perhaps, than is recognized, is the immediate cause of death. It has long been known that bread and milk, if given to canaries in full quantity, swells in their stomachs, and thus, pressing against the heart, impedes its action, and often causes their death. The same result some- times occurs in the infant. At p. 15, vide supra, I have enumerated several fatal cases in which the coroner's verdict assigned over-feeding with pap as the cause of death. 2. A diminution of the amount of cerealin which should be normally contained in grain, and does not exist in ordinary pap, again explains much of its indigestibility, and this depends chiefly on the manner in which the bread is made; and here I must follow Dr. Dauglish 1 in his re- marks on the subject. Pure white bread is made from the flour of the interior of the grain of wheat, which is much the whitest. That nearest to the outer skin is much darker, and makes brown bread; but, whereas the former is com- paratively rich in starch and poor in gluten, the reverse is the case with the latter. Hence one reason why bread made with entire grain, even in its interstices, and exclusive altogether of the bran, is darker than ordi- nary bread. But more than this, the flour which adheres to the bran, and which amounts from 10 to 12 per cent, of its nutritious matter, was, till lately, supposed to be gluten. This portion of the grain has now been found by M. Mege Mouries to consist chiefly of a vegetable ferment and metamorphic nitrogenous body, which he has called cerealin, and another body called vegetable casein. This cerealin, in its native state, acts as a most energetic ferment and solvent in an aqueous solution, on starch, dextrine, and glucose, producing the lactic and even butyric changes, but not the alcoholic. But it is especially active on gluten, and lactic acid has been developed, when in the presence of these three before-named substances. Thus, its action upon gluten exactly resembles that of pepsine on fibrine. Singly, it acts but slowly upon the gluten, but if conjoined with lactic acid the solution of it takes place very rapidly. As a proof that cerealin is a most active digestive solvent of gluten and starch in flour, the experiment of Mr. Stephen Danby, of Leadenhall Street, may be mentioned. He found that when 2 grains of dry cerealin were added to 500 grains of wheaten fiour, and the whole digested in half an ounce of water at a temperature 1 Ranking* s Retrospect, voL zxzii., p. 1. Medical Times and Gazette, May 12, 1860. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 179 of 90 for several hours, 10 per cent, more of the gluten and 5 per cent. more of the starch were dissolved than when an equal quantity of flour, to which this extra proportion of cerealin had not been added, was ex- perimented upon. M. Mouries states that the activity of cerealin is destroyed at a tem- perature of 140, but Dr. Dauglish has found that it is simply suspended by the heat required to cook bread thoroughly. Cerealin, like pepsine, is soluble in water, but not in alcohol; hence bread or flour cakes made without fermentation are easily soluble, whereas those subjected to alco- holic fermentation are not. The activity of cerealin is destroyed by most acids, and by alum in particular. Hence, another reason why aluminized bread is indigestible. The non-fermented and aerated bread of Dr. Dauglish possesses an advantage over that usually sold, because it contains this ingredient, cerealin, unchanged, and is therefore more digestible. This fact may be used to explain many popular customs. Many na- tions, indeed the majority, live on unfermented foods or breads. The Hindoo and Chinese on rice; the American Indian on maize; the Irish- man on potatoes; the Scotchman on oatmeal; the African often exclu- sively on manioc bread, and thrive well, and maintain their strength. The Frenchman lives on his white bread, which has fermented; hence one of the reasons why he cannot compete in heavy work with the English- man, who lives on flesh. His bread is not sufficiently nutritive, and does not contain enough cerealin to dissolve all the gluten. Panification generally, and where the bread rises well, has another advantage, which is also in a measure brought about by roasting or baking grain. The in- habitants of the Mediterranean live on vermicelli and macaroni chiefly, also non-fermented. But here there is this difference these substances are first dried, and so made more porous, and thus a greater surface is exposed to the digestive jidces. Gluten, when prepared from flour in the ordinary way, and deprived of its cerealin is, from its compactness, very indigestible. Only the surface is affected by the digestive fluids. One of the objects of baking grain and flour, as in the use of baked flour for our nurseries, of macaroni, or raising it into a spongy mass as bread, is to divide the material, and expose a much larger surface of it to tho pene- trating digestive solvent. If, as in the case with aerated bread, this can be done without fermentation, so much the better. The above explanation prepares us for understanding the reason that if bran tea be mingled with the food of badly nourished children, they thrive on it; so also where non-fermented or so-called digestive breads are used. There is excess of cerealin, and so the breads are easily di- gested. Dr. Dauglish tells us the afirated bread has been found most effica- cious in many instances. "Private gentlemen have sought int.-rviiw.s witli him to record the history of their recovery to health after yoars of sufiWing and misery by the simple use of this bread as diot. C'hililn-n 180 INFANT FEEDING AND ITS INFLUENCE ON LIFE. that have been liable to convulsive attacks from an irritable condition of the alimentary canal and nervous system have been perfectly free from them immediately the new bread was substituted for fermented bread. And cases are now numerous that have been communicated by medical men of position in which certain distressing forms of dyspepsia, which had remained intractable under every kind of treatment, have yielded as if by magic almost immediately after adopting the use of the aerated bread." My own experience is generally confirmatory of this opinion. Although it must be admitted that occasionally aerated bread is scarcely light enough for some persons, it is certainly, as a rule, more digestible, and eminently more satisfying to the appetite. It was extensively used in the Samaritan Hospital and gave great satisfaction, and was only suspended when it ceased for the time to be made. This contingency, however, for- tunately no longer exists. The principle upon which the so-called light or digestive breads are made is to add to a mixture of carbonate of soda and flour a quantity of cream of tartar, or some equally unobjectionable and pulverulent salt, so that on the application of moisture or heat a neutral salt may be formed and carbonic acid set free, this last by entangling the particles of dough causing the bread to rise. Arguing upon these premises, and looking to the uses of the phosphates in the animal organism, Professor Horsford, of Philadelphia, 1 has recommended an acid phosphate of lime, a dry and pul- verulent salt, which, after its action with moist carbonate of soda, leaves phosphate of soda a blood constituent, and phosphate of lime an essential constituent of blood and bone. In his own hands and those of his friends, it appears to have answered beyond expectation. Dr. Samuel Jackson, Professor of the Institute of Medicine in the University of Pennsylvania, speaks also most highly of its effects. Practically, I have no experience of it; but, speaking theoretically, it appears devised upon scientific prin- ciples. One advantage which it possesses is that it enriches white bread with phosphate of lime, which, as Dr. Jackson states, existing more abun- dantly in the bran, is usually rejected in most kinds of white bread, and thus lost to the economy. 3. Another fraud extensively practised in London is the large admix- ture of rice flour in bread. This, I believe, is not generally known. Its great whiteness and its great power of absorbing water are properties peculiarly well known to bakers, and not only to ordinary bakers, but to many of our hypocritical workhouse-poor feeders. I have been informed by a wholesale corn and flour merchant that there is a species of rice-flour which is expressly kept for the purpose of adulterating bread, and which is largely employed in some of our London workhouses. In this way the 1 Banking's Half- Yearly Abstract, vol. xxxil, p. 7. American and Cliemical News, etc. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 181 nutritive power of the bread is considerably diminished, although the calorifiant power is increased, the proportion of the former to the latter being, instead of 1 to 7, as it ought to be in wheat-flour, increased to 1 in 10 or 11, producing precisely the same results in the human frame as those which follow the employment of a diet too exclusively saccharine, viz., scrofula, atrophy, and all its dependencies, so commonly observed in some of these large establishments. 182 INFANT FEEDING AND ITS INFLUENCE ON LIFE. CHAPTER VII. Vegetable Substitutes for Milk: Lentil Powder, or Revalenta Baked Flour Mrs. Wells' Vegeto-Animal Food Nestle's Milk Food Liebig's Malt Extract Food Dr. Hassall's Views of it Dr. HassaH's Milk Food Yorkshire Food Tea Cocoa When Vegetable Food should be given. I TURN now to speak of some varieties of food which are largely used, and have often been found very effective substitutes for milk. 1 cannot undertake to enumerate all these, but reference to a few may be useful, viz., lentil powder, baked flour, Nestle's milk food, Liebig's malt extract, Hassall's food, Yorkshire food, and Robb's biscuits. 1. Among the vegetable substances, that which comes closest to milk in its composition is, without doubt, lentil powder, or, as it is called for the purposes of obtaining a better sale, Revalenta, Arabica, containing both phosphoric acid in abundance, and chloride of potassium; it also in- cludes casein, the same principle which is found in milk. Moreover, its nutritive matter is to its calorifiant matter in the proportion of 1 to 2, milk being in that of 1 to 2. No wonder, therefore, that under its influ- ence many children affected with atrophy and marked debility have com- pletely recovered. I have given it with the very greatest advantage in such cases, and, so far as I may judge from my own experience, 1 should conclude that practice fully carries out the result which, from a knowledge of the composition of lentil powder, we should have been led to antici- pate. Lentils have also a slightly laxative effect, and therefore in many instances, where the child is of a constipated habit, they are to be recom- mended. Peas and bean meal in this respect resemble lentils; the former, however, is objectionable, because it produces flatulency. The latter is not generally obtainable; still the bakers take advantage of this fact in regard to the beans, and usually, where wheat by partial germination has lost some of its nitrogenous element, or where the flour used is poor in quality, they add a proportionate quantity of white bean flour to restore it to its proper nutritive value. I have said that lentil powder has a slightly laxative effect in many cases. But frequently another effect follows its employment. One of the most distressing symptoms in hand-fed children, when the food they take disagrees, is constant vomiting. Everything given comes up again. As with some cases of adults, so with infants, a sickness which has some- times baffled every means tried, as if by magic yields at once, and per- manently to the use of lentil powder. The fragile, jaded, emaciated patient suddenly gains power and strength, becoming visibly fatter under INFANT FEEDING AND ITS INFLUENCE ON LIFE. 183 the influence of the food given. Words fail me to express the surprise and delight with which I have seen in some desperate cases these happy results follow, and I cannot, therefore, speak too highly of its adminis- tration in these cases. Indeed lentil meal properly prepared, and re- duced to a fine powder, possesses most highly nutritive qualities. It is highly nitrogenous, and is estimated to possess four times the nutrient power of beef, weight for weight; 1 while its excessive cheapness (Is. 8d. for 2 Ibs.) allows of its being easily obtained by even the poorest per- sons. No wonder that Revalenta Arabica, the other name for lentil powder, is so popular a remedy. 2. The only advantage which another popular kind of food seems to have (I allude to what is called baked flour} is, that it contains a smaller quantity of water, which has been expelled during the heating process; and in this respect it comes to resemble more closely, because more con- centrated, an animal compound. Moreover, by the baking, the starch granules are rendered more separable, and, as before stated (p. 179), the gluten is reduced to a more porous state, and more readily acted upon by the gastric juice, and as an aliment, therefore, is more nutritious and digestible. Again, from its greater capacity for absorbing moisture it is somewhat more astringent, and less likely to produce diarrhoea, which indeed it often checks ; but the absence of chloride of potassium and fatty matters in it, both so essential to growth and cell-development, is, I think, a fatal objection to it. Hence, if it be given, it should, to supply fat and chloride of potassium, be mixed with milk. 3. Baked flour enters into the composition of most of the ordinary foods for children. In former editions I spoke most favorably of one so prepared by Mrs. Wells, as the best combination I had seen, and heard most favorably spoken of, namely, the vegeto-animal food, in which baked flour is mixed with sugar of milk. Now, as the salts of milk are usually left in its preparation in combination with it, the food prepared contains a sufficiency of phosphoric acid and chloride of potassium. When flavored with a little spice, it forms a very agreeable food for infants: so far as I have tried it, I am satisfied as to its effects being beneficial. One advantage it possesses, common, however, to all properly contrived mixtures, when these are already mixed in due proportions, nothing is left to the discretion or whim of nurses, who, when not too disposed to spoil the child's food by excess of sugar, are so often careless in preparing it; so that in the hands of the most ignorant it may be safely used. I regret much that this substance can now only be obtained wjth diffi- culty. A kind of food, however, which I think much resembles it, and has acquired a great reputation abroad, is Nestle's milk food. Its composition shows a close resemblance to human milk in a Braithwaite's Ilttrotpect, 30-40. 184 INFANT FEEDING AND ITS INFLUENCE ON LIFE. assimilable form. The basis of it is choice milk from Swiss cows, which is concentrated in vacua at a low temperature, so as in no way to be de- composed and lose its nutritive qualities. A little sugar and specially baked bread powder are now added and thoroughly incorporated with it. 1 have seen it given with marked advantage to weakly children. Its preparation is very easy, for it only requires to be mixed with water, then to be boiled for a few minutes with continued stirring. A tablespoonful of the powder, mixed with ten tablespoonfuls of water, forms a food to be given in a feeding bottle. A tablespoonful with five of water produces a pap. Regularity should be the rule of a good alimentation for children, their food ought to be given often, and in small quantities at a time, in order not to load nor fatigue their stomachs. If the child is predisposed to constipation, then it is to be given with more water; if subject to diarrhoea, it should be given with less water, and so used thicker. 4. Liebig's Malt Extract Food for Infants. This distinguished chemi- cal philosopher, if he had done nothing greater, may be looked upon as having by this food not only supplied a great desideratum, but saved the lives of thousands of infants. He had long been aware that cow's milk does not adequately represent the milk of a healthy woman, and when wheaten flour is added, although starch is not unfitting for the nourish- ment of a child, the change of it into sugar in the stomach during diges- tion imposes an unnecessary labor on the organism, which will be spared if the starch is beforehand transformed into the soluble forms of sugar and dextrine. This can be effected by adding a certain quantity of malt to the wheaten flour. The following is the best way of preparing the food: Half an ounce of wheaten flour and an equal quantity of malt flour; seven grains and a quarter of bicarbonate of potash, and one ounce of water, are to be well mixed. Five ounces of cow's milk are then to be added, and the whole put on a gentle fire. When the mixture begins to thicken it is removed from the fire, stirred during five minutes, heated, and stirred again, till it becomes quite fluid, and finally made to boil. After the separation of the bran by a sieve it is ready for use. By boiling for a few minutes it loses all taste of flour. 1 This soup is now prepared in a simpler form, and sold as a powder, to which water need only be added, warm or cold, to make it ready for im- mediate use. It requires no cooking, milk, or sugar. The powder itself is of a brown chocolate color, sweet, and of an extremely agreeable flavor, and indubitably contains in its most concentrated form all the nutritive elements essential to maintain infant life. For infants under three months, to 1 teaspoon of the powder 4 tablespoonfuls of water are re- quired. For those above three months a double quantity of the powder should be used to the same quantity of water. Children above three 1 Lancet, January 7, 1865, p. 17. Braithwaite's Retrospect, 53, p. 40. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 185 years and adults may take 3 teaspoonfuls of it to the 4 oz. of water. Emaciated children should take the same dose as infants under three months. It needs no further sweetening, as it already contains in proper proportions the pure condensed Swiss milk. This extract, when tirst taken by children who have been imperfectly nourished, occasionally purges. This effect is stated to be due to the great control this food ex- ercises over gastric and intestinal disturbances through its alkaline prop- erties.' The remarks made by Dr. Hassall on this preparation of Liebig's are very instructive: " In the preparation of it, the two principal objects at which Liebig aimed were, 1st, to produce a food which should resemble human milk in the relative proportions of the heat-giving and flesh-form- ing constituents; and 2d, to reduce it to the state most easy of digestion. " It should be clearly understood, however, that the formula given by Liebig, although it furnishes an article about the same relative composi- tion as human milk, is yet of twice its strength, or, to use the words of Liebig himself, it contains the ' double concentration of woman's milk,' and therefore there is reason to believe that in some cases the food may prove too rich for the infant's stomach, and may require dilution. "It appears to me that the great merit of Liebig's preparation consists in the use of malt as a constituent of the food. This, from the diastase contained in it, exercises, when the fluid food or soup is properly prepared, a most remarkable influence upon the starch, quickly transforming it into dextrine and sugar, so that in the course of a few minutes the food, from being thick and sugarless, becomes comparatively thin and very sweet." (Lancet, July 29, I860.) I may here remark that, from the absence of the salivary glands secre- tion in very young infants, this action of diastase becomes a most impor- tant and necessary adjunct where this food is supplied, and ensures its digestion. Dr. Hassall, to show that the action of this diastase is very consider- able on the starch, gives the following analysis: Uncooked Food. Albuminous matter 9.25 per cent. = 1.43 grains of nitrogen, dried cooked food composition, so that less heat is required in the preparation of the liquid food. Dr. Hassall finds that a temperature ranging between 140 and 148 is amply sufficient to effect the complete transformation and solution of the starch corpuscles, and, indeed, to cook the food sufficiently.* It is due chiefly to the untiring exertions of the Countess Lersner Ebersburg, one of those devoted and earnest servants of God whose >n is to do good, and who, like ministering angels, irradiate the 1 Sold by Charles Uensall A Co., 7 Trump-street, London, and Ansar, Horford & Co. , 77 Strand. Ibid. op. eit. 186 INFANT FEEDING AND ITS INFLUENCE ON LIFE. paths of humanity, that this food is now largely and most successfully em- ployed in England. She has now, after unceasing efforts, established an institution, the Lersner Ebersburg British Institute, where this food is almost invariably supplied to the little infants. Her own account of it is touching: "I founded it in memory of two dear little babes of mine, whom the Lord took from me after a very short illness. I began with one district, but no sooner did the good results of this happy mission be- come known, when applications for opening neighboring districts grew so numerous, and the good effects so marvellous, that it would almost have seemed cruel to deny this boon of life to so helpless a portion of human- ity. During the period from February, 1870, to February, 1871, 8,250^ Ibs. of malted food extract were distributed to twelve eastern (Bethnal Green) districts." I have myself seen the best effect for good produced in some very trying cases, and where even confirmed disease which justified the most melancholy forebodings has disappeared under its use, and a healthy, fat infant been developed. Of the great advantages of this food there can- not be a question. Dried Cooked Food. Albuminous matter. 15.84 gr. = 4.45 gr. of nitrogen. Fatty matter 8.49 Sugar of glucose 37.73 Sugar of milk 10.90 Dextrine and starch. . .27.04 Total 100.00 It will be observed by an examination of the above figures that a very large proportion of the starch has been converted in the course of the preparation of the food into sugar. These remarks of Dr. Hassall are very important, as proving the ex- cellency of Liebig's food for infants; but Dr. Hassall adds some scarcely less important remarks in reference to the directions for its preparation^ which he believes are open to improvement. Thus: Liebig directs that the malt should be ground in a common coffee-mill, and the coarse pow- der passed through a sieve. This necessitates the subsequent straining of the food a tedious operation in order to remove the bran and re- maining particles of husk. And, further, that the food should be put upon a " gentle fire " previous to its being finally boiled. Now, a gentle heat may mean almost any temperature nearly up to the boiling point, and, since the action of the diastase is destroyed about 150 Fahr., the temperature ought never to be allowed to exceed that degree. Dr. Hassall therefore recommends that the malt should be well freed from husk and finely ground, that the wheat flour should be lightly baked, and, finally, that a thermometer should be employed in the preparation of the food. 1 1 It is so prepared by Savory & Moore. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 187 The effect of baking the wheat flour is partially to cook the starch en- tering into its composition. 5. The pertinent remarks made by Dr. Hassall on Liebig's food for infants are an excellent preface to the food which Dr. Hassall has himself introduced to the profession. For many a long year that distinguished physician has carried out, and that most successfully, his investigations of aliments. He has shown, by a comparison between the composition of human and cow's milk, as well as of wheat, that any food to be suitable for infants, children, and invalids must have a composition similar to that of milk and wheat; that is to say, it must contain all the elements com- mon to those two articles, and these in the right proportions. Furthermore, these constituents should be presented in the form and condition most suitable for digestion. This object is effected partly by the nature of the constituents, and partly by its preparation and cooking. The average composition of 100 parts of this food in a dried state is as follows: 1 Nitrogenous matters including gluten, albumen, cerealin, and diastase 13.49 Starch 66.33 Sugar and dextrine 10.57 Fat. 1.44 Cellulose 6.00 'Ash... 2.17 100.00 1 Containing nitrogen 2.02 * Containing phosphoric acid 0. 64 It will thus be seen that this food, like the two types, milk and bread, contains all the necessary elements for sustenance and growth; but, in addition, important principles which greatly aid its digestion namely, cerealin and diastase; and it has, moreover, been subjected to a partial process of cooking, which likewise helps considerably its assimilation. For infants, one tablespoonful of the food, equal to about 30 grammes or 462 grains, rather more than one ounce, should be contained in every half-pint of the prepared food. This, deducting 10 per cent, for the average moisture contained in the food, gives 9.50 per cent, of solid matter in the food prepared with water only; but since it is made with half cow's milk, the solids contained in the milk, namely, 6.58 per cent., arc to be added to the previous quantity, making together 16.08 per cent, of solids. Now, the prepared food contains 14.33 per cent, of carbona- ceous matter calculated as starch, and 3.35 per cent, of nitrogenous com- pounds, while human milk, basing the calculation on the average compo- sition already given, yields IIJ.UG of carbonaceous constituents as starvli, and :?.!'> per cent, of nitrogenous matters. \V<- thus see how very closely the prepared food agrees with human milk in its composition, the slight difference which the figures show being in favor of the food. The same 188 INFANT FEEDING AND ITS INFLUENCE ON LIFE. striking resemblance is also exhibited by calculating the carbonaceous matter into fat, that of the prepared food amounts to 5.97, and of human milk to 5. 09 per cent. He thus proves by calculation that his prepared food really agrees in its composition and its nutritive properties almost exactly with human milk. 6. Among the best bread compounds made out of wheat flour, that which from my own experience I should recommend (because I have seen it frequently attended with beneficial results to children who were evi- dently losing flesh and strength under other ordinary foods) is Ilobb's bis- cuits. This kind of food is almost always readily digested, and infants seem to relish it wonderfully. There is one more variety of child's food to which I must allude, be- cause it seems to be prepared upon really scientific grounds. I mean Yorkshire food. I am informed it is in common use in the north of England and in many families in London, and that the experience of those who employ it is that their children will often thrive on nothing else. This statement, however, is doubtless exaggerated. It is prepared by taking three pounds of baked flour, half an ounce of phosphate of soda, and a quarter of an ounce of carbonate of magnesia. Three teaspoonfuls of this mixture are rubbed up with a little cold milk or water, and reduced to a pulp; to this pulp a cupful of milk or water is then added, and the whole warmed. This soon thickens and constitutes the food. It will be seen that two advantages are offered by this mixture. First, excess of phosphoric acid is supplied; and secondly, the disadvan- tage usually resulting from artificial food, namely, constipation, is avoided. I do not pretend to allude to every kind of infant food which may be prepared, or which has been in use and found very beneficial. It would occupy too much time to speak of the various kinds of children's food made and sold. I do not doubt there are several of great value ; but it is no part of my intention to make an examination of each of these. I have mentioned the above as those with which I am either best acquainted, or which seem to be made upon true scientific principles and calculated to fulfil all the desiderata of infant feeding. The application of these gen- eral principles to other aliments is best left to others. It will suffice, I think, if I now refer to some of the liquid adjuncts which may be used with these kinds of aliments under certain circum- stances. There is a vegetable compound in use among the inhabitants of these islands which has some advantages even when given to children, and that is tea, and what is remarkable is its close resemblance to juice of flesh. The equivalent of tea as a nutritive substance is very high, considerably higher than the best cereal grain. The exhausted leaves, after tea is made, contain also from 12 to 14 per cent, of casein. In juice of flesh we have creatine and creatinin present, two animal compounds which, ac- cording to Liebig, closely resemble the active principle of tea theine. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 189 The richness of tea in albumen, fibrine, and probably casein, is also re- markable. The large quantities of potash and phosphoric acid, likewise, is worthy of note. 1 According to Mulder, the portion of soluble matter which hot water extracts from black tea varied in six specimens from 29 to 38 per cent. From the same number of green teas, from 34 to 46 per cent. Peligot found that the mean quantity obtained from the dry commercial article was from black tea 38 per cent., and from green tea 43 per cent, in each kind, and he estimated the amount of nitrogen to be 4 per cent. Thus, from 100 parts of tea, supposing it entirely extracted by hot water, G per cent, of theine would be contained in the decoction. In domestic econo- my, however, the entire quantity of theine is never extracted, about one- third being left behind in the leaves.* Liebig has directed attention to the good results which attend the employment of tea among our laboring classes, as a nutritive agent, and he concludes that this is owing to the resemblance it bears to the juice of flesh in its chemical composition. More recently, my friend, the late Dr. Edward Smith, has investigated the effects of tea upon digestion. These experiments have proved First, That tea has the power to in- crease the transformation of other food, and particularly of such as con- tain carbon. This is probably due to the gluten which tea contains, and which acts as a ferment. Secondly, it increases the function of the skin, as is seen by the perspiration which often follows: its use thus correcting one of the disadvantages of milk and cream. " If any one will notice," adds Dr. Smith, "the effect of a basin of milk when taken alone, he will find that the hands and the exposed parts of the skin become hot and 1 Composition of Tea (Java and Hyson) Enapp. Salt*. Infusion of Tev. Etherealoil 75 Potash 47.4r> Chlorophyl 2.14 Soda 5.03 Wax, re*in, and gum 15. 09 | Lime 1.24 Tannin 15.76 J Magnesia 6.84 Theine 53 \ Oxide of iron. '.21' Extractive 20. 75 Phosphoric acid 9>H Apothein 3.78 ' Sulphuric acid 8.72 Muriatic acid, extractive 20.59 Silica. 2.81 Albumen -'.<'>"> Carbonic acid ]'.(! Fibrine (in part casein ?) 22.64 Oxide of manganese 71 Salts 5.20 Chloride of sodium Carbon and sand 1 . < >'. 100 100 1 100 parts of the following teas afford Gunpowder. floachonjr Watrr ........................ 10 ............................. 8 41 :\. ( volatile oil .5 | ,., 47 w>th jtheine 6. 4 Exhausted leaves .............. 43 containing casein 14. 49 190 INFANT FEEDING AND ITS INFLUENCE ON LIFE. dry, and will at once appreciate the fact that the addition of milk or fat to tea has the effect of preventing the increase of perspiration, and there- by the cooling of the body." Speaking generally, Dr. Smith believes " that the essential action of tea is to promote all vital actions, and to increase the action of the skin." ' It is necessary, however, that there should be a supply of food upon which it may act, otherwise the in- crease of vital action will waste the body. This is one way, therefore, in which it may prove beneficial as a corrective of milk, or rather as an adjunct. The active principle of cocoa, theobromine, very closely resembles theine. Cocoa, however, contains much more oily matter and phosphoric acid, and in this respect has been found very useful. The so-called ho- moeopathic or soluble cocoas are popular favorites, essentially consisting of arrowroot and cocoa. Mr. E. D. Moore's cocoa and milk paste, which contains sugar and concentrated milk, will be found a useful food in some cases. Boiling water need only be added, and the food is at once pre- pared. It is scarcely fitted for very young infants, but even in these, under proper medical direction, it may be found useful in cases analogous to those in which tea is found serviceable, but where more fatty matter is needed. Lastly, to conclude this part of our subject, after the curt allusion made to some of these vegetable substitutes for human milk, the question presents itself At what period may vegetable food be given ? My reply is, not before the eighth month : and for these reasons. Man belongs to the omniv- orous class ; there must, therefore, be a time when vegetable food may be safely given. There is no doubt a relation between the period of time occupied in incubation or gestation, and the time when an animal is so far developed and grown as to partake of herbivorous food without dan- ger. Thus, if a granivorous bird occupy three weeks in incubation, a mammal nine months in gestation, we should, d priori, expect the off- spring of the former to be sooner capable of maintaining life independently of its parent than the latter. Again, the same thing would apply to an herbivorous animal provided with a stomach fitted for digestion of vegetables, i.e., a compound stom- ach, which would be sooner independent than a carnivorous animal with only a membranous stomach, even though the period of gestation were the same in both. Thus, in the cow and in the human female gestation has the same duration; but in the offspring of the former, the calf, we have the compound stomach of herbivora; in the child we have the simple membranous stomach of carnivora; and so the former depends less upon its parent, and attains soonest independent existence and maturity. But the best test of capability of independent life in man is the dental appa- 1 " On the uses of Tea in the Healthy System." Journal of the Society of Arts, February 15, 18G1. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 191 ratus. The appearance of the teeth is the index that the child is matur- ing rapidly, or the reverse; or whether it is or it is not in that condition when vegetable food may be safely administered. The order of appearance of teeth is variously stated: and the earlier do not agree with the more recent tables, 1 as Drs. Merei and "VVhitehead have shown. From their results, " excluding those cases with only me- dium development, and reckoning those only with a favorable and those with unfavorable development, they conclude that in the former, in 128 out of 161 children (or 79 per cent.), the first teeth appeared before the eighth month was past; in 38 at eight to nine months; in 12 after the ninth; and in 3 after the twelfth; while in the great majority of children with unfavorable development, namely, in 71 out of 119 children (60 per cent.), the first teeth were cut at eight months and upwards; in 46 from nine to twelve months; and in 16 even after twelve months; and only in 48 (44 per cent.) before eight months." * Upon these data it would appear that the eighth month is about the earliest period that vegetable food may be. borne. The teeth which ap- pear are not of value, because they are then incapable of mastication, but simply as evidence that changes have occurred in the organs of digestion, which have progressed pari passu, and that the salivary and pancreatic glands, the intestines, the glands of the membranous stomach are in full development, and capable of digesting vegetable aliment. Then, and only then, therefore, as a rule, may vegetable food be given, and conse- quently weaning may be tried if necessary. But even in this case tlio most easily digestible only should be administered, as a beginning; and it is best to continue also, in great measure, the animal milks in combina- tion. Individual cases may, of course, form exceptions. I have alluded to some of these before; and it is clear, if development is earlier in some, so we may conclude that these could bear vegetable food at an earlier date. 1 Anterior incisors 7th month. Lateral " 9th Anterior molars 12th Canine 18th " Posterior molars 2 years. * Report of the Clinical Hospital, p. 14. 192 INFANT FEEDING AND ITS INFLUENCE ON LIFE. CHAPTER VIII. On the Method of bringing up Children by Hand. Advantage of allowing Children to Buckle Animals directly The Volatile Principles of Milk are thus not lost. Difficulties in conveying Milk. Error in our Foundling Hospitals. HAVING now dwelt upon that class of cases where the mother is either able, or can be made able to suckle her own child, we pass on to the sec- ond inquiry referred to, viz. If she be not able to suckle the child at all, certain principles ought to be observed in feeding it, whether the artifi- cial food given be animal milks or something more distinctly artificial, leaving the employment of a wet nurse as a pis oiler. In those cases where we are compelled to bring up a child by hand, there is the greatest need of care and judgment. Prior to eight months this difficulty is considerably enhanced. 1 After that period teeth are generally present, the anatomical conformation of the alimentary canal is well-nigh completed, and the child is enabled to digest even vegetable materials. But in the earlier periods, and particularly in the first three months of existence, the danger of death under artificial feeding is very great, as most of the tables before referred to prove. 2 This is especially true for illegitimate children. In a table drawn out by Mr. Acton in his paper before quoted, the chance of death at this period amongst illegitimate children, such children being generally brought up by hand, is about one-third of all the deaths in the year: thus out of 326 children, 31 died under 1 week, 45 above 1 week and under 1 month, 110 under 3 months, 74 under 6 months. 27 under 9 months, 39 under 1 year. Now I believe that no treatment can be safely recommended in these cases, which can bear any comparison with that which experience has proved to be most successful in other countries: I allude to the direct suckling of the child from the breast of some other animal, as for instance the goat, to which I have already referred. 3 Besides, it is the most natu- ral. This itself is no small advantage. But it also does away with the necessity of an experienced nurse to prepare the child's food secundum artem, so that it shall not disagree. Lastly, no improper practices of the animal are likely to endanger the safety of the child, which, after suckling a short time, it will come to love and protect as its own offspring. Some precautions, however, are neces- 1 Page 34 et seq. * Page 33, and Appendix A. Pages 141 and 149. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 193 sary at first, as a child may be injured by the violence of the movements of the untrained animal. For instance, it is difficult to admit the pru- dence of allowing a child to suck a mare, and even with some cows such a proceeding would be highly hazardous. The most natural way would be to select a cow known for her gentle disposition, and then if the child were not held by a person to the udder, it might be placed on a raised bed, which would stand in front of the cow's hind legs, so that she would be prevented from moving. The nipple might be taken hold of, and thus the child be fed directly from the breast. The udder, however, of the cow would be too large for a small child to suck, and therefore, speaking practically, a goat would be the animal selected. The goat could be easily overpowered and tied down, its feet enveloped in some cloth, and the child, till such time as the goat became accustomed to the plan and allowed it to be done without hindrance, could be safely allowed to suck the udder directly. If the cow be preferred, it appears prudent to milk the cow at some place as near the child as possible, and as often as the child requires it. The cow should then and there be milked, and the milk at once conveyed into a proper feeding bottle, and the child allowed to suck from it in the ordinary way. Undoubtedly, the plan has experience to recommend it. But more than this; I have already shown, pp. 141, 142, 145, and 153, that by prop- erly feeding these animals we may obtain from them, as well as from cows, a milk which shall so closely resemble human milk as scarcely to be distinguishable from it even by chemical examination. The particular disadvantage which attaches to the employment of milk as it is usually obtained from cows, even when free from adulteration, is thus obviated. Very fresh milk undoubtedly agrees best with children. Now it has occurred to me more than once that the explanation may be possibly given, namely, that the milk, when warm, precisely as the blood, loses by evaporation some vital volatile principle, and is thus ren- dered more difficult of digestion. In confirmation of this view it may be stated, that the existence of such volatile principles, as I have before stated, vide sitpra, p. 123, has been proved incontrovertibly by the ex- periments of Parmentier and Deyeux, although unfortunately their chem- ical composition has not been made out. With the intention of making this out, they distilled frequently several specimens of milk. Speaking of the distilled product they remark: " It would be a mistake to condemn the distilled water of milk as simply water. Its smell, taste, and espe- cially the ready manner in which it is changed by exposure, prove . \i- dently that it holds in solution one or many substances. But what are these substances? is it a ferment which, like cerealin or pepsino, ails its digestion?" "This is indeed a difficult problem to solve. All that is possible at present to say is, that these substances are easily decomposed, since we funl their n-tiiiiins in the water which contained them; they are those remains which affect the transparency of this fluid, and give it that viscosity and putrid odor which it acquires after a time." 13 194 INFANT FEEDING AND ITS INFLUENCE ON LIFE. Messrs. Parmentier and Deyeux believe this product to be analogous to those obtained by the distillation of muscle, urine, blood, lymph, and albumen, which also as readily decompose. These volatile principles are occasionally affected by the aliment previously taken; particularly by some of an aromatic character, though not by all these: but they are, nevertheless, always present, and obtainable from milk. Ferris proved that ammonia constituted no part of these principles, nor was it evolved during any period of its decomposition. So far, however, it may be conceded, that there are some volatile principles which escape from milk during exposure to the air. We have an analogous example in the case of the blood. Where blood is first drawn it is perfectly fluid, and could be safely injected into the veins of another animal of the same species. If, however, it is allowed to remain for a few minutes aside, it coagulates, separating into clot and serum. Dr. B. W. Richardson has shown that this change depends upon the escape of ammonia, which holds the fibrine in solution. Now it is a re- markable fact, that new milk has a much stronger odor sui generis when first drawn than after it has been kept for a time and is cool. Moreover, we are all aware (more particularly in reference to cow's milk, although the same truth applies in a lesser degree to other kinds of milk) that exposure to air causes it to become acid, from lactic acid fermentation; and this, as before seen, is one of the causes of the diar- rhoea and other abdominal discomforts so commonly observed among children. On this supposition two popular customs may be explained. First, that boiled milk does not agree so well with children as milk which has not undergone this process, because the volatile principle, whatever it be, has been expelled by the boiling. Secondly, and no doubt also, this is the reason why, when ass's milk is ordered, the animal is brought to the door and usually milked immediately before the milk is taken. As in the case of the blood, which when coagulated may be said to have lost its vitality, so it may be with the milk. It can, therefore, be no matter of wonder, that as milk is usually obtained in towns, even when it is perfectly unadulterated, yet by reason of the necessary exposure to which it must have been submitted, it so commonly disagrees with chil- dren; while in the country, where it is usually given very soon after it has been drawn, it agrees so well. There is another reason also why milk as usually obtained in towns should be unwholesome. It is a matter of common observation that there is much difficulty in bringing milk from country places by the railways into London, the very agitation of it causing it to be decomposed, and tending to the production of butter and buttermilk. To obviate this in- convenience, all sorts of methods (and some of these are very ingenious) to prevent agitation have been adopted. Still it must be obvious that even the transport of cold milk in a cart some two or three miles only must be attended with this alteration of the intimate chemical union of INFANT FEEDING AND ITS INFLUENCE ON LIFE. 195 its elements, and particularly so, as I have before stated, when the milk has been previously watered, which circumstance favors the separation of the cream. The objection is not a solid one which would deny that milk can be so deteriorated because it is nevertheless occasionally found to be nutritious to a child. The ordinary black pudding, and even meat, are nutritious; and in both these cases change, by which all volatile products have been expelled, has taken place. But adults have powers which in- fants may not possess of assimilating these substances. The same is true of milk. Some children may also have a stronger digestion than others. But as a rule and precisely as they have very little power of generating heat, while adults have a good deal so to children these volatile princi- ples may be essential to the requirements of their organism, while to adults and to some stronger children they may be superfluous. What- ever be the cause, the fact is incontrovertible the newer the milk is the better it is for the child; and it points most distinctly to the absolute necessity of allowing the milk to remain as short a time as possible ex- posed to the air before it is given to the child; and therefore is evidence of the immense advantage which would accrue by allowing all infants to take the milk directly from the nipple of the animal. Acting under the knowledge of these difficulties, whenever a child is being brought up by hand, and it is practicable, I always recommend that the cow, like the ass, should be brought to the door, and then and there milked, and the milk in its fresh state at once given to the child. It is remarkable how well some children will thrive under this mode of procedure when other means have failed. And here I may take the opportunity of replying to a question that has been asked me, as to the best mode of bringing up children on a large scale by hand; in other words, what is the system which I would recommend to a foundling hospital. This depends upon several con- ditions: 1. I have shown that the mortality of children in towns is much greater than that in the country (pp. 22 and 35). Therefore, foundling hospitals should be built in the country. 2. The children should not be too closely congregated; hence the sep- arate rooms should be numerous (p. 19), and they should have proper ex- ercise (pp. 19 and 27). '.}. Those animals which produce milk being generally not only more healthy, but producing a richer milk, and being tamer, when living at the seaside, the country station, should, if possible, be a watering-place. Add to this, that as the air is always purer and more antiscrofulous, struma, a malady to which hand-fed children are peculiarly obnoxious, may be avoided. 4. As by a particular kind of food (pp. 1 I ! . 1 -.', 1 ". and 1 .">:?), a milk may be produced in the cow and goat which shall come to resemble very closely woman's milk, the animals should be fed according to rule. Ass's 196 INFANT FEEDING AND ITS INFLUENCE ON LIFE. milk might be tried also to enable us to judge of the effects produced (p. 148). 5. Means should be taken to feed the child upon milk directly from the animal, or given to the child at the earliest possible moment after milking (pp. 123 and 193). 6. These animals, the goats and asses for instance, might be used to give the children such change of air in vehicles as might be found desir- able. 7. By well-regulated railway arrangement, the transmission might be effected safely, somewhat upon the same principle as at Lyons (p. 10), so that the mortality might be positively diminished by the journey (p. 26). 8. If such measures were taken, and every facility were given to ad- mit of the reception of infants, infanticide would soon cease to be the re- proach of this Christian country, and many souls would be added to the population. 9. The large and ample funds of our foundling hospitals would no longer save mere hundreds, but in cheaper, larger, and more healthy pre- mises, in a pure and country air, thousands would live to bless the day of their reception in them. If the conclusions come to above are correct, they justify the belief that the means hitherto taken in these institutions for the preservation of life have been always too partial, often erroneous. They point out in un- mistakable terms the importance of establishing our foundling hospitals upon a totally different principle. What advantage would accrue to large towns, if foundling hospitals and other institutions in which children are brought up were to adopt these simple common-sense principles, and so bring up the children committed to their care ! How many parents would thus have the comfort of rearing children instead of laying them in their cold graves! How many thousands of infants, slowly and certainly, how- ever unintentionally, are killed by injudicious feeding in workhouses ! How many women now writhing under the gnawing pangs of remorse, who might have sent their children to such institutions had they existed at a cost quite commensurate with their small means might have been still happy in the non-commission of infanticide. And in how many homes would the example of vice rewarded as an inducement to further crime have been obviated ! The question is, too, important as a means of saving the lives of thou- sands who might hereafter prove useful and ornamental members of soci- ety, and it ought to be taken up by the State. The late Emperor Napoleon was a great friend to the establishment of foundling hospitals. He hoped in this manner to have a nursery for his future armies. But the Emperor Napoleon did not understand how to bring up the foundlings, and the result was that, like our own, his found- ling hospitals ' became charnel-houses for the dead. Now, however, that 1 Vide supra, p. 26. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 197 we are better acquainted with the conditions of infant life, why should not his principle be borne in mind and acted upon, if not for our armies and navies, at least for the sake of humanity. It is an encouraging symptom in the opinions of the day, that the sub- ject of bringing up children by hand, and that more judiciously, is begin- ning to occupy the particular attention of the public and the profession. Let us hope we are on the eve of better things, and that we may, please God, rid ourselves as a nation from bad customs and malpractices, which not only diminish our numbers, but are both cruel and unchristian. PART IV. CHAPTER I. General Remarks on Prevalence of Abdominal Diseases. Defective Assimilation. Forms of Disease Three Stages Malignant Variety Post-mortem Appearances Nature of the Disease. Principles of Treatment. The Dietetic Means of Insur- ing Digestion of Nitrogenous, Fatty, and Saccharine Aliments Need of Pancreatic Juice. Vegetable Aliments. Mineral Aliments Water; Lime-water. Advan- tages from the Combination of Milks Precautions necessary in using. India- rubber Nipples Advantages of using for a Time other Animal Milks. IN the first part we had occasion to speak of the great number of cases of 'abdominal disease which proved fatal to children. Taking the children under one, 1 the number of deaths from developmental diseases are 70.6 per cent, to all deaths, and inclusive of the several diseases 51.4 per cent, to all deaths; and the accounts from the Manchester Hospital for children 79 per cent, of the deaths occurred to children under two years, and were due to diseases arising from defective or faulty nutrition. In London in 1872 out of 18,140 deaths from specified causes of chil- dren under one year, we have 399 who died from diseases of digestive organs, 1,859 from developmental diseases, 2,492 from diseases of nutrition, 378 from dietetic diseases, C87 from consumption of the bowels, making a total of 5,815 under these heads only, or 32 per cent.; and this is by no means the entire number, since convulsions, which constitute so large a proportion of cases which die from abdominal disease, are excluded. In the third Report of the Children's Hospital, in reference to the table of diseases treated, Dr. Whitehead remarks : " The most important item in the preceding tables is undoubtedly that which rrprrsmts dis- orders of the abdominal organs, for although the number (1,116) of these stands below that representing chest affections, the first three groups, de- velopmental disorders, rachitis, and constitutional debility, and probably also some cutaneous affections, may be considered as belonging to the same category, as they frequently owe their origin to the same causes, namely faulty nursing, erroneous diet, uncleanness, impure air, and un- healthy locality. Thus considered, the number of gastro-intestinal or digestive and assimilative disorders will exceed that representing tin > 8e Appendix A. 200 INFANT FEEDING AND ITS INFLUENCE ON LIFE. the chest, large as it is, by more than 700. I exclude dyscrasic affec- tions, some of which may be considered to have a similar origin; but should the last-named be taken into account in this sense, they would swell considerably the number of the class of diseases, by far the most destructive of life to infancy, which owe their origin to causes susceptible of great mitigation, if not entire removal, by hygienic measures." J Upon the subject of these several diseases in detail it is not my inten- tion to dwell here; I may refer to one or two of them in the sequel. I think it better to consider now more fully the subject of defective assimi- lation as a general morbid state brought on by injudicious feeding, and because it is doubtless the very "fans et origo " of the several diseases above referred to, and of many others closely allied to them. For the same reason the term defective assimilation will be made use of in lieu of that which is more usually employed, atrophy or marasmus, which is only a very characteristic form in which it frequently occurs. In the third Clinical Report of the Manchester Hospital for Children (p. 69), Mr. Whitehead gives the following opinion, which is very con- firmatory of my own on this disease : " Almost invariably it may be traced to bad nursing, erroneous diet, impure air, or want of cleanliness. I believe it to be entirely preventable by proper hygienic measures, as it scarcely ever occurs in the children of attentive and thrifty mothers. This is a most serious malady, and not of uncommon occurrence, as 178 cases of decided form were treated, of which number 50 (or 29 per cent.) died." So serious an affection should be most closely watched; it comes on so treacherously that it needs all the intelligence of a medical man to detect it, particularly in its first stage; for when once it has reached its second stage in many cases, but almost always when it has reached its third, then it is, as far as I know, perfectly incurable. I do not include, however, those cases of atrophy arising from simple tuberculosis and syphilis. I believe that both these varieties, the latter very frequently, are curable; but I wish exclusively to confine myself to those cases of atrophy arising from defective assimilation. Causes. The predisposing causes of this disease are a hereditary tubercular taint, previous debilitating disease, but more especially the sequelae of exanthemata. The exciting causes are those previously enumerated, viz., injudicious food, bad air, want of cleanliness. These causes appear to be so powerful in their operation for evil that district registrars often call attention to them. Thus, in one of the reports of the registrar, in November, 1859, we read : "In the East Wymer sub-district, the large number of deaths (18) from atrophy, seems, on inquiry, to de- pend upon improper food, from the mothers not suckling their children, as they say it would interfere too much with their work." 9 But even the healthiest children may become subject to the malady, especially when they 1 Third Report, p. 66. * Medical Times, November, 1859, p. 543. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 201 are deprived of breast-milk in the. earliest periods, and are fed indiscreetly. From my own experience I should also gather that one of the most power- ful causes of its production, is that peculiar atmosphere which is invari- ably developed when young children are congregated together in any large number. Forms of the disease. In order to describe the disease more conve- niently, I shall divide it into three stages. The 1st, or premonitory; the 2d, or emaciative; the 3d, or exhaustive. first stage. The child may appear at times to be in ordinary health, and its spirits may be good; more frequently, however, it is unusually peevish and irritable by fits and starts, apparently without reason; the flesh feels flabby, and loses that silky texture so common in young chil- dren; it will frequently throw up its food, which then smells intensely acid; its appetite is not good; its sleep is disturbed. There may be con- stipation of the bowels; the motions when passed are like clay, with white lumps in them. In the second stage all these symptoms are increased in intensity; there is more decided irritation of the intestinal canal ; vomiting may now be of frequent occurrence, and there may be diarrhoea, the motions being very green, intensely offensive, and very acid, so as often to exco- riate the fundament and surrounding parts, the emaciation is now more rapid, the eye assumes a peculiarly bright expression, and the child looks aged; sometimes there is no diarrhoea, but the process of emaciation con- tinues, and the motions are replete with undigested matters. The third stage is but a further development of all the symptoms al- ready enumerated; the child's appetite is now voracious to a degree; nothing seems to satisfy it, but all the food it takes does it no good. Aphthie now appear on the mouth, which gradually extend down the ali- mentary canal. If there be diarrhoea present it proves perfectly unman- ageable. Thirty and forty motions daily are not of uncommon occur- rence, and these appear to be nothing else but undigested food; the emaciation becomes perfectly frightful in the course of a few hours the child has the look of a wrinkled old man in every part of its body; the eyes possess an unnatural brightness, and seem to project out of their sockets. It is voracious to the last, so long as it has strength to take food; it is sleepless, constantly whining and crying for more; it loses its flesh more and more, till it dies in the last stage of inanition. When the disease assumes this aphthous character, especially if a number of children be congregated together, so that an infantile hospital atmosphere pervades the apartment, it is apt to assume a contagious character, and become exceedingly malignant; so much so, that if the same towel or the same artificial nipple bo employed by another child, it will catch the disease. Children previously quite healthy will brromo affected by the disorder, which will speedily pass on in most cases to a fatal issue. The affection does not confine itself to the alimentary mucous membrane ; sometimes it is so fearfully contagious that no 202 INFANT FEEDING AND ITS INFLUENCE ON LIFE. measures of precaution prevent its extension to other mucous mem- branes. On one occasion, in a nursery where the disease broke out, two of the adult girls in attendance became affected with these aphthae on the con- junctiva, having much the appearance of scrofulous ophthalmia, only the ulcers were more lengthened, and there was no photophobia. Chloride of lime was largely used in the rooms; the whole walls were washed with a solution of it. The same spoon was never used for another child, and was always washed after use in a solution of chloride of lime. A sepa- rate nipple was kept for each child. Still the disease often recurred, and proved equally contagious. These children ate enormously, but got thinner and thinner, till at last they died, as I have before said, with all the symptoms of inanition. Where diarrhoea is not present the illness may extend over a period of several weeks. But the symptoms are analogous, and as certain to be developed, only more gradually so. It is singular, even in such cases, how the little shrivelled old-looking child will sometimes smile at you, particularly after a meal. It is, alas, but a temporary sunbeam in the midst of the general wreck; no quantity of food given, not even cod-liver oil, will do any good, however assiduous and varied the trials made. Sometimes the disease having reached the second stage, or while yet in the first stage, does not pass on to the third; that is, the primary as- similation is defective only, but not entirely prevented. Tuberculosis, with other developmental disorders, then makes its appearance, generally as tabes mesenterica, more rarely as phthisis. By far the most common of the diseases it gives rise to is anaemia, with more or less of rachitism, a disease graphically described by Sir W. Jenner, as produced by what- ever is favorable to the production of watery blood, viz. impure air con- stantly breathed, food insufficient in quantity or defective in quality, de- ficient light, want of cleanliness. Painful as these latter complications are to behold, they exhibit, nevertheless, a fortunate phase in the original disease, because, under proper treatment they are comparatively manage- able, whereas defective assimilation, in the third stage, is very seldom, if ever, cured. The post-mortem appearances present different peculiarities: 1st, in those who have died from diarrhoea, as a complication ; and 2d, in those in which this last has not occurred. In both varieties there is great emaciation, scarcely any fat remaining; the cellular tissue is very scanty, and the muscular tissue much wasted. In the variety where diarrhoea has existed, the alimentary canal from its beginning to its termination, is lined with red patches and aphthae; these vary from the size of a pin's head to that of a bean. And, as has been shown, these, after a time, be- come more or less filled with o'idium albicans. In addition, Peyer's glands are much reddened and swollen. Sometimes there are no aphthae, but the mucous membrane from below the liver is intensely reddened with a bloody and very acid mucous exudation upon its surface. In those cases INFANT FEEDING AND ITS INFLUENCE ON LIFE. 203 where there is no diarrhoea the mucous membrane of the alimentary tract is pale, but Fever's glands are very much swollen, and project from the mucous membrane as round patches about three or four lines broad by ten or twelve long, apparently filled with exudation, and precisely resem- bling those enlarged Peyer's glands found in cases of Asiatic cholera. Nature of the disease. In its worst forms, it is the power of primary assimilation, or digestion in the alimentary tract only, which is lost, while that of secondary assimilation, or the absorption and appropriation of assimilable matters, if present, may still be effected. It is, therefore, manifest that ordinary dieting will never suffice to restore the child. Starchy and vegetable matters, which are so generally prescribed and taken, should not be given. These substances, when digested, are first converted into sugar, and subsequently into fat. But in children affected with this disease they are not in any way convertible into this substance. That this is the fact was before shown (p. 174); M. Guillot, of Paris, having proved that the starchy matters of the aliments taken by infants whom it was wished to bring up by hand, and who died, were found un- changed throughout the alimentary tract. This was beautifully proved by the iodine test. How far sugar is or is not in any measure digested in such cases remains for future inquiry. It is probable, however, that as glucose it is occasionally assimilated. The albuminous matters, particularly the casein and oily substances, do not appear to be digested any better. The milk taken passes away by the bowels in many instances only curdled, but otherwise unchanged. Now this is a state of things which is peculiar to this disease. It does not occur in other analogous atrophies (in infants), at least to the same extent. It comes, in fact, to resemble some cases of senile atrophy in cancerous subjects, especially where the pancreas is affected with the disease. It is true we often find among little children considerable gastric irritation and anaemia present. But in all assimilation or digestion is, to a certain extent, possible. In the cases, however, now under consideration it is not so. Even the attempt to feed them on breast-milk has been made and has failed. They do not seem either able or willing to take it. In Dr. Whitehead's cases the chief measures employed were improved diet and cleanliness, assisted by cod-liver oil and chalybeates. I confess, however, that for my part, except in the first stage, and more rarely in the second, I have never seen any of these measures do permanent good, at least in the third stage. But, secondly, if the power of digestion in primary assimilation is lost, that of the appropriation, or the absorption, of digested matters, or secon- dary assimilation, appears to be present. The faculty remains only in abeyance from want of digested matters to takf up; because, first, many poisons are capable of absorption; and, secondly, from the continued ab- sorption of the child's own fat and cellular tissue it ia manifest secondary assimilation is carried on. Principle* of treatment. The foregoing remarks necessarily lead to 204 INFANT FEEDING AND ITS INFLUENCE ON LIFE. the question as to the modes of treatment to be adopted; and these may be considered under three heads: I. The dietetic, which will involve the consideration of the means to be adopted for ensuring the readier diges- tion of (a) albuminous, () fatty, and (c) water, and some mineral ali- ments. II. The hygienic, including the preventive rules to be observed in the nursery. III. The medicinal treatment. I. The dietetic treatment, and (a), as regards the albuminous sub- stances. As primary assimilation only is defective, it is clear that if we could supply a child with food which has already undergone this process, i.e., already digested, we should be giving that food most fitted for its wants. The food would have simply to pass through the alimentary canal, not for digestion, but for simple absorption. The child's powers until it is stronger would not be overtaxed, while secondary assimilation would go on under the most favorable circumstances. We have already shown, when speaking of animal substitutes for human milk (vide p. 162), that this can be done by artificial gastric juice. In this manner milk or meat already digested may be given. In the first case the casein, and in the second the albumen, are supplied to the child in a condition in which either can be readily assimilated. With the same intention, the essence of rennet, as it is called, which is merely a concentrated solution of the mucous membrane of the calf, may be used as an adjunct in the food given. The " liquor pepsinis " fulfils the same indication. Both contain in a concentrated state the active principle of gastric juice, and so will facilitate primary assimilation where, by reason of want of power in the juices secreted by the child itself, ordinary food given as such would not be digestible. With this intent, M. Joulin, 1 in a paper on the " Employment of Pep- sine in the Inanition of New-born Children," relates some experiments which he conducted. That gentleman observed, that on several occasions he had lost chil- dren from congenital weakness. Death could not be traced to disease of any one viscus; the entire system seemed to suffer. Respiration became in some degree impeded, but nutrition seemed to be chiefly interfered with. Twice the symptoms were well marked, the respiration was, if not vigorously, at least regularly performed, the voice was sonorous, and screams enduring. But the insufficient nutrition effected did not supply the system with materials adequate to the support of life. One case was that of a very small, wrinkled, exceedingly emaciated child, four days old, yet presenting almost the appearance of decrepitude. It weighed only 3 Ibs. Troy. The voice was weak, but distinct, and respiration not obstructed. The mother was an excellent nurse; but, although the infant took the breast readily, it constantly threw up every meal. What passed through the bowels was unchanged, although slightly 1 Moniteur des Sciences. Journal de Med. et de Chimie Pratique, August, 1861 : Banking's Half- Yearly Abstract, voL xxxiv., p. 266. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 205 tinged with bile. Diarrhoea was also present. Syrup of poppies, and blistering on the epigastric region were tried without good result. Emaciation was on the increase; the child was, in fact, dying. At this stage, M. Joulin ordered 15 grains of Wasmanoz pepsine to be divided into ten powders. One powder to be given mixed with a few drops of sugar and water, and introduced with a little of the mother's milk into the mouth of the child, who had now scarcely strength to take the breast. This remedy was begun on the 8th May, 1859. The condi- tion of the child continued stationary up to the llth, when the diarrhoea ceased, and the child appeared much stronger. By the 20th, all vomiting and diarrhoea had ceased. The remedy was continued till the 30th, when the child was quite well, and in two years became a fine vigorous little fellow. This is a case which speaks strongly to the convictions. If, at so early a period of life, when vitality and digestion were so weak, the artificial pepsine effected a cure, d fortiori will it be likely to do so in the case of older children; and so I have found it in practice. The digestive powers are thus assisted, and food, which was before useless, because un- digested, readily becomes assimilated. (b) As regards fatty matters. For these a different digestive juice is required. But this may be supplied in three ways: 1st, by an artificial pancreatic juice. 2dly, by supplying fatty matters as fatty acids. 3dly, by the admixture of phosphate of soda with the food. By either of these processes we may supply the child with a fatty aliment, which (like the albuminous matters already digested in gastric juice) may be taken up by the lacteals and absorbed into the system. 1st. By an Artificial Pancreatic Juice. Bernard showed that, if fatty matters are taken by animals in whom the pancreatic gland (or sweetbread) is diseased, they will pass through the bowels unchanged. The same is observed when this organ is cancerous, or so diseased even in man, that the secretion from it does not reach the intestines. The fatty matters are not assimilated. It would hence appear probable, upon a principle analogous to that of the former case and as before seen, 1 that if an artificial pancreatic juice could be prepared, we should place the child in the position most favorable for the absorption and secondary assimilation of fatty matters. The experiments of Bernard, however, are too exclusive. It cannot be denied that one of the uses of pancreatic fluid is to emulsify fats so as to permit of their absorption and assimila- tion in the blood. But Frerichs, Lehmann, I^eng,* and others, have shown that this transformation will occur in cases where the pancreatic ion is artificially kept away from the intestines. Again, a mixture of the pancreatic fluid with bil; and the ordinary intestinal juices efiVrts this change far more readily. All this proves that the artificial juice re- quired is something more than purely artificial pancreatic juice; but prac- >Pagel6H Carpenter's Phynotogv, p. 431. 206 INFANT FEEDING AND ITS INFLUENCE ON LIFE. tically this would be very difficult to obtain, and, if obtained, to keep fresh for use. The advantages to be derived from the use of such a juice appear to be still more important when we come to consider some of its other prop- erties upon aliments in primary digestion. First, it is not only a solvent of fatty matter, but also as powerful an agent in converting starchy mat- ters into sugar, although, as in the former case, it does so more readily when in connection with the other intestinal juices and bile. Secondly, it would appear to be especially necessary in the case of very young in- fants (and particularly in those to whom starchy matters are given) ; as in infants under two months there is actually no saliva secreted to com- pensate for any defect in the pancreatic juice. And lastly, because it is now evident, from the experiments of Drs. Corvisart, Brinton, and Har- ley, that under particular circumstances the pancreatic juice does exert a solvent or digestive influence even upon albuminous matters. Unfortu- nately, however, we have not yet accurate knowledge enough to prepare this artificial juice; nor has any chemist prepared pancreatic compounds analogous to the essence of rennet, or liquor pepsinis, for convenient use. The price also of sweetbread in large towns is an additional difficulty in the way. It is to be hoped, however, the desideratum being known, that some means may be devised by which it may be procured, so as to admit of convenient employment in cases like those under consideration. Dr. Harley l has, indeed, recommended pancreatine, the active principle of the pancreatic fluid, as a remedy in weak digestion, and he believed he had been able to procure it sufficiently pure; but it is not to be had as yet in the London markets. A very useful preparation, however, is now everywhere procurable. I allude to Dobell's Pancreatic Emulsion, than which, next to cod-liver oil, I know of no better fattener. It is easily taken by children, and from its containing pancreatine, fulfils all the indications, as an emulsion of fatty matters, to be desired. Secondly. Another way in which this emulsion of fat can be accom- plished is by giving the patient, not fat, properly so called, but the fatty acids of which they are composed, and which are very readily absorbed into the system. The good effects of cod-liver oil are probably in some measure due to the excess of fatty acid present. So, also, those of but- ter. It is indeed a matter of popular observation, that many children grow fat upon bread and butter. They appear to thrive on it when other means fail. This good effect cannot be due singly to the bread, for rea- sons before stated,* but to the free acid which is also in excess in butter. The same explanation will apply to the good effects of cream on some children. Except, however, in the three instances here mentioned, fatty acids, as such, in anything like a reasonable quantity and at moderate 1 British MedicalJournal, October, 1858. Vide vupra, p. 176, et seq. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 207 prices, cannot be procured. There are, of course, difficulties which pre- vent their employment on a large scale, and limit experience. The third method, upon the whole, is at present the most practicable. I have already alluded to the peculiar property which phosphate of soda has in emulsifying fats. 1 This is a salt which is readily obtained, and therefore very readily mixed with the food supplied to children. When the matters given are of a vegetable nature, and whenever the case is one which justifies their employment, cerealin is the substance to be given instead of pepsine, for the reasons before stated (p. 178). In practice, the difficulty is to obtain it as a powder, and ready prepared. Here, therefore, bran-tea, which is especially rich in cerealin, may be given. A strong solution may be prepared by filling up with lukewarm water a tum- bler already half filled with wheat-bran, stirring very freely for half an hour, and straining through a coarse sieve. From one to two tablespoon- fuls of this bran-tea should be added to the vegetable food, and its diges- tion will be ensured. (c) Water, and the mineral alimentary matters, or medicaments essen- tial to the proper assimilation of the constituents of the class of aliments before mentioned, should be also given. The most important of these is water, and this should most certainly be good of its kind. Usually, where milk and water are given, it is the warm or boiling water which is added to the milk. I have already pointed out the disadvantage of boiling or even warming the milk by the fire. 1 In most places where the water used is moderately good, the very act of boiling the water before use tends to destroy any active ferment contained in it; and as the lime generally held in solution in it is thrown down in the process of boiling, a sort of artificial filtration has taken place, and the impurities of the water are deposited with the falling par- ticles of the lime. Occasionally, however, and this is especially the case where rain-water is used, even after boiling, its color shows it contains many impurities. It is wise, therefore, and especially if the water used be lukewarm and not boiling, to select water that has been properly fil- ter^! through charcoal, which has the peculiar property of destroying all smell and impure matters. For the same reason, when water is given to children as an ordinary drink or mixed with their milk, it should always be filtered or boiled previously. It is for this last reason that toast or barley-water is to be preferred to ordinary water. This is not a mere refinement. I have seen carelessness in this respect lead to fatal results. During cholera seasons, impure water, the chief nidus for cholera ferment, will often produce the disease. The same is true for typhoid fever. 1 But even under more particular circumst.-ui. s the same unhappy effect may be observed. I remember full well the deaths of two infants from drinking impure water in a northern watering- place. Here a lazy servant, to save herself the longer walk towards a 1 Vide tupro, p. 181. * Page* 188 and 148. P 151 . 208 INFANT FEEDING AND ITS INFLUENCE ON LIFE. well of good water, was content to take the less pure water in the neigh- borhood, which, although apparently pure looking, was mixed with sewage matter, and thus proved fatal to them both. What I have already said in speaking of adulteration of milk with water (p. 150), and the fearful epidemics of typhoid fever which have sprung therefrom and destroyed so many promising infants, will be felt to apply especially to the present considerations. Pure water is, above all things, essential in the appliances of a nursery for infants. We have before seen that in many of these cases of defective assimi- lation there appears to be an excess of acid in the alimentary canal (p. 201). Hence the advantage of keeping test-paper and galactometers (p. 169) in the nursery. These should be always at hand, to enable us at the onset of any untoward symptoms which may seize the child, to determine how far the milk supplied may be regarded as the cause of the attack. The excess of acid is, during life, evidenced by the constant craving appe- tite of these little ones; and the post-mortem appearances before referred to, prove it unmistakably. It therefore forms an essential part in the treatment of such cases to administer alkalies to neutralize this excess. It is for this reason that lime-water is oftentimes so efficacious. But lime has also other peculiarities, to which I have before alluded (p. 134) ; car- bonate of lime is insoluble in the blood except there be excess of carbonic acid; and phosphate of lime increases the power of the blood to contain carbonic acid in excess. On the other hand, an excess of lime is also useful to allow of the for- mation of biphosphate of lime, which, from the experiments of Blondlet, appears to be the acid principle of the gastric juice. 1 The great use of lime-salts in providing material for the muscular and bony structures, is a strong reason for giving them in combination with the alimentary matters supplied. The uses of chloride of potassium as a solvent of carbonate of lime have been already insisted upon, and need not be again referred to. 1 For these reasons, wherever children are brought up by hand, large quantities of lime-water, sugar of milk, and dill water are required. It is well, therefore, to keep these in large bottles on a shelf ready for use, and these may be always kept in a state of preparation. If there be any diffi- culty in obtaining the lime-water from a chemist as often as required, it may be prepared in the following manner, and will generally be found to suit for all practical purposes: Let a quantity of pure quicklime, say four or five lumps about the size of a lump of sugar; be placed in a large bottle; let this be filled with dis- tilled water, or, if this cannot be got, with water that has been boiled or filtered; the whole well stoppered. A small quantity of the lime, about 12 grains, at the ordinary temperature of 60 Fahr., will be taken up. If allowed to stand, and filtered when required through a piece of calico, we have for all purposes tolerably good lime-water. As fast as a quantity 1 Journal de Phys., April, 1858. * Page 135. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 209 has been taken out from the large bottle, it should be filled up with fresh water till again required. In this way we have a continual supply. It needs only that the quantity taken out and filtered should be also kept in a well-stoppered bottle; else it is apt to be decomposed by absorption of the carbonic acid of the air, and becomes converted into chalk, and thus gives rise to constipation of the bowels. The coexistence of flatus with considerable abdominal pain, although in part relieved by the lime-water, still points to the necessity of adminis- tering some carminative. It was one of the great advantages which Mrs. "Wells's vegeto-animal food possessed over most of those ingredients usu- ally given to children, that it contains in its composition some kind of carminative. In most kinds of food, therefore, one should be added, and one which may prove effective, and yet pleasant to the taste. Dill-oil is the carminative usually selected for a child to use the nurse's expression, " to disperse the wind; " and as a rule, it is advanta- geous to give small quantities of dill-water in the regular food the child takes, in quantities varying from one to two teaspoonfuls. Many other of the non-poisonous essential oils, such as carraway, peppermint, mint, cloves, cajeput, etc., would answer as well: and dill has one disadvantage, that it is not very miscible with water, requiring that the herb should be directly distilled with water. In small country places, where chemists are not always near, and occasionally not very abundant in their supplies, it is often difficult to procure dill-water in good condition. To remedy this disadvantage, the London College recommend the oil to be rubbed with magnesia first, and then with distilled water. The objection to this mode of preparation is, that the solution is somewhat milky, and portions of the oil, not taken up, float upon its surface. The same is true if the oil is rubbed up with sugar. The proportions to be used are one drop to three grains of magnesia or sugar, and one ounce of water. In practice, however, as we use lime-water, I have found it of advan- tage to mix the dill-oil with the lime-water at once. The quantity required, one drop per ounce, is very readily taken up, and mixes well. A little boiled milk, about two teaspoonfuls, will also readily mix with it, and this small quantity may at any time be mixed with the child's ordinary food without doing harm. The same facility in after admixtures of the dill-oil with water, obtains if we rub up the oil with quicklime direct ly instead of magnesia. Another excellent carminative is wine. It is a remarkable fact, that many children who have by injudicious artificial food been brought to that state that they cannot digest fatty, albuminous, or starchy matters, or at least do go very imperfectly, appear to be capable of digesting alcoholic substances. Wine whey, made by pouring a wineglassful of good sherry or port into three wineglassfuls of boiling milk, is a convenient form. Tin- little creatures will suck it with great glee, and under its influence they are seen to thrive daily. As they take it the pain from flatus dis- appears. The wind l>r-ak.s upwards at once, and the child, previously in 14 210 INFANT FEEDING AND ITS INFLUENCE ON LIFE. great pain, is quiet, and soon falls into a tranquil sleep. The wine whey should not, however, be given extensively, and as a substitute for the ordinary milk food supplied. One meal in the twenty-four hours of this wine whey will suffice, and the quantity given at a time should not ex- ceed one wineglass. I shall, however, again have to refer to the use of wine. Occasionally, brandy may be substituted for the wine ten to fifteen drops in a teaspoonful of water or milk, sweetened. Brandy so given is often found more useful when a tendency to sickness exists, because it is freer from acid. Some cases, however, occur where there is a great deal of wind, and carminatives, even in very moderate quantities, do not appear to relieve, but rather to aggravate the symptoms. It is astonishing how well char- coal acts in some of these cases both the vegetable, but especially the animal may be used. Mixed with a little syrup, the baby likes the taste. The ferment, which irritates the mucous membrane of the intestine, is thereby destroyed, and almost immediate relief to all the symptoms fol- lows. A pinch or two in a teaspoon with a little sugar will often suffice. Whatever charcoal we use, however, it is important it should be in very fine powder, and recently prepared, or have been kept in well-stoppered bottles, else its effect will be very small. It must be able to absorb the gases. But even if an old specimen of charcoal, in a case of difficulty, be placed in a crucible and made red hot, and then thrown into water and dried, it is at once made fresh again; so that the difficulty need only be temporary at the utmost. Animal charcoal has two advantages. It is, 1st, a more effective ferment destroyer. 3d. It is much more easily miscible with water or syrup from its greater weight, and it also contains lime salts. In the great majority of cases, the readiest method of giving children the required alimentary principles is by using fresh milk, which has the advantage, before spoken of, of not only supplying the proper azotized and combustible, but the mineral ingredients in requisite quantities, and particularly the volatile principles. An exclusive restriction to fresh milk, however, will not suffice, except in cases where we have to deal with par- tial defective assimilation only. The other means of treatment previously recommended must be combined. I have before maintained that the popular prejudice, that it is danger- ous to combine two milks, is founded on erroneous conclusions. 1 And looking to the immediate preservative influence of breast-milk in preventing the mortality of infants, it is at once obvious that wherever it can be done it should be supplied, if not exclusively, at least in as large a measure as possible. If the child has not lost the faculty of sucking, the difficulty is comparatively small, because all children prefer the sweet taste of human milk to that of milk from any other animal; and when a 1 Pages 40, 41. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 211 wet nurse for the exclusive use of such a child cannot be provided (and I have already strongly protested against hired wet nurses), a married woman suckling another child may often be found to give it a morning and an evening meal, and this without detriment to her own child. But if the measures and precautions given above, when speaking of defective lactation, 1 be taken, nearly all mothers may be so acted upon by galacta- gogues as to supply a very fair quantum of milk, thus obviating most, if not all, the disadvantages of exclusive hand-feeding. This is one of the reasons why it is so wrong in those who take charge of children to at- tempt to bring them up by the spoon and not by the bottle with an artifi- cial nipple attached. The faculty of sucking once lost in a child, is sel- dom, if ever, regained; and thus if an emergency occur when, from the child's state of health, breast-milk would be desirable, the difficulties in its administration are materially increased. For the same reason the employment of the breast-shaped bottle (pp. 49, 50), to be placed in the usual position of a woman's breast, by what- soever nurse the child may be fed, is to be preferred. When, however, the child has lost the faculty of sucking, there is great difficulty in giving it the breast-milk. It may be milked into the child's mouth; but this process often fatigues both child and mother. The woman has to acquire the faculty of being milked just as any other milch animal. But when this has been done, the milk being collected in a cup may be subsequent- ly given to the child whose natural instincts have been so completely per- verted, either by the use of a small india-rubber bottle-syringe, by which it can be squirted into the child's mouth at successive jets, or by the spoon. I might, however, remark, en passant, that although it is undeniable that infants do lose the power of suction, and that once lost it is not again acquired at that early age, yet we should be cautious before we conclude that a child does not suck. A babe exhausted by defective as- similation has but little muscular power. Now that india-rubber nipples are so commonly used many are made so stiff and resistant that the child cannot suck with them. After a very ineffective attempt it falls back, and the conclusion is at once come to that the child cannot suck. But it is not so. Better by far use the old-fashioned cow-teat, with all its dis- advantages, than one of these unyielding nipples. There is another dis- advantage, even if the child be strong enough to use it. In the effort re- quired he sucks in a quantity of air with the milk, and hence suffers sub- sequently from flatulence. That this is the case we can very readily con- vince ourselves. If a closed bottle be examined as a child sucks, it will be found that bubbles of air enter into the bottle, apparently from tho child's mouth, as the milk is sucked in, in rapid succession. The nipplo then may be said to act properly. It is not so if it be too stiff: the bub- bles are few and far between, but it sucks air. An excellent nipple, 1 Part II., chape. IT., T. 212 INFANT FEEDING AND ITS INFLUENCE ON LIFE. which I have seen used, is that invented by Mr. Cooper, of Oxford Street. This is very yielding, and, moreover, enables a proper regulation of a co- pious or smaller flow of milk into the child's mouth, according to its age, by a stop-cock provided at the inner end, which drops down to the bot- tom of the bottle; and so, if the artificial nipple plays well, no air can be taken in. The taking in of air in undue quantities while a child is sucking is, in reality, sometimes attended with very serious results convulsions and even death; and, short of these unfortunate contingencies, the child is constantly in a state of discomfort and crying, so as to be often a nui- sance to all who come near it. My late friend, Dr. Ballard, wrote, as be- fore said, a very excellent little book on the subject of what he called fruitless Sucking. 1 It is one of the baneful customs of ignorant nurses often to put a piece of flannel into the mouth of a child so as to keep him quiet while he is sucking it. But he necessarily sucks down in this man- ner a quantity of air, which produces colic, diarrhoea, and occasionally convulsions. This is, after all, a very dirty habit; but apart from this, Dr. Ballard has shown it leads to actual disfiguration of the child's mouth, which projects forward and assumes a sheep-like shape. Dr. Ballard has often pointed out to me boys and adults where the disfiguration produced by this baneful habit was so painfully present, as to convert what would have been a good-looking man into a sheepish, ugly creature. It is pos- sible my friend rode his hobby a little too often, and may have exagger- ated the effect produced. If so, it doubtless was unwittingly, for he was an honest believer in his theory; and certainly it must be admitted that it takes away much from the dignity and beauty of a face to have a fea- ture in it so disfigured. More recently, another kind of india-rubber nipple has been made. Instead of being provided with only one hole, it has several, and these are rather slits than actual openings, so that a kind of valvular action is kept up. The nipple in this manner comes more closely to resemble the cow's teat. The flow comes more readily, and is more easily checked if too copious. More important, however, than even the choice of a nipple, is the state of it. Every article employed should be kept in the most scrupu- lous cleanliness. Nothing is so essential to success, especially if the child is in any way brought up by hand. Next to actual neglect of the child, error in this particular is the greatest sin which a nurse can com- mit. And, fortunately, most nurses of any pretensions will attend to the outward and inward cleanliness of the pots, cups, pans, spoons, etc., used. It is, however, chiefly in the cleanliness of the teat used that .there is fear of inattention. It should always be placed in lime-water after use, and not only wiped outside before used, but sponged out inside. Curdled milk in a sour state may sometimes accumulate at the upper end 1 Page 76. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 213 of the nipple. An excellent, because simple, way of doing this is to fasten a piece of sponge or flannel to the end of a short stick, by which the inside of the nipple can be, as it were, mopped clean. It is most important that in any place where more than one child is fed from a bottle, each child should have its own teat. The indifferent use of tHese is sometimes very injurious. I have seen in a public institution a whole ward infected with malignant thrush by one child, where a careless nurse, wise in her own conceit, had thought fit to disregard the medical direc- tions given. When human milk cannot be procured, or, if obtained, does not agree, it often happens that another animal's milk, whether taken simply or combined with the food, will effect a complete recovery. Thus ass's, goat's, or mare's milk may be given; care being always taken, that, as in the case of human milk, these milks should be perfectly fresh. Indeed, in defective assimilation we frequently find that when the milk of one of these animals is given, it seems to supply some ingredient which was needed in the child's organism, although we are unable to define the principle more exactly, and which the human milk before given did not contain. The following examples will illustrate my meaning: Mrs. P , being much annoyed with a wet nurse whom she had in her service, was at last compelled to part with her. Being aware that a friend in the neighborhood was possessed of a goat, it was asked for to supply the wet nurse's place. The child took to the goat at once, and the poor thing after a short time would run up the stairs when she was loosed for the purpose of supplying a meal, and the child would suck the goat like a young kid. Mrs. P , in reference to this case of her own child, makes the following very pertinent remarks: "I had no particular reason for selecting this mode of nourishment, but that it presented itself at the time, and I considered it approached nearer cow's milk than that of any other animal, and therefore contained more of the elements of nutrition than human or ass's milk." The little boy did at any rate exceedingly well under this treatment. The husband of this lady, a medical man at Gravesend, had und-T his care a child who was treated by mare's milk, arid cured in like man- ner. " The little babe was six weeks old when he was sent for. It was reduced to a shadow by diarrhoea. Ass's milk had been tried, as also that of one of the father's best cows. As the father was himself a far- mer, we cannot doubt that this cow's milk was the best of its kind; still the child wasted away. One day, when putting up his horse in the stable, Fie saw a foal sucking its mother, when it occurred to him to rMOOUMOd the foal to be weaned, and the mare's milk given to the child. The !! , t was magical. The child completely recovered, and is now five years old, an 1 as fine a boy as the most fastidious parent could desire to see." A child under my care, although suckled by a wet nurse, whose milk on examination appeared te be good, was seized with diarrhoea. Nothing could control this. Ass's milk was now given. It perfectly succeeded 214 INFANT FEEDING AND ITS INFLUENCE ON LIFE. for a few days. However, as the good effect did not persist, another wet nurse was procured, and the child did well. A medical man of eminence informed me he had brought up, almost exclusively upon ass's milk, his own sickly child, this milk restoring it completely to health. It was not done, however, at a cost under 40. Thus the expense of this remedy in towns is a serious objection to its employment. Except this last example, however, I have never heard of ass's milk sufficing of itself to restore a child, its good effects soon wear- ing away, and rendering, after a period of a few days, the employment of other food necessary. The question must be looked upon as still open to further experiment. The above few examples, however, are numerous enough to show that in some cases of defective assimilation we may occasionally employ very unusual modes of alimentation with perfect success. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 215 CHAPTER H. Dietetic Treatment, Continued. Of the Nature of Aliments to be given, and the mode of their Administration. Cow's Milk, Adjuncts to. Necessity of using Test Paper. How some kinds of Diarrhoea which Supervene are to be Treated. The Exhibition of Soups. Raw Meat. Dr. Leveret's Cases. Examples occur- ring in Dr. Morris's Practice. Analogous Experiments with Adults. Underdone Meat. Cases. Vegetable Remedies to be Conjoined. Frequency of Feeding. Ix the previous chapter we have chiefly referred to those agents, not necessarily aliments, but which by their solvent action upon articles of food given at the same time tend to nourish a child. We must now speak as to the kinds of artificial food to be given. In early months, for the reasons before assigned, it should be exclusively animal. We should always endeavor to obtain milk from a cow at grass, because it is more likely to be wholesome, and the disposition to fermen- tation is less. This milk should be given to the child in a diluted state, i.e., in the proportion of one or two pints of water to one of milk, ac- cording to the age of the child, diminishing of course the amount of water as the child becomes older. If the cow's milk be already diluted with two parts of water, sugar also should be added in the proportion of one to two drachms to every pint. If, however, there be only one part of water, and the milk is pure, the amount of sugar contained is already about 24 per 1000, the normal proportion of human milk, and it need not be therefore increased. This proportion is calculated on the latest analy- ses of milk, and will in practice be found to agree very well with most children. At the onset, here we meet with two classes of objectors. Curious enough, they contradict one another. First. That such a mixture will produce diarrhoea. Second. That it will produce constipation. 1st. Some practitioners have told me that such a mixture is very apt to produce diarrhoea, and as lately as 1861, ' M. Dubois pointed it out as an evil arising from the administration of spoon meat to children who also take the bottle. The Editor of the Journal f /'rustical Med'f'n,* dial Surgery, after commenting upon the fact that a new-born infant, in one of M. Dubois's wards, passed green motions every morning, and yel- low natural motions every evening, proceeds to say: "This fact is one of daily occurrence in the lying-in hospitals, and is referable to mixed ali- mentation. An infant is, during the day, nursed by its mother, and ' April, 1881. 216 INFANT FEEDING AND ITS INFLUENCE ON LIFE. passes yellow and homogeneous excrement. At night a more or less adulterated milk is administered liberally with the sucking bottle to pre- vent its crying. In the morning the motions are green, colic is present, and the anus red. This returns regularly day after day, and often in- duces fatal enteritis. In hospital the number of wet nurses is too small a circumstance accounting for the defective feeding, which M. Dubois has often noticed and regretted; but the same fact is likewise observed, from other reasons, in private practice. The opinion is too generally prevalent that children may be brought up by hand as well as by the breast. This method may, sometimes, it is true, be successful, but only in families in an easy position, and under quite exceptional hygienic cir- cumstances, etc." ] The second opinion is so general that it scarcely needs comment, and more than once it has been urged to me as one of the chief objections to bringing up a child by hand, as it necessitates also such a quantity of purgative medicine to be administered. Opinions of so contradictory a nature require comment. The expla- nation is, that if we place a child in impure air and give it bad milk, whether the maternal milk or that obtained from the cow be at fault, we must expect diarrhoea and other evidences of defective assimilation. It is not the mixture which is injurious, but that one, it may be both, the milks employed, are bad of their kind. From what I have before stated when speaking of Dr. Ballard's views on the effects of fruitless sucking,* and on the employment of unclean and the same nipples, 3 especially in hospital practice, it is at once obvious that the diarrhcea present is much more likely to be due to these two causes than to admixture of two milks. Conversely also, again, if the hygienic conditions maintained are good, and the milk of good quality, experience shows that the admixture of two milks, so far from being injurious, may prove very beneficial. I do not find, as a rule, under artificial feeding judiciously carried out, whether with or without maternal milk, that the bowels suffer; or, if they do, whether from constipation or diarrhosa, that they cannot generally be pro- perly regulated. Such disorders will occur, however, in the healthiest child, whether artificially fed or suckled. One thing I am particular about. Whenever it can be done I never give ordinary sugar, but always sugar of milk. This may appear inconsistent. But sugar of milk will often check diarrhoea, as I have before stated, and I cannot too strongly recommend its employment in preference to ordinary sugar in these cases; and, more than this, sugar of milk, as it is usually sold, contains all the salts of milk in solution, and when substituted for the ordinary white sugar, it often not only stops excessive purging, 4 but keeps the bowels regular. This constipative effect can be besides, if need be, more directly 1 Banking's Retrospect, vol. xxxiii., p. 256. 8 Page 213. 1 Pages 76, 212. Page 170. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 217 removed by the addition of a little carbonate of magnesia, in the same way as phosphate of soda is added in that variety of baked flour food to which I have before referred ; ' and, indeed, most writers on children's diseases agree in recommending this salt, as the antacid substitute for lime-water in all cases where the bowels are not sufficiently relaxed. Lastly, to every pint of artificial food prepared, from an ounce to an ounce and a-half of lime-water should be added to neutralize the amount of acidity present. This amount may be generally determined either by testing the milk with litmus paper, or more accurately by the symptoms observed in the child. To ensure the proper examination of the milk, I think in every nursery where children are brought up by hand there should be test-paper kept, very slightly reddened, and some slightly made blue. If the former is turned blue when dipped in the milk, the milk is alkaline, and very little lime-water is needed. But if not affected, or if it be more intensely red- dened, then the blue litmus paper should be dipped into the milk, and this last will of necessity become reddened. In these cases'there is excess of acid present; lime-water, therefore, should be added in larger quanti- ties to neutralize this. The moment the litmus that was reddened has resumed its natural blue color enough lime-water has been added. In practice it will be found that two to four teaspoonfuls of lime-water to the half-pint will suffice, and even be more than sufficient; but this excess, for the purposes of the growth of the child's bones and teeth is desirable. But I have said the presence of excess of acid may be more accurately determined by the symptoms. These are frequent hiccough, and apparent griping, especially after food, as evinced by an occasional cry, and it may be drawing up of the legs. A loose motion generally follows, the color tending to the green. There is also very generally vomiting present, and the ejected matters have an intense acid odor. These are premonitory symptoms, which if not attended to, will often pass on to diarrhoea. In these cases lime-water in excess is indicated, and the proportion may be increased to two tablespoonfuls to the half-pint, and even more. All admixtures of vegetable matters at early periods are contrary to nature, and, except in disease, they should be avoided, or given only as correctives of bad milk. I have already alluded to the manner of esti- mating and correcting inferior kinds of milk (p. 170 et seq.), by arrowroot, tea, and cream. Occasionally, where the diarrhoea is very obstinate, rice- water may be substituted for ordinary water, as the diluting medium, together with the proper medicinal remedies to be just now mentioned. These are circumstances which, when they occur, are very apt to dishearten a parent, and the difficulty is usually met by at once flying to a wet nm- . But I am certain this is often done prematurely. It is rare that a judi- cious treatment will be found to fail. The most distressing symptoms present besides the diarrho-a are the great apparent weakness, and tho > Page 188. 218 INFANT FEEDING AND ITS INFLUENCE ON LIFE. pain, accompanied with sleeplessness, observed in the child. If the suffer- ing child is treated in time, these symptoms will seldom attain to any very great amount; but in no disease is the old adage more truly verified than in this affection, " One stitch in time saves nine." Unfortunately, how- ever, these cases are often neglected. In the better classes of life the child is usually at once given to a wet nurse. Too often, however, it cannot suck the breast from sheer weakness, and except the milk is milked into its mouth, even with a wet nurse no good can be expected. Where a wet nurse cannot be got, the child usually dies, as much from want of judgment in those who take charge or it as from exhaustion. Food of various kinds, which it cannot digest, and that very frequently and in large quantities, is forced into the child's stomach. The diarrhoea is in- creased, and death usually follows. Now the secret in these cases is to feed the child, little and often, and to give wine in comparatively large quantities. Half a teaspoonfnl of milk, prepared and corrected as before said, given every quarter or half an hour; wine and water, or better still, wine whey (made with one part of wine to three of boiled milk), will often do marvels. I have seen a child so weakened and reduced by diarrhoea (in this case induced, how- ever, by a wet nurse's milk), that it could only take its food by a feather for nearly eight hours, all the while looking more dead than alive, blanched, and pallid to a degree, and yet make a perfect recovery. Wine whey, indeed, is here our sheet anchor. Where children are older the same good results follow the use of Hogarth's essence of beef, given almost undiluted. I have now seen so many similar cases, and so apparently hopeless, recover, that I never give up a child, and I am thankful to say that, under Providence, I have been the means of saving life upon more than one occasion by adopting this plan perseveringly. These extreme examples are, however, comparatively rare. If due attention be paid in providing a child with a proper quantum of good food, fresh air, and exercise, particularly if it be fed at regular hours when very young, say every two or three hours; and three times a-day and once at night only, after it is four years old we may then safely hope serious complications will be avoided. Now and then, however, not only is diarrhoea present, and intense debility, but the stomach is very irritable; no kind of food can be kept down, particularly milk, not even wine whey; and those substances, per- haps, which have hitherto best agreed with the child, cannot now be borne. The aliments to be given in these cases are two: Good black tea mixed with milk, whic i last should be given only in sparing quantities, and raw meat. 1. Tea, for the reasons before stated (p. 188), comes to resemble very closely beef-tea, and as such may be looked upon as a very good sub- stitute. While it dilutes the milk, which in the cases we are now con- sidering appears to be too rich for children, it facilitates the digestion of the smaller quantity of milk now given, and itself sustains the strength INFANT FEEDING AND ITS INFLUENCE ON LIFE. 219 of the little child, retarding the waste of the body. The small quantity of sulphate of copper which it contains seems to act as an astringent, and as it often does in the adult after an attack of sea-sickness, it allays the nausea also. The following case, stated succinctly, is an example of this kind. A little child, aged about one year, of delicate constitution, hearty never- theless, and who, from the age of four months, had been brought up bv hand on milk and water at first; subsequently milk only, corrected by lime-water and sugar of milk was suddenly seized with vomiting; the moment it took its milk, of which it always partook with its usual avid- ity, it became sick. Diarrhoea also supervened, the motions passed were unchanged food, the child became weak and emaciated, and appeared to be losing flesh every day. My colleague, Dr. Savage, being called into consultation, recommended that pure milk should be discontinued, and from two to three parts of weakish infusion of black tea to one of milk should be given to it. No other treatment was ordered, but this sufficed to restore the functions to their normal condition. In this case the child was not bilious, and the milk was exceedingly good. The simple fact was, it could no longer digest pure milk. 2. The other aliment which proves so beneficial in this state of stom- ach, is raw meat. I have already alluded to it (p. 164). Raw meat con- tains in its composition, besides the nitrogenous fibrine, also an abun- dance of phosphoric acid and chloride of potassium; and thus, for the reasons before stated, it contains two elements of great importance to a growing infant. The small bulk which it occupies also renders it, be- cause at the same time intensely nutritious and exceedingly digestible, of the greatest value. Dr. Leverett tells us that one or two mouthfuls are enough for a repast. It has the same advantage over cooked meat which raw albumen of egg has over that which is boiled hard. The juice of flesh contains, among its other ingredients, albumen, and the coloring matter of the blood; the former coagulates at a temperature of 133 Fahr., the latter at a temperature of between 158 and 165. When these principles are coagulated they are very much more difficult of di- gestion. Indeed, many persons, even among adults, cannot digest them at all, and suffer intense pain after food, particularly after eating cooked meat. Hence the advantage of giving raw meat to weak persons and to dyspeptic individuals. But this is not all. Raw meat often settles the stomach and alimentary canal, when all else which is taken is rejected by vomiting. Indeed, so general is its utility, that after some years of ex- perience I have come to regard it as one of the best and surest IWMdMl which we possess in such cases. I prefer, however, first giving the experience of Dr. Morris to my own, lest I should be regarded as too much of an enthusiast in its favor. " The first cases to which I )r. Morris (before referred to, p. 165) gave the raw meat, were two little German brothers, five and six years of age, who had been much reduced by long neglected intermittent fever. Soon after 220 INFANT FEEDING AND ITS INFLUENCE ON LIFE. their admission to the hospital the fever had yielded to quinine, but an obstinate diarrhoea had resisted all the ordinary modes of treatment, and they had been reduced almost to skeletons. Just then Dr. Morris came on duty, and commenced at once the use of raw meat. The children soon began to improve, and in less than a fortnight the little fellows who had been so recently too weak to sit up in bed, were playing in the wards with the other convalescents. About this time cancrum oris made its appearance in the hospital. Many were attacked, and amongst others the younger of our little Germans; yet, notwithstanding the unfavorable state arising from his previously reduced condition, he recovered under the use of raw beef and the topical application of nitrate of silver. "Dr. Morris's next case was a child two years old, suffering from hereditary syphilis. He was a miserable-looking object. Death, which seemed of all things the most desirable for him, had been warded off for some days by the free use of brandy. Raw beef was prescribed, but al- most without hopes of benefit. It was given in brandy, for which he had a greater relish than for anything else. In a week there was a change for the better. As soon as possible iodide of potassium was administered, in order to eradicate, if possible, the constitutional taint. The brandy, of which it was positively said he took two ounces daily, was gradually decreased in amount, and when we last saw him, after the treatment had been continued for some two or three months, he was fat and hearty." ' I select these cases from many others to which Dr. Morris gave raw beef, because they show, in the most convincing manner, the beneficial effects of this remedy. Dr. Morris prescribed it whenever the system was exhausted by previous disease or inanition. Generally he used it with marked benefit. I may now, perhaps, with less risk of being found fault with, relate two cases which, amongst many others, occurred in my own practice. A little child, aged about eight months, was reduced, while yet sucking its mother, to a state of extreme debility. Bronchitis was present. It lay on its back unable to sit up, much emaciated, and in a semi-conscious state, moaning occasionally, but otherwise showing but faint indications of life. The mother's breast was milked into its mouth, and wine given. The child rallied a little, but still not to any great degree. Raw beef was now given. In two or three days it was able to sit up, and was conva- lescent in a week. A second case was that of a young babe, who had been brought up by hand, and was affected with jaundice, and excessively weak. Mercury and wine were given, but the latter seemed only to have a partial effect, and the former seemed to produce so much weakness that it could not be persisted in, except in excessively minute doses. Raw meat was now given. The child did not appear to relish it, but it was persisted in for two days. This period, however, sufficed. The child was enabled on 1 Dublin Medical Press, May 9, 1860. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 221 the second day to sit up for several hours, and gradually recovered. These cases, together with others, are sufficient to show what a valuable remedy we have in raw meat, in cases of debility and inanition; but I might ex- tend them indefinitely. Case upon case have I seen cured by this simple remedy. I know nothing in the way of food more assimilable for an infant, nothing more nutritious; indeed I estimate three claret glasses of the properly prepared juice to be equivalent to a mutton chop in nutritive value. If we notice the operation of this remedy when occasionally given to adults, we learn much which is particularly instructive when applied to infants. With this view, the mention of a few cases may prove interest- ing. There is at first a difficulty in giving it to an adult, which, judging from my experience, does not apply to children. In the former, Dr. Leverett says, " the difficulty is to overcome the natural repugnance at eating raw flesh. M. Trousseau, however, declares the disgust may be overcome, even in the case of the most fastidious and delicate ladies. He told us of one to whom he gave it. At first she took it, he said, with loathing and aversion, soon with ease, and before long she ate it vora- ciously." ' I have noticed this last effect myself among adults. A grown girl actually assured me that she had been taught by her father to eat a raw steak, and the idea seemed in itself to give her a relish. With her it amounted quite to an unnatural and repulsive fondness. And, after all, reasoning without prejudice, this predilection for raw food is not so unusual as we believe. It is traceable among those even who eat cooked meat. Some persons very much prefer under-done meat. They, moreover, find by experience it agrees best with them. This pref- erence is so little exceptional, that where it occurs we may fairly conclude it is instinctive. We all know the fondness of the highly-gifted and in- tellectual Germans for Switzel (raw sausages) and uncooked hams. The raw beef, however, has not the disadvantages of this kind of food, noticed at p. 165; and, after all, the absolute difference, therefore, between per- sons who take very under-done meat, and those who take raw food is more one of degree than of kind. In another case, where the patient had gastrodynia, and could retain nothing upon her stomach, so that anannia and intense debility were present, raw beef scraped, and spread between two pieces of thin bread and butter, effected a cure. The idea of eating raw meat at first was very repugnant to her feelings, but it wore off very goon. Dr. Leverett, before quoted, tells us " Dr. Morris was equally successful with raw meat among adults. In an adjoining ward was a man sunVrini: fr>m chronic diarrhoea. He had runt/ie gauntlet of treatment for diarrhea without r. lief ; for if better under one plan of treatment one day, he was wors> tli.- next. There was no physical sign of consumption, though the obstinate 1 Dublin Medical Prett, May 9, 1800. 222 INFANT FEEDING AND ITS INFLUENCE ON ^LIFE. diarrhoea gave ground for suspecting such a condition. Raw beef was working wonders in the children's department why should it not be tried for him ? It was given, and in less than two months the man left the hospital cured. Raw beef had saved his life. Two summers since, while in Paris, Dr. Leverett saw a precisely similar case of supposed tuberculo- sis of the mesenteric glands, in the service of M. Trousseau, at the Hotel Dieu. The result was, however, different, for the patient died. The au- topsy showed no trace of tuberculosis: and M. Trousseau, in lecturing afterwards on the case to the class, expressed great regret at not having given raw beef. He had done, he said, everything else; and added, that he would never let such another case die in his hands without giving raw beef. He believes the remedy invaluable." " In 1856," continues Dr. Leverett, " while Resident Physician in the Episcopal Hospital, Philadelphia, the various visiting physicians allowed me to administer raw beef in a number of cases, in many with a decided benefit. In one case of chronic dyspepsia, with great irritability of the stomach, it was retained, when almost everything else was rejected. In the later stages of typhoid fever it proved a valuable article of diet, as I should have mentioned that it did at the Philadelphia Hospital. I found that it could be rendered palatable to adults if sprinkled with salt and allspice, and spread on a thin slice of bread, or between two slices as a sandwich. I recollect none to whom it was given who did not soon learn to take it at least without dislike. Of the cases to which it was then given I will give an account of but one. It was that of a little girl to which my colleague, Dr. Hopkins, and myself, were called. We found her suffering from the sequelae of scarlatina. Her parents had a few days previously laid two of their children in the grave from the same com- plaint. The life of this, their last, was despaired of. We found her a pitiful-looking object. She was only one year old, but appeared an old woman. She was extremely emaciated, her skin hanging on her bones. She had large bed sores, a hard tumor of the right parotid, and a fluctu- ating tumor on the left wrist. She was moaning or crying almost inces- santly with pain. The case seemed, as it had been decided, desperate. We determined to give quinine in small doses as a tonic, and raw beef as an article of diet. We made anodyne applications to the tumor of the wrist, the principal source of pain, and painted the tumor of the parotid with tincture of iodine. She soon showed some improvement. When she became tired of raw beef we had it boiled, but so slightly as to cook merely the surface; then we changed to mutton, and soon returned to raw beef. She gradually recovered, and was eventually restored to per- fect health." ' When everything else had failed I have given raw meat to little suck- lings, infants so young that I could not put the pulp of the raw beef even in small pieces upon the tongue, because they had not the sense to 1 Dublin Medical Press, May 9, 1860. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 223 swallow it. However, a piece of raw beef, thinnish, of a certain length, was put into the child's mouth. Suction at once was induced, till the meat became diminished in size, and colorless as fish. It is remarkable how soon the diarrhoea and gastric symptoms ameliorated in character, and how the strength of the little invalid improved. Remedies previously inert now began to take effect, and in a short time the natural food was resumed. When a child is so weak or so young that the raw meat cannot be sucked, then raw meat juice, made with lukewarm water, in the way be- fore specified, may be substituted. 1 By means of a small india-rubber hollowed ball, or bottle, with a jet attached to it, it can be introduced within the mouth, and squirted, in very small quantities, about a teaspoonful at a time, down the throat. As it reaches in this manner to the first part of the pharynx, even in cases of extreme weakness it is involuntarily swallowed, and so the child obtains nourishment and is able to rally. I have kept children alive in this way for days, when weakened to that degree, or so affected with disease about the mouth that they could not suck, as, for instance, in can- crum oris, bad aphthous spots, etc. We can also readily see how the same instrument may be employed to administer wine whey, etc. In the treatment of all cases in which the raw meat or raw meat juice is employed, it is manifest that there must be great disadvantage if the meat supplied be in any way tainted, or affected with parasites, as in- stanced at p. 346 et seq. We have in raw meat a first-rate remedy, but it must be good meat of its kind to act well. If, however, a child has teeth, which, as I have before stated," is an indication that those physiological changes which are essential to the di- gestion of vegetable matters have taken place, then vegetable matter may be usefully combined with the food which is given to the child. Of these several preparations have been from time to time recommended, and used with advantage. Thus we hear of " Hard's farinaceous food," of baked flour, tops and bottoms, biscuit-powder, and a variety of other aliments of that kind. In my own practice, without denying that with some chil- dren these substances will prove occasionally very useful, I have generally limited myself to the employment of three substances: "Mrs. Wells' Vegeto- Animal Food," " Robb's Biscuits," and "lentil powder;" and among breads, pure home-baked, the aerated or unfermented bread. I have already spoken of these several substances in a former chapter. 1 In the first, we have many of the ingredients which exist normally in milk, namely, the sugar of milk and the salts. In lentils, we have the nitrogenous principle present identical with the casein of milk; and so the fiange from purely animal milks to these compounds is more gradual and likely to agree with the child. In the success which follows the em- ployment of Robb's biscuits the same analogy cannot be traced, but there > Page 161. * Page 191. * Pag 182 et t*q. 224 INFANT FEEDING AND ITS INFLUENCE ON LIFE. certainly is something in their composition which proves particularly fat- tening and wholesome to children. If the meals given be properly regu- lated, and due attention be especially paid to the state of the bowels, we have every reason to anticipate that the plan followed will be attended with success. Dill or cinnamon water, as occasional carminatives, should be given, particularly with Robb's biscuit and lentil powder, etc. ; and it should not be forgotten that lentil powder is occasionally purgative, for which reason it should be watched, and not continued too long if it be too active in this respect. "VVe have, lastly, to consider the simple yet important question How often should a child be fed. 1 In extreme infancy, for the first two months or so, it may be wise to give them their food every two hours. As soon, however, as it can be done, the child should be taught to suckle or feed at regular hours every three or four hours and then to sleep, if need be, after it. But I am a very great advocate for teaching a child another good habit, and that is, to take its food at night as seldom as possible. I like to teach the child to take its food four times in the day, but once only at night. It is better both for mother and child. It gives the child an opportunity of having a longer night's sleep, and affords the stomach also a longer period of rest. It is certain it is more healthful for a suck- ling mother because she sleeps better, and besides it makes a nurse more contented. A very little firm management will suffice for this. It only needs to be gradually done. Otherwise babies are very apt to get into the bad habit of sleeping all day and waking all night, to the immense an- noyance of nurses as well as parents. 1 Page 51. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 225 CHAPTER III. Hygienic and Preventive Treatment of Defective Assimilation in the Appointments of a well-regulated Nursery. Extent and Ventilation of a Nursery. Cleanliness of a Nursery. Impropriety of Keeping Dirty Linen in Them. Temperature. Cur- tains Ablutions. Warmth of Water and Variety of Soaps. Exercise, Clothing, Perambulators. Early Rising and Going to Bed. External Light. Cleanliness of Wet Nurse. II. THE hygienic treatment involves the question of the appointments of a well-regulated nursery. This last is all-important, if we wish to bring up healthy children. Moreover, it is also the best preventive treatment against the occurrence of defective assimilation in those liable to it, and as such needs especial discussion at this point of our inquiry. Wherever it is practicable, the child should not be confined to one room, except in illness. A night nursery, as well as a day nursery, should be provided. This very change of air has a wholesome tendency. The sleeping room should not be too small; six hundred cubic feet is the least that can be safely given to an adult; a child requires at least four hun- dred. Although smaller in bulk, its respirations are more rapid; and it sinks more readily under the influence of a deleterious atmosphere. 1 The confined air of towns is, as a rule, made worse by the closeness in which rooms are kept. The absence of confinement in country places is one of the reasons why they are so much more healthy. A child must not be al- lowed to breathe its own expired air over and over again. In the long run, with unusual delicateness, scrofula or consumption of some kind will be surely developed. The large size of the room, although it will make this less possible, will not always suffice; the ventilation must also be good; a burning fire which can be borne in winter assists in the purification of the air of a room, but does not do enough; and in summer it cannot be tolerated. The simplest and most effective ventilation with which I am acquainted is secured by perforated zinc plates in the walls on a level with the ceiling. These may be arranged in two ways, either when the tops of the windows reach to the ceiling, at the top of the window, so constructed as to admit of the closing of the window to a greater or less extent, and to increase or diminish at will the entrance of air the zinc plates should extend com- pletely across the top of the window, and descend to from four to six inches; or, secondly, tin- xinc plates may be placed between the windows, and in this case should be usually from about one to two feet long by six 1 Pages 90. 200. 15 22(5 INFANT FEEDING AND ITS INFLUENCE ON LIFE. inches broad. This second plan has an advantage, as two plates, the per- forations of one of which are larger than the other, may be used. The larger being placed externally, the smaller internally, and so all draught is obviated. During winter, the inner one is always kept in, and in very cold weather may be closed in part. In summer it may be removed alto- gether. "Wherever these plates are placed, however, it is imperative that, in the portion of the wall opposite to them, similar plates should be placed over the doors and opposite windows in the adjoining rooms, if they are separate, so that a free current of air may pass along the ceilings, and no draughts descend upon the children. This system can be most advantage- ously carried out in the case of entire houses in every room; only in this case it is well to have a similar draught to proceed from the bottom of the house to the skylight above, both the places where the air enters and passes out being also guarded by perforated zinc plates. It is this plan which has been so satisfactorily carried out at the Cripples' Home and the Samaritan Hospital, in London. There are some practices kept up in most nurseries which are very detrimental. One is the drying of napkins by the fire-place. Indeed, nursery-guards with a double rim round them are made and sold with this very object. Independently of the dampness thereby induced, as they are often not washed at all, and in many cases only rinsed out in water, the urinous odor given out is intensely unwholesome and offensive. Not only is ammonia emitted, but perhaps cyanate of ammonia, a poison, and so an atmosphere may be generated which will prove highly injurious. But more than this, I have known several instances, and, indeed, among wealthy families, where the ordinary unclean napkins or utensils are left an undue time, sometimes hours, in the nursery; or, what is more usual, as it saves the nurse a little trouble, they are not at once removed to a distant part, but placed outside the nursery door, to poison the sur- rounding atmosphere, and to foul the air in the nursery the moment the doors are open. It cannot be supposed but what such a course of mis- conduct must prove very injurious to children. That very atmosphere so fatal to infants before spoken of (p. 19), is at once generated and main- tained. It is extraordinary, however, that all these contingencies may be removed by a very simple procedure. If chloride of lime be used in the proportion of four ounces to the quart bottle of water and well shaken, and about a tablespoonful of this solution placed in the chamber utensil before it is used by the child, there will no odor generated. Moreover, if the same quantity be placed in a utensil already containing urine, free chlorine is given out by mutual decomposition, and all odor is at once de- stroyed. All soiled napkins should be removed at once to a distance, so that the air should in no way be contaminated. The temperature of a nursery should not be under 65 when the chil- dren are very young, and it may be one or two degrees above that. When they have reached the age of one, 60 is sufficient. Curtains to beds are in every way to be condemned; they should never INFANT FEEDING AND ITS INFLUENCE ON LIFE. 2'27 be tolerated. They tend to annul all ventilation in the b'ed; they oblige the child to breathe the air already expired over and over again, and tend to make it particularly obnoxious to cold. If it is believed that a draught conies from a door or window, a screen is the proper thing to ward it in this way ventilation is modified, not arrested. Upon the same princi- ple, caps, however becoming, should be avoided in the house. They ren- der the head, supposed so likely to suffer from exposure, more obnoxious to cold. A child's head is either in such constant perspiration that, if the cap be removed at any time, it may catch cold, or if the tempera- ture falls it suffers, because the ordinary covering does not suffice. I be- lieve that hydrocephalus, or water on the brain, is often due to impru- dences in this respect. Infants should be blue-coat boys, at least in their nurseries. There is another advantage. Exposure of the head promotes tli" growth of hair, and makes it stronger when it does grow. A child should be early accustomed to cold water. Except in extreme infancy, when tepid water only would be safe, a morning cold sluicing, from the head downwards, is most beneficial. It will suffice at night to use lukewarm or warmish water for the purposes of cleanliness. Of course this general statement in no way precludes other local ablutions, if necessary. The custom, however, which obtains in some families of washing the child with warm water in the morning, sometimes of the temperature of 100 Fahr., is, I think, highly reprehensible. Instead of being a hurried process, as it is sure to be when cold water is used, the heat, agreeable by practice to the child, leads the nurse to prolong the operation, and so the child comes out of the bath, not only feeling weak or, but extremely liable to catch cold on exposure to any vicissitude of tem- perature. Now, the exhilarating and bracing effect produced is one of the advantages of a cold bath, and it is as true, if not more so, for the in- fant as it is for the adult. It is a matter of daily observation that per- sons accustomed to take colds continually, have entirely lost the tendency by using a cold water bath every morning. It fortifies the system, k- the body in a healthy glow, and enables it to resist with better success the alternations of heat and cold. Moreover, it is an excellent preserva- tive against chilblains and chapped hands, so often a source of discomfort to our little ones. Of the use of powder, I can only speak in commendatory terms. It is well calculated to prevent chaps and excoriations. Much will depend, however, on the degree of fineness of the powder; and the se.-nt with which it is perfumed. Among the best of these powders, because it adheres so much more closely to the skin, and is so delight folly smooth, th- volia Uevigata of Mr. Taylor, of Baker Street, is by far the. best that I have met with, and I feel I cannot too highly recommend it. Again, one occasionally meets with powders which are excessively scented. Not to speak of the evil effects of the odor when constantly inhaled, this v profuseness of some odoriferous principle in it proves vrry detrimental to any excoriated surface. For this reason, it is sometimes wise to use ordi- 228 INFANT FEEDING AND ITS INFLUENCE ON LIFE. * nary Fuller's earth, flour, or arrowroot in preference. No such objection, however, applies to Mr. Taylor's Civolja. For the same purpose some oily inunctions will be found efficacious to affected parts, such as sweet oil, cold cream, etc. Glycerine rubbed in occasionally will do much good, unless the chapping be extensive, when, although curative, it gives great pain, and is then too much an object of dread to sensitive infants to be persisted in. In these cases, honey is the best application, and should be used at night and washed off in the morning. Much is said in the present day as to the injurious effects of certain soaps, more especially the ordinary whity-brown used for all domestic purposes, which is alleged to irritate the skin, and otherwise promote chapping. I believe this is all a mistake; no soap is so effective for the purposes of cleanliness, and if the superior kinds are used, in which there is not an excess of soda, it is the best; indeed, the very chapping between the legs and under the arms, so common in children, is often cured by washing the parts over with this soap. I think it cruel, however, to al- low the face and eyes to be washed over with it in the coarse and rough way in which I have often seen it done. The nurses have almost ap- peared to me to take a sort of morbid delight in its employment in this way. Even to an adult, soap in the eyes is a very painful ordeal to go through; in the end it inevitably produces chronic, sometimes acute, ophthalmia. I think, therefore, children should be spared this barbarity, and the eyes, at least, carefully avoided. In the above remarks, it is in no way my intention to forbid the use of scented soaps, and especially castile soap, the genuine honey and real glycerine soap, for the purposes of ablution to those who prefer them, but to show that they have no advantages in most cases. So, I think, a piece of soft flannel is more effective and should be preferred, except in the case of very young children, to the sponge, as both more cleanly and likely to produce a healthy glow after its employment upon the skin. Every child should, as far as practicable, take daily exercise? Fresh air is everything to a child. I believe the healthy look of many of the ragged boys and girls who crowd our dirty alleys and courts, even in London, is due to this one contingency. Certainly, their food and rai- ment and habitations are not, as a rule, calculated to benefit their health. Tjie good sanitary condition of many of the inmates of the ragged, dirty Irish cabins is, probably, in measure also due to their constant daily open air exercise and insolation. I do not mean to say that a child should go out in very foggy or damp weather, or when it is intensely cold, particu- larly during an east wind; but, even in such days a ten minutes' run, if the child be warmly clad, and especially dry footed, will do much good. It is the late hours at which the children are kept out, which are so in- jurious. Even in London, between ten and two, it is rarely that a few minutes of bright weather may not be found and taken advantage of. In 1 Page 27. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 229 the summer, if damp on the one hand, and the meridian sun on the other, be avoided, and if, especially, the head is kept well guarded from the sun's rays, the longer a child is out in the open air the better. But here I must lay great stress upon this protection of the head. I believe, even in the North, but certainly in Southern England, exposure to the sun is a frequent cause of cerebral disease, even though the heat borne may not amount to a " coup de soleil." This is especially the case with very young infants, in whom it should be remembered that the opening in the fontanelle has not yet been closed. I have seen indiscre- tion in this respect often give rise to cerebral congestion, in some cases to water on the brain, convulsions, or permanent idiocy. One word about perambulators. They have been severely condemned, I think unwisely. It is alleged that they enable nurses to attend to their own pleasures either in idle reading, or companionship with followers. This is true. I have seen it over and over again in our London Parks, and at the sea-side. So also the children will fall asleep in them, and catch cold if the weather be unpropitious. But, on the other hand, it is not the use of & perambulator that makes such a nurse unworthy of confidence. Such a person would probably act foolishly even if she did not use one. Then it is sometimes positively cruel to compel a nurse to carry an unusually heavy child. She will either sit down on a bench, where a child is equally liable to catch cold, or will shorten the period allotted for the child's exercise. Again, some children are too fond of walking, and do so before their skeleton is in a fit condi- tion; hence, if rickets be present, deformity, most frequently for life, is the result. This is avoided by using a perambulator. If a child be asleep it is easy to return home. Let us remember that we should not work a willing nurse, any more than a willing horse, too severely; and if the child be warmly clad, the advantages of the perambulator far out- balance its disadvantages. Jn very cold weather a warm bottle and a rug can be placed in the carriage, and so the child may be kept warm. This is often not possible when a short-coated child is carried. The legs are exposed and often become very cold. Nor does the use of the perambu- lator necessarily preclude moderate walking exercise. It merely allows of rest both to the nurse and child, and when the ground under foot is wet, the child at least remains dry. As to the use of clothin;/. .\ diild should be kept warm, especially in its feet. Damp feet are always more likely to injure a child than ex- posure to almost any other kind of cold. A general, but, I must say, a very cruel habit in vogue in England among many persons, is to send out their children with short socks and short drawers, so that the ^renter part of the leg, even in the coldest days, is exposed to the influenee of tlic external cold. In fact, it is deemed wise and the best way of hardening a child to expose him to a degree of cold, and that when children have so little power to generate heat, which would prove dangerous to a hardy full-grown Scottish kilt- 230 INFANT FEEDING AND ITS INFLUENCE ON LIFE. wearer, who as a full-grown man is able to generate and keep up bis ani- mal heat so readily. To talk of cruelty to animals, after this, is a simple absurdity. Common sense is at once condemnatory of such a practice. The amount of clothing should be regulated with the season and the day. Habitually, therefore, in every-day practice, it is well to inquire and satisfy oneself as to the kind of day, and regulate the dress accord- As with adults, so with very young children, early to bed and early to rise, must be the maxim. Xo child under ten should be out of his bed after eight at night, and none under five after six or seven. It is not, however, in this particular that parents usually err. It is in the hour of rising. It is a common prejudice to say a child needs sleep, and so he is left in bed till nine or even later in the morning. I think, except in the case of very young children (of two or three years old), this is a mistake. Too much sleep is apt to produce a certain amount of cerebral congestion. The erect or semi-erect position is as necessary for a child as the recum- bent. In a weak child, the latter may produce passive congestion of all the lower parts of the body. We have seen its injurious influence so well described by M. Hervieux (p. 27). If the child needs sleep, it is better to let it have a midday siesta. The alteration will have done good. Seven in the morning is not too early for a child over two years old, who has retired at seven the previous night to sleep. Moreover, it teaches a child from early life a good habit. Our fond- ness of the bed of a morning is very often a sin which those who have brought us up have to answer for rather than ourselves. Besides, it is to be borne in mind that the morning air is always purer than night air. It is richer in oxygen; and during summer, it is even in London most refreshing. I make it a rule to give a child a crust of bread every sum- mer morning, and if he be not too young, to send him out for a run, for a few minutes or longer, as the case may bo, before breakfast. Except in damp weather it will be found a healthy plan, and one to which chil- dren who have once enjoyed it always look forward with pleasure. I believe it is imperative that a nursery should be freely accessible to external light. There is, to speak socially, always a cheerfulness in bright light, which keeps up the spirits of the child, as the night from an oppo- site effect produces sleep. We have already shown (p. 42) that the absence of light tends to retard growth, if it does not in some cases absolutely stop it, and the pasty-white, cachectic face is almost always a character- istic of it. For this reason, a sombre dark nursery is to be avoided. In like manner, the experiments of Stark, before alluded to (p. 43), prove that dark tints or colors absorb odors, another reason why they should not be used. Let the papers be, therefore, bright and cheerful, but let us not fly to the opposite extreme. Green appears, from the entire aspect of nature, to be the favorite color, and it is certainly that which is most agreeable and soothing to the eye. But a large number of the green colored papers, and certainly the cheaper varieties, and even INFANT FEEDING AND ITS INFLUENCE ON LIFE. yellow papers, as shown lately by Dr. Leonard Sedgwick, are arsenical ; the emanations and sweepings therefrom are poisonous. Such kinds of papers should, therefore, be banished from nurseries altogether. If used at all, they should be well varnished over. After all, plain white-washing above and painted skirtings appear to be the most rational kind of decorations. The yellow color is also unhealthy. It prevents the admission of the chemical rays of light, and is hurtful to animals as well as to plants. I need not add that if the strictest regard to cleanliness applies to the child as well as the articles used for its food, so regard should be had to the cleanliness of the wet nurse. If it be the mother who suckles her child, in our own ranks of life, such a remark would be libellous. Such precau- tions are, however, necessary with hired wet nurses. Their breasts, especially the nipples, should be kept very clean, to obviate the disadvan- tages of animalcular formations before referred to (p. IOC). A conscien- tious mother is bound to be a very close observer of the wet nurse she employs. Irregularity of conduct, the occurrence of the catamenia, a deficiency of milk, are often thus discovered in time, and a great deal of future mischief to the child is thus prevented. And here I may add that I am not one of those who would discourage extraordinary and plentiful ablutions even for a wet nurse. Indeed, a sea bath may be allowed in summer, if the breast is carefully dried and kept warm subsequently. As cleanliness is a great element of health, so it can only lead to an amelioration both in the quantity and quality of the milk. I do not say that in every case a sea bath is desirable, but in very manv. The woman should not, however, be allowed to stay long enough to become cold. In and out the sea is all that is necessary, followed by an energetic rubbing all over the body, to ensure the occurrence of the glow and reaction. 232 INFANT FEEDING AND ITS INFLUENCE ON LIFF,. CHAPTER IV. On the Medicinal Treatment of Defective Assimilation. Carminatives, Purgatives, Cod- liver Oil. In the Diarrhosa, Nitrate of Silver and Sulphate of Copper Opium. Febrile Excitement best quieted by Inunctions Rationale of their Operation. Nutritive Injections. Aphthae, Malignant Variety. Treatment. Conclusion. III. The medicinal treatment of defective assimilation is very difficult, and mostly unsatisfactory. In the milder cases, simple attention to the food is the best means of overcoming the disease. The occasional use of carminatives, and a half teaspoonful of castor oil, if needed, with small doses of alkalies, will often remove all irritability of the alimentary canal. Cod-liver oil, in teaspoonful doses, is almost always beneficial: if there be much acidity, one or two drops of liquor potassa? mixed with it, or more according to the age of the child, is readily taken. This oily mixture should always be given after meals. Sometimes, where there is reason to suspect indigestion, it is well to combine the oil with half to one teaspoon- ful of the essence of rennet, and this may be followed with much advan- tage. In more severe cases, however, and if diarrhoea be present, the best remedy is, without doubt, the nitrate of silver, in doses from l-16th to l-8th of a grain : sometimes the sulphate of copper in similar doses proves effective. I cannot say that 1 have found that much dependence can be placed on most of the usual remedies recommended, such as catechu, logwood, chalk mixture, or opium, except as adjuncts, just as rice-water or arrowroot acts. They do very little good; the latter is chiefly bene- ficial in checking pain. Yet anodynes are certainly sometimes useful. I know that, as a rule, they are condemned; but where a child cannot have sleep, and cannot rest without them, they are imperatively called for. The nervous child is over-excited, it needs to be calmed; but two to five drops of tincture of henbane, in about a teaspoonful of dill water, at night, will suffice. It is remarkable how, after a week or ten days, the child sleeps normally, and no longer needs it. As a temporary remedy anodynes, therefore, must be deemed very useful. Opium is more certain, but it is also a much more dangerous remedy to give to children. I have seen two children killed by it. In one case, one drop of laudanum was fatal. But in quarter-drop doses, gradually increased and carefully watched, these unfortunate results can be usually avoided. A convenient way of giving it is to dip the end of a penholder into a bottle of laudanum, and then put it on the tongue of the child. In this manner a very small drop is given, and so all danger is obviated. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 233 Defective assimilation is sometimes accompanied by feverish excite- ment, which usually comes on at night, and is no doubt due in great measure to the gastric irritation. It is in such cases that external inunc- tions of oily or lardaceous substances are so effective. The rationale of the operation of these substances is not yet entirely explained, but of the fact there can be no doubt. If a child's skin be burning from fever, so as to be actually unpleasant to touch from its heat, the other ordinary symptoms of anorexia viz., rest- lessness, sleeplessness, rapid pulse, thirst, debility will also be surely present, and the emaciation induced will be extreme. Debility will soon come on to an alarming degree, particularly if diarrhoea be present, and death will soon close the child's sufferings. In such an exhausted state the use of antiphlogistic remedies, such as calomel or antimony, are clearly contra-indicated. Now these are precisely the cases in which external inunctions with oily matters, as first recommended by Mr. William Taylor, of St. John Street Road, 1 do so much good. If a child so affected be com- pletely rubbed over with a mixture of suet and sweet-oil (a certain amount of consistency being necessary to allow it to remain upon the body), in about three hours' time, or even before, the skin will be found to have cooled and become soft ; the anorexia present will have disappeared, and often a quiet, comfortable sleep will follow. The child is left in this state, and the next morning may be washed in a warm bath. Two or three applications of these inunctions generally effect a cure of the feverish ex- citement, and the irritation of the alimentary canal is usually at the same time greatly benefited. I have said the rationale of this mode of cure is not so clear; it may, however, be the following, to which I have also elsewhere referred. There is probably in all animals, particularly young animals, a certain amount of cutaneous respiration, i.e., some action between the oxygea of the atmosphere and the capillaries of the skin. The way in which this process is carried on I do not presume to explain.* If, however, this ex- ternal communication with the oxygen of the air be cut off which may be done by rubbing over the body with an impervious varnish, as has been done by experiment upon animals the temperature falls several degrees. Thus Becquerel and Breschet* found the temperature of rabbits, first shaved, and then covered with a varnish, fall in an hour from 100 to 76; in another rabbit to G9^. The experiments of Dr. Fourcault prove that the application of this varnish produces what he calls "cutaneous asphyxia, which is mark- imperfect arterialization of the blood, and a considerable fall of tempera- ture, and which, as it produces death in the lower animals, would proba- bly do so in man." 4 Certainly fish absorb oxygen and exhale carbonio 1 In a Paper read before the Medical Society of London. 1 Vide K**ny on Pneumonia, by the Author, p. 88. n>tr* Rendut, Oct., 1841. Carpenter's Phynoloff]/, p. 646. 4 Carpenter's Phyriotogy, p. 682. 234 INFANT FEEDING AND ITS INFLUENCE ON LIFE. acid, not merely with their gills, but the whole surface of their body, so long as surrounded with water impregnated with air. Embryos of birds and insects do the same. So also the development of the egg is stopped, in warm water (which is necessarily deprived of air), and in irrespirable gases. This has been proved by Viborg and confirmed by Schwann. These experiments, we may say with Carpenter, 1 " place in a very striking point of view the importance of the cutaneous 'surf ace as a respiratory organ, even in the higher animals." The fall of temperature during perspiration is usually attributed to the cold produced by evaporation. But looking to the oily character of the sebaceous exudation on the skin, and the greasy character of the perspiration in some persons, it may be a question whether this natural oily covering does not contribute equally with the evaporation of the watery matters of the perspiration, to produce the coolness of the skin observed under these circumstances. There is another way, however (and this is especially true for chronic cases), in which inunctions do good. The late Sir J. Simpson, of Edin- burgh, has shown the good results of external inunction of cod-liver oil in those cases where the remedy could not be taken in the ordinary way. In some cases of defective assimilation, there is, together with the emaci- ation present, occasionally hectic fever. Thus, if children so affected be rubbed with the cod-liver oil, both symptoms often disappear, and there is much amendment in the symptoms. The late Dr. H. Wright informed me of a case of a little girl in whom dyspepsia, with emaciation to a great extent, was present, and in which he effected a cure by milk baths. I presume in this case, as in the former instance, there was absorption of the nutritive and fatty matters through the skin, which could not be digested in the ordinary manner when taken by the mouth, and so recovery resulted. This same advantage may be sometimes gained by nutritive injec- tions. Aliment in a fluid state is often readily absorbed in this way, as in the sad examples of adult persons, intent on suicide, and who have cut their throats. In these persons, swallowing in the ordinary way has be- come impossible, yet they have been kept alive for six weeks by these in- jections. The same is true for cases where, from disease of the stomach, food could not be swallowed without provoking vomiting. Life in this manner has been prolonged till the irritation of the stomach has subsided, and food could be again taken in the ordinary way. Even cod-liver oil may be absorbed if given in an injection. Persons who have so taken it have complained to me of feeling the taste of it in their mouths for hours after. This is equally true as regards young children. There can be no doubt, however, that one of the most distressing symptoms in many of these cases is this constant tendency to vomit. Everything which is given appears to provoke nausea a very few minutes 1 Carpenter's Physiology^ p. C46. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 235 after it has been taken, and is all up again. Much that I have said be- fore as to the use of tea, lentil powder, and beef essence applies here; but I am not speaking of dietetic but medicinal remedies. Sometimes the single drop of opium given, as before stated (p. 232) upon the extremity of a penholder, will allay all sickness, and it may be repeated at intervals of four or six hours. A little bismuth, two to four grains, put upon the tongue, with or without a little carbonate of soda, will have the same ef- fect. Half a minim of dilute hydrocyanic acid I have sometimes found very useful. More lately nitrate of amyl, in a quarter to a half drop doses in a little water, will check all sickness. A pinch of animal char- coal in the same manner, mixed up with a little sugar, is also a useful remedy, and especially indicated when the evacuations are unusually of- fensive. Sometimes it is best to alternate those remedies; but in every instance they require close watching, and an accident, such as a sudden faint or convulsion, may occur which may carry off the little sufferer. Lastly, I may notice the treatment of those aphthous exudations which so often accompany defective assimilation. The mild form will generally yield to borax and honey, weak solutions of alum, and the other remedies employed ordinarily in thrush. The other variety, the malignant or conta- gious, is a much more serious affection. It more closely resembles diph- theria, and requires an analogous treatment. Generally wine whey, or wine, should be freely given. As local applications, the only remedies which in my hands have cured, have been, first, a weak solution of nitrate of silver, applied by means of a sponge all over the aff< -etc ! parts, twice or three times a day. Secondly, the tincture of sesquichloride of iron, in strength varying from one part of the tincture in from seven parts to an equal quantity of water. In cases where the throat or nasal mucous mem- branes are covered with these aphtha?, I have used a fine syringe, and in- jected sparingly, either down the throat or up the nasal cavity, the weaker solution. Whether the cure be due to the presence of free chlorine, to the free hydrochloric acid, or to the astringent local effect, I know not, but the aphthous exudation has got well. Such local and general treat- ment, however, must not supersede the hygienic, before referred t<>. I'UK air, isolation, the free use of disinfectants, and scrupulous cleanli- ness, are also needed; in fact, every measure is to be taken which will in any way prevent the development of that infantile hospital atmosphere whirh I have already spoken of, and which is always observed wheresoever many children are congregated together, and is invariably deadly in its effects. 1 I have dwelt thus long upon the subject of defective assimilation, be- cause I believe this morbid condition is, so to speak, the parent of those several rachitic, tubercular, developmental, and other fatal disorders which so commonly occur among older children. A due attention, therefor--. \> it, in its causes and prevention as well as treatment, will be the means of 19. 236 INFANT FEEDING AND ITS INFLUENCE ON LIFE. saving life and preserving health. If due regard be had, not only to the condition of the child, but also to that of the mother, I think we may safely hope for the most fortunate results. Having so far considered the disease, which I think is the origin of most of those distressing ailments which are commonly met with in chil- dren, it may not be out of place to make a few remarks on the subject of rickets and scrofula. From the most careful experiments, it appears that rickets is generally dependent upon the weakly health of the suckling mother. Thus, Sir W. Jenner states, " whatever renders her delicate, whatever depresses her powers of forming good blood, that tends to induce rickets in the off- spring. Of the influence of the father, I am very sceptical. Of this much I am sure, that where the mother is in delicate health, in a state of which anaemia and general want of power form the prominent features, without being the subject of disease usually so called; there the children are often, in a very decided degree, rickety, and that although the father is in robust health, and the hygienic conditions in which the children are placed, are most favorable. On the other hand, I know no case (though I do not deny there may be such) in which the mother being robust, the hygienic conditions favorable, and the father delicate, the children have proved rickety." " Phthisical parents are no more likely to have rickety children than are non-phthisical parents. Nay, the facts contained in a table made for me by my friend, Dr. Edwards, some years ago resident at this hospital, and now physician to the Consumption Hospital, at the East of London, render it probable that they are even less likely. It is very common for the first or the two or the three first-born children to be free from any signs of rickets, and yet for every subsequent child to be rickety. Again, if a woman have one rickety child, in the large majority of cases all her subsequent offspring will be rickety. The explanation of this fact is, that among the poor the parents are generally worse fed, worse clothed, and worse lodged the larger the number of their children; the man's wages remain stationary, the calls on his means are increased. And, among the rich and poor, the larger the number of children, the more has the moth- er's constitutional strength been taxed, and the more likely is she to have lost in general power." ' I have introduced this passage in full because it so entirely agrees with my own experience, and so readily points out the curative measures to be employed. If a woman be weak, the more need of assisting her by giving the child artificial food besides the breast-milk, as well as by put- ting her under proper tonic treatment herself. In this way you allow her to supply her offspring with better milk, and by enabling her to nurse longer, you put her in a condition in which she is less likely to bear chil- 1 On the Causes of Rickets, by Dr. Jenner, Med. Times and Gazette, May 12, 1861. Banking's Half- Yearly Abstract, vol. xxxii., p. 52. INFANT FEEDING AND ITS INFLUENCE ON LIFE. 237 dren fast. It is the duty of a medical man to point out to a mother who has children fast that she is probably preparing herself to witness, in the sequel of her history, her children deformed. I make this statement ad- visedly. I have met with women, and even in the better classes of life, who seem to take a pride in the frequency of, and small intervening periods be- tween, their confinements. The result has been in the long run rickety or badly developed children. To effect this, they suckle their children for only a limited period, because then they believe their chances of becoming again enceinte greater. I hesitate not to say that if a mother is able to do it, and her strength allows of it, she ought to suckle her child for at least twelve months. Drs. Merei and Whitehead's tables prove this. A child should not be weaned, if possible, till it has teeth, and then only if the mother suffers from suckling. Even then she may be assisted by also feeding the child. There is one point in connection with the origin of this disease in- sisted upon by Dr. Tilbury Fox, and before noticed, to be borne in mind, namely, that rickets generally occur in the children of women who have repeatedly menstruated during lactation, and that those cases in which rickets were not present are those in which children were also artificially fed. If this opinion be correct, it also points out the advantage of com- bining artificial food in these cases with the mother's breast-milk. The disease may be divided into three stages: 1. Where we have present, besides the general weakness of the child, abnormal excretions, highly offensive and dark, enlarged ankles and wrists, but no actual de- formity or bending of the long bones. These form by far the larger proportion of cases. 2. Those in which all the above mentioned symp- toms are more marked, the long bones especially somewhat bent; ossifica- tion generally retarded. Lastly, and these are less numerous cases, where the disease has gone on to produce actual deformity, and, in some cases, become altogether cripples. And here it may be important to notice that deformities are for tho most part acquired, and occur during the first year of life not congeni- tal. In the only table setting this forth from the Lying-in Hospital, Dublin, out of 13,933 births, 19 males and 28 femalo-. or 3.4 per 1,000, were born deformed in some way; of which 11, or. 7 per 1,000 were affected with club-foot or deformity of the lower extremities; 2, or .14 per 1,000, with deformity of upper extremity; and 6, or .4;! JT 1,000, with spina bifida. Ten died, or .70 per 1,000, during their residence in the hospital, i.e., about one month, or at the rate of 8.40 per 1,000 in tho year. Upon the same scale, in the year 1872, out of 825,907 births in I lari'l, we should have had 2,808 children born deformed, out of which number 23.5 would have died in tho year. Tho Registrar-General's re- turns, however, state the number of children, under one year ol.l, from malformations and deformities to be, not 23.5, but 24.4 for tli- These deformities appear for tho most part to be of the same ! 238 INFANT FEEDING AND ITS INFLUENCE ON LIFE. those occurring in the Lying-in Hospital, but may in addition include, properly, malformations produced by rickets. Thus, in round numbers, it is probable that over 39,000 deformed children existed that year under one year old in England, of which number some 37,000 had become de- formed during the year, i.e., about 1 in 18, or 54 per 1,000. The late Mr. Holmes Coote had estimated to me the proportion of cripples, con- genitally deformed, which presented themselves at the Orthopaedic Hos- pital, to those which have become so, as 1 in 13. Even admitting the numbers to be somewhat exaggerated, yet they are high enough to prove that the negligence displayed by those who have the care of children in bringing them up, and in feeding them, is most gross and reprehensible, and to an extent that appears scarcely credible. Rickets, especially in its first and second stages, is curable, and even in the third may be greatly benefited, although sometimes the deformity cannot be removed. Everything that tends to improve the general health, such as good food and good air, is necessary. The remedies are iron, cod-liver oil, and lime. The best preparation of iron in this disease that I am acquainted with, is the superphosphates of iron and lime com- bined. The salt actually deficient in the bones is the phosphate of lime, and this is in this way directly supplied to the system. Experience has also shown that cod-liver oil has a most beneficial effect. Tuberculosis, the deposit or circulation of tubercular matter in the blood, shows itself generally among infants in four forms. 1. General scrofula. 2. Consumption of the lungs. 3. Tabes mesenterica or con- sumption of the bowels. 4. Tubercular meningitis, generally accom- panied with water on the brain. I have annexed for convenience the percentage proportion of deaths from these causes, as compared to the deaths from all specified causes, from which it will appear that the deaths from consumption of the lungs, as well as from scrofula, properly so called, are rare. 1 Consumption, properly so called, and so fatal in adults, is with children under five, a comparatively rare form of disease. Mesenteric disease, or consumption of the bowels, on the other hand, is the most common, and next to it disease of the brain; but as the terms hydrocephalus and brain disease here spoken of may include diseases other than tubercular of that organ, this last is probably exaggerated. I have already described the scrofulous temperament (p. 126), and there is no doubt that the deposits which in some cases occur in the neck 1 Proportion of deaths from scrofula, phthisis, tabes, hydrocephalus, and brain disease, to deaths each class, all specified diseases : Each disease. Deaths Deaths Deaths, all ages. under 1. under 5. Scrofula 100 13.0 29.8 Phthisis 100 1.8 5.2 Tabes Mesenterica 100 42.6 81.1 Hydrocephalus and brain uisease . . . 100 25.7 58.5 I NT A NT FEEDING AND ITS INFLUENCE ON LIFE. 239 and secreting glands are identical with those which occur in mesenteric disease. These patients are also peculiarly liable to that variety of ophthalmia so common among the ill-fed children of the poor. Except that scrofula is hereditary, whereas rickets is not, the causes are identical. Impure air, especially air that has been breathed over and over again, de- fective hygiene, want of light, cleanliness, and good food, are, without doubt, the causes which, either singly or unitedly, lead to its production. Essentially, however, and in the better ranks of life, it is chiefly attri- butable to two causes in operation, excluding always hereditary taint, that we have to ascribe its development. One is, the overcrowding of children together. Experiment has shown that if an animal be kept con- fined in a barrel or closed box, so that the air supplied is always more or less vitiated by the carbonic acid which it expires, however well fed that animal may be, tubercle will be developed in about three months. And so it is with many of the spoiled children of the wealthy. The hot and ill-ventilated rooms, and the massive curtains with which they are sur- rounded, effect as much evil as the small and close rooms of the poor. But it is chiefly by the sweets and bonbons with which they are spoilt, as well as the starchy aliments with which they are fed, that the strumous development is ensured. We have already seen the effect of an excess of saccharine food in the production of strumous ophthalmia. Add to this, that the bad and vitiated tastes induced by this species of pamper- ing, prevent them from relishing proper and wholesome food when it is given to them. I had occasion to speak before of the distillers' refuse given to cows, 1 and how readily it depraved their appetites, and ultimately led to the development of ulcerative disease among them, and so it is in this case. The quality of the blood is deteriorated, and the several diseases of tubercular character are developed. A sugary diet besides leads to the production of worms, a source of much dyspeptic distress to children, sometimes of convulsions. Common sense points out the wickedness and absurdity of many prac- tices even nowadays carried on and maintained by many who ought to know better; and certain it is, that parents and those who take care of children often treat these tender little ones, as they would not think of treating their pot animals, favorite dogs, or horses of value; and surely that sweet and lovely thing we know a babe to be, is worth many animals, however costly and valuable. In conclusion, if by what I have said I may, under Providence, be th- means of saving the life even but of a single child, and of making but one sorrowing mother, or one grieving father happy again, I shall be thankful, and shall consider I have not written in vain. Yrt this is not all I havede- sired to accomplish. I have wished to call the attention of the commu- nity to the subject of infant feeding, as one fraught with difficulties and > Pg 145. 240 INFANT FEEDING AND ITS INFLUENCE ON LIFE. social evils of no ordinary kind, and calling loudly for more care, and even for legislative enactments. The food of our little ones must not be adulterated or poisoned. Our foundling hospitals must be regulated by wiser laws; the encouragements now given to crime must be repressed; and parents who by their ignorance prove themselves unworthy to care for their children, must be taught their responsibility. This is a noble work for philanthropists of both sexes; it is, moreover, to its full extent, a Christian work; and blessed shall they be who perform it. "Inasmuch as ye have done it unto one of the least of these My brethren, ye have done it unto Me." APPENDIX APPENDIX A. Deaths in London from Causes arising for the most part from Defective Nutrition. Want of breast milk. . . . UXDEB OKI 1851. 229 or .3 YEAS OLD. p ct 465 Teething 290 417 Thrush 157 119 Diarrhoea. . . 1,436 1 665 Dysentery 39 26 Tabes 363 395 Convulsions .. 1,535 1,511 Atrophy. . 784 1.932 1871. or .4 p.ct. 330 or .29 act 466 160 2,795 9 672 2,100 1,000 4,833 or 6. 6 pet. 6,530 or 6.6 p.ct 9,041 or 8 p.ct All causes of death 11,631 or 14.9 p.ct. 15,076 or 15.5 p.ct. 19,128 or 16.8 p.ct All births 78,300 97,064 112,617 APPENDIX B. Mortality in Foundling Hospitals in different parts of the World. Percent. Dublin 91 . Marseilles 90 . Kt. Petersburg 40 . Florence 40 Barcelona 60 Paris 80 . All France 60 . 75 . Dublin 48.7 . Paris 50 . ... 63.4 Close of last century. 1818 IT.Vi til) 1838 Mortality of Foundlings in the Departments of France in regard to the totality of their number. (a) Department* chowing the highnt rate of mortality. Per cent. I i-f 1'vn'i'i ' --i / (6) DepartnxmU nhowine the 1 o* mortality. Hante-Sa6n6 . . owwtrmt* FvomC . 33.3 to 50 > in. Infeneure J Hautc-Garonne ) . . 2.2 to 2.5 (;irude ) Loiret [ 25 to33.3 Haut-Rhin Jura t > t,. I 'I 8eine-et-Marne ) Aube ( nr-t.-il Haute-Pyp6ne ) ' ' Ardocbe 1 FiniKterre 1 .. 3.3 to 4 Cher C6te d'Or f 20 to 25 Moselle Voage* j He-et-Vilaine Loire- Inferienre Seine ret* ix>t-fc-Oaronne "| N,,vr,. .. 8.3 to 5 M.-:m. . 26.5 BMH i'v. M .s Bu-Ktun Mran . :i.O 244 APPENDIX 0. Mortality of Foundlings in France in regard to the number of Expositions. Highest. Per cent. Basse-Alpes. 83.3 Loire-Inferieure ) Loiret [- 76.9 Seine-Iuferieure ) Vaucluse Ardeche Aude Aveyron Cher Gets Gironde Ile-et-Vilaine Manche \ Seine \ 71.4 60 Mean. 72.4 Low Per cent. Haute-Saone Haut-Rhin 5.6 Vosges 03 Moselle 11.3 Ponts 13. Finisterre 158 Ariege 15.9 Hautes-Pyrene'es 16.3 Jura 17.4 Nievre 17.5 Bas-Rhiu 17.8 Haute-Garonne 18.4 Lot-et-Garonne 19.2 Mean.. . 13.4 APPENDIX C. Infant Mortality in Brighton. Fifty cases taken from the books of the Registrars of the several districts, showing the age of each child, the cause of death as certified, with additional information obtained by personal inquiry into the method of feeding, etc. 1. Girl; aged 4 months. Died sudden- ly in a fit. Coroner's inquest 2. Boy; aged 9 months. Died of bron- chitis and convulsions. 3. Boy ; aged 8 months. Died in a con- vulsive fit. Coroner's inquest. Alleged cause, teething. 4. Girl; aged 7 months. Died of diar- rhoea (during dentition). 5. Boy ; aged five weeks. Died of diar- rhoea. 6. Boy , aged 8 months. Died of hoop- ing-cough. 7. Girl; aged 2 months. Died from want of breast-milk. 8. Girl ; aged 6 weeks. Died of bron- chitis and convulsions. Death sudden. 9. Boy ; aged 6 months. Died of hooping-cough and convulsions. 10. Girl; aged 3 months. Died of marasmus. 11. Boy ; aged 9 months, mesenteric disease. Died of Fed on boiled French roll given with a spoon ; very little breast-milk. Fed freely. Fed on boiled rice and sago, and the breast. A fat, heavy child. Fed upon tea and muffin heartily the night before it died. Always ate heartily, and had also breast-milk. Was a very thin and puny child. Fed partly from breast, partly with boiled milk. Fed partly from breast, partly with boiled milk. Fed entirely from mother's breast. The mother died when the child was five weeks old. It was weakly from birth, and did not thrive upon the food given. The bottle was not tried. The mother says it had nothing but the breast as food ; and no drug or medicine except given by a medical man. Had breast-milk the first four mouths : then bread and water food sweete: ed. The mother, not having sufficient breast- milk, tried bread and milk, and then milk and water, without success. The child was weaned suddenly, and fed without judgment. APPENDIX C. 245 12. Girl ; aged 3 months. Died of con- vulsions. 13. Boy ; aged 5 weeks. Died of bron- chitis. 14. Boy ; aged 9 months. Died of diar- rhoea and convulsions. 15. Child; aged 3 months. Died of convulsions. 16. Girl; aged 4 months. Died of marasmus. 17. Girl ; aged 4 months. Died of diar- rhoea and convulsions. 18. Boy ; aged 3 months. Died of diar- rhoea. 19. Boy ; aged 5 months. Died of atrophy. 20. Girl; aged 4 weeks. Died of con- vulsions. 21. Boy ; aged 10 mouths. Died of con- vulsions. 22. Child; aged 9 months. Died of convulsions. 23. Girl ; aged 10 months. Died during dentition. 24. Girl ; aged 3 months. Coroner's inquest : verdict " affection of brain from overloading the stomach." 25. Girl ; aged 6 months. Coroner's in- quest : verdict "accidental death." No blame attached to nurse. 26. Girl ; aged 4 months. Died of marasmus. 27. Boy ; aged 8 months. Died of diar- rhoea. 28. Boy; aged 4 months. Died of phthisis. 2'J. Boy ; aged 1 year. Died of phthisis and convulsions. 80. Girl; aged 11 months. Died (as allep-il , of ^institutional debility. Died in a fit of convulsion*. 81. Child; aged 9 months. Died of bronc : tion ; nil three deaths oocurn d w.tliin a week or two. 1 by mother, partly fed, for six months : a pint of thick food thr< o or four times a day. Aft*r ix months was put out to dry nurse; f*d with mn nnd milk and gruel a few mir.nt' Iwforo i Probably a caws of overfeeding. Suckled entirely by the mother. Weaned at ten days old : fed on arrow- root and gruel. Weaned ttiMfnly three weeks before death ; fed on bread and milk. 246 APPENDIX 0. 34. Boy; aged 3 weeks. Died of "ex- haustion of vital powers." 35. Girl ; aged 9 mouths. Died of hooping-cough and pneumonia. 30. Boy ; aged G months. Died of con- vulsions. 87. Boy ; aged 3 months. Died of hooping-cough. 38. Child ; aged 1 month. Died of "constitutional weakness." 39. Boy ; aged 1 month. Died of "diseased stomach." 40. Girl; aged 8 months. Died in dentition. 41. Child; aged 9 months. Died of bronchitis. 42. Girl; aged 6 months. Died of pneumonia. 43. Girl ; aged 7 months. Died of con- vulsions during dentition. 44. Boy; aged 5 months. Died of hooping-cough and convulsions. 45. Child ; aged 1 year. Died of hydro- cephalus. 46. Boy ; aged 1 year. Died of convul- sions. 47. Girl ; aged 2 months. Died of diar- rhoea. 48. Child ; aged 5 months. Coroner's inquest: verdict "overfeeding." 49. Child ; aged 7 months. Coroner's inquest: verdict " overfeeding. " 50. Child ; aged 4 months. Coroner's inquest: verdict "overfeeding." Suckled by a wet nurse ; but fed also on rolls and cow's milk. Suckled entirely by the mother. One of twins ; suckled by the mother ; also fed on prepared barley. Ailing from birth. Suckled by the mother. Suckled entirely by the mother. Fed on cow's milk and water. Fed on the mother's breast. Brought up by hand, on new milk and tops and bottoms. Fed partly from breast, partly with bis- cuit powder and cow's milk. Fed entirely on cow's milk and water. Dentition unusually early ; ten or twelve teeth in seven months. Fed partly from mother's breast ; also on bread sop. Always fed a great deal (the mother having difficulty in suckling). When weaned, had anything (i. e., everything). Convulsions came on with teething. Treatment consisted of blister to top of head, mustard to the back of the legs and neck, and leeches to the temples. Partly fed from mother's breast ; also with boiled bread. Very little breast-milk ; had baked flour and biscuits boiled. , These cases happened together in the same house. The child of a wet nurse, and her nurseling, were fed on a hearty supper of bread food ; and were found dead at 4 A.M. A similar case to the preceding two. APPENDIX D. Mortality in early montht, Parts of England, 1842, compared to Btrtht. MO NTH8. TT J__ PLACE. Births. i f * f A 1 vi-ar England 517739 J }:;.">:; 9059 i;."i:; 14913 12408 11428 7 v 7"t London 100 60240 4,7 2102 1.7 1116 1.2 838 2.8 2034 2.3 1700 2.2 1548 15.2 9438 Oxfordshire 100 514o 3.4 244 1.8 93 1.3 72 3.3 133 2.6 121 2.5 118 15.6 781 Cambridge 100 5979 4.7 325 1.7 111 1.4 84 2.5 105 2.3 145 2.2 106 15.1 976 100 120o8 5.4 719 1.8 219 1.4 151 1.7 HI 2.4 277 1.7 253 16.3 1942 Monmouth 100 4910 5.9 192 1.8 97 1.2 62 2.7 142 2.2 113 119 1G.1 727 South Wales 100 16836 3.9 646 1.9 241 1.2 173 2.9 2.3 268 2.4 HB 14.8 1916 North Wales. 100 10693 3.8 407 1.3 144 1. 116 1.9 195 1.6 140 1.5 150 11.3 1153 Norfolk 100 12271 3.8 OH 1.4 285 1. 180 1.8 417 1.3 297 1.4 214 10.7 HH Kent, extra metro- \ politan, except V Greenwich . . . . ) 1UO 14326 100 5.6 M 5 2.1 238 1.6 1.4 188 1 3 3.3 431 3. 2.4 HI 2.5 1.6 IN; 1 9 16.8 2124 14.7 Surrey, extra metro- ) oolitau Mi 100 227 3.6 81 1.3 69 1.1 Ml 2.2 132 LM 1"-. 1.6 m 12.1 Dorsetshire :,]',:: M 59 t^ 147 111 106 700 Yorkshire W. R.. 100 40165 8.3 2428 1.1 702 .9 464 2.8 1025 2.1 913 2. 974 ISJ Hi Yorkshire, E. R 100 7284 6.04 448 1.7 s:; 1.1 117 2.17 2T>5 2. 181 2.4 133 inirt Yorkshire, N. R Lancashire Devonshire 100 HM 100 14098 100 i.-.-m 6.06 313 5.5 B7I 5.07 IM 1.1 80 1.4 1417 8.1 180 1.7 50 1.9 1015 1.5 !::.! 8.4 ttl L'.; HH 8.0 ;:::_> M 88 1.5 HH 8.4 HI 1.7 00 1.5 HU 8.4 HI 17.8 761 18.5 12605 10.4 1716 Rutlandshire , . ... 100 7:tS 8.1 85 1.1 11 .85 16 3.1 16 8.1 16 1.6 4 11.0 H 100 4.7 1.5 9.1 3.1 3.1 .5 LfJ APPENDIX E. GENERAL BULBS. (a.) No vegetable food, particularly arrowroot, should be given to any child with- out teeth, except by special order from the medical man. If teeth be present, it may occasionally be given. (b. ) If the milk be poor in quality, the animal food under Section No. III. may be given to children under six months, and under Section No. II. to those under three months. A. ANIMAL FOOD. DIET FOB INFANTS WITHOUT TEETH. I. Under Three Months. Take of milk and water, of each four oz. ; sugar of milk, one drachm ; lime-water, two teaspoonfuls. Mix. IL Under Six MontJis. (a.) Take of milk, six oz.; sugar of milk, one and a half drachm ; water, two oz. ; lime-water, one tablespoonful. Mix. If the above disagree : (b.) Substitute for Whey. (Mr. Turner's) Dissolve one oz. of sugar of milk in three-quarters of a pint of water, at a temper- ature of 160 deg. Fahr. Mix with an equal quantity of good cow's milk. (c.) Milk Whey. (Mr. Lobb's). Set aside half a pint of new milk, to allow the cream to separate. When this has taken place, take the skim milk left, add half a teaspoonful of prepared rennet, and heat over the fire up to 160 deg. Fahr., until the curd has separated. Filter through a coarse sieve ; add to the whey, in summer three drachms, in winter three drachms and a half of sugar of milk, and lime-water one tablespoonful. III. Infants under Nine Months. (a.) Take of pure milk, half a pint; sugar (of milk), two drachms; lime-water, one tablespoonful. (b. ) Prepare Mr. Lobb's Whey, with fifteen drops only of prepared rennet instead of thirty. B. VEGETABLE FOOD. DIET FOR INFANTS ABOVE EIGHT MONTHS, IF POSSESSING TEETH. I._ Vegeto- Animal Food. (Mrs. Wells's).* '*^/ * To be had at Mr. Greenish's, 20 New-street, Dorset-square. (This consists of baked flour, sugar of milk, and a little carminative or spice. ) Take about a dessertspoonful, make up into a paste with cold water, add from two to APPENDIX F. 249 three tablespoonfuls of boiling water, then mix the whole with a quarter of a pint of milk raised to a temperature of 100 deg. Fuhr. Finally, add one tablespoon! ul of lime-water. II. Nestled MUk Food. For Feeding Bottles. Mix one tablespoonful of the food with ten tablespoon fula of cold water. Boil mixture for a few minutes with constant stirring. For a Light Pap Mix one tablespoonful of the food with five tablespoonfuls of cold water. Boil as before with constant stirring for a few minutes. N.B. No milk or sugar should be added. III. Lentil Food. Prepare in the same way as above with lentil powder. IV. Yorkshire Food. Take of baked flour, three pounds ; phosphate of soda, one ounce and a half ; car- bonate of magnesia, a quarter of an ounce. Mix. Take three teaspoon fuls of the food, and add water and milk as in preparation of vegeto-animal food. V. Bread Sop. Take four ounces of stale home-baked or aerated bread, break it up in small piece*, add boiling water enough to soak it, mash it up completely. Add gradually milk raised to a temperature of 130 deg. Fahr., stirring up all the while with a spoon. Pass through a coarse sieve. N.B. Robb's biscuits, or tops and bottoms, may be substituted for the bread. APPENDIX F. ADDITIONAL FOODS FOR WEAKLY CHILDREN. TO BE GIVEN ONLY UNDER MKDICAL DIRECTION. L Wine Whey. Boil three wineglasses of milk, and add a wineglass of sherry or port wine. Strain, and add a wineglass of warm water; a wiueglaosful of this may be given once or twice a day. II. HogarlKt E*rnf. l'J!. tt leq. Althaus on electricity in defective lacta- tion, 79 Althaea, or muluchia arbaca, at a galacta- Alum, frequently contained in wheat and flour, 176 ; forma with phosphoric acid insoluble salt, and so phosphoric acid is not assimilated, 177; Accum on, 170; Hassall, Markham, Mitchell on, ib. Anaemia as a cause of defective lactation, 56 Anderson, influence of food on milk, 145 Auemone pratensis, or pulsatilla, as a gal- actagogue, 99 Anethnm fomiculum, or fennel, as agalao- tagogue, 99 ; dulce, or graveoleus, or dill, ib. Anglo-Swiss and Aylesbnry milk, con- densed, 157 Animal, direct suckling from. 192 ; mares and cows, difficulties with, 14'!. 11):!, 213; goat, 141. 141>. IX 1 ; :,.ss. in I Animal food essential to a child, 44, 129 Anisum pimpinella aa a galactagogue, 99 Apium sativum, or parsley, as a galacta- Appendices: A. Deaths from defective nutrition. ','11 ; 1 1. Mortality of found- ling hospitals in different parts of the world, ib. ; in France especially. C. Fifty cases of death registered in Brighton due to imperfect feeding, ib. ; D. Mortality in early months in England in 1843 as compared to births, 24 ' General nilcx for infant feeding at differ- ent ago*, 246; /*. Additional food for weakly children, 247; (}. Earthworms as a galactagogue, ancient rccijK 249 Arrowroot, innutritiuus aad indigestible as 256 INDEX. food, 15, 174; as a demulcent to coun- teract poor milk, Dr. Merei on, 109 Ash well, Dr., dangerous results of over- Buckling, 54-57 Asphyxia, from arrest of cutaneous respi- ration, as a cause of death, 233 Ass's milk compared to human, 140 ; chem- ical composition, ib. ; objection to, 148 ; excess of salts in, ib. ; specially of sugar, ib. ; deficiency of fat, 149 ; absolute effi- ciency of, still unascertained, ib. ; re- markable cases of its successful employ- ment, 213, 214 Assimilation, defective, as a disease, 200 ; statistics, ib. ; causes, ib. ; three stages, 201 ; characters of first stage, ib. ; of second stage, ib. ; third, ib. ; occasion- ally malignant, ib. ; and contagious, ib. ; duration, 202 ; primary assimilation only continues defective, ib., 203 ; results, . 202 ; post-mortem appearances of, ib. ; nature of disease, 203; secondary as- similation not defective, ib. , 204 ; Guil- lot's views on, 174 ; principles of treat- ment, 203 ; 1st. Dietetic, 204 ; adminis- tration of artificial gastric juice, ib. ; of pancreatic juice to digest fats, 205 ; fatty acids, 206 ; cerealin, 207 ; mineral aliments, lime, 208 ; carminatives, 209 ; dill, ib. ; wine, ib. ; brandy, 210 : char- coal, ib. ; proper mammary bottles, 211 ; proper nipples, ib. ; in diarrhoea as a re- sult of mixed alimentation, 215 ; tea, 218 ; raw meat, 220 ; vegetable aliments, 223 ; quantity of food to be given, 224. 2d. Hygienic Treatment: Day and night nursery, 225 ; cubic size of rooms needed, ib. ; cleanliness of napkins, 220 ; chloride of lime as a disinfectant, ib. ; mode of employment, ib. ; temperature, ib. ; bed curtains, ib. ; exercise, 228; protection of head. 2^9 ; perambulators, ib. ; paper used on nursery walls, 230 ; cleanliness of wet curse if employed, 231 ; sea-bathing of, ib. 3d. Medicinal Treatment : In diarrhoea of, 232; fever- ish excitement of, 233 ; cod-liver oil, 234; milk baths, ib. ; nutritive injec- tions, ib. ; vomiting in, treated by lentil powder, 235 ; opium, bismuth, nitrate of amyl, ib.; aphthous exudations in, treat- ment by wine, iron, ib. Atrophy of breast as a cause of defective lactation, 72 B. Bachhoffner on encouragement to crime by mercenary suckling, 112; mortality of illegitimate children, ib. Ballard, Dr. Edward, on adulteration of milk with water as a cause of enteric or typhoid fever at Islington, Balsall Heath, &c., 151 ! Ballard, Dr. Thomas, on fruitless sucking as a cause of disease, 76, 212 i Balsall Heath, enteric fever at, 151 ' Barley, poor in nitrogenous aliment, 175 ; contains dextrine difficult of digestion, ib. ; and insoluble casein, ib. Barreswill on eggs, 158 Basil, sweet, wild thyme, as a galacta- gogue, 98 Becquerel and Rodier, quantity of milk required for a child, 52 ; on electricity in deficient lactation, 79 ; composition of human milk, 123 ; of ass's milk, 140 ; and Vernois on goat's milk, 141 ; on country and town milk, 142 ; influence of food on milk, 145 ; on adulteration of milk, 150 Beef essences (see Raw Meat Juice) ; Ho- garth's, 161 ; Brand's, 247 (see Essence of Meat) Beef teas as a substitute for milk, 160; Liebig's, ib. ; characters and composi- tion, ib. ; preparation of, ib. ; defective in nutrition, ib. Belladonna in galactorrhoea, 66 ; opinions of Dr. Gardner, ib. , 67, 70 ; Thomas, Dr. Gaillard, 66 ; Messrs. Fifield, Ranque, Schniir, ib. ; Dr. Goolden, ib., 68; Hughes, 66 ; Burrows, Barry, 67 ; New- man, ib. ; conflicting opinions recon- ciled, 68 Bernard, Dr., on expulsion of fatty mat- ters by bowels, 205 Berry, winter green box, or chequer berry, partridge berry, or mountain tea, as a galactagogiie, 97 Bertillon, mortality in early life in Paris, 2 Birkett, Mr., influence of non-suckling on production of cancer in breast, 59 Biscuit powder, 223 Blindness in defective lactation, 57 INDEX. 207 Boedecker, Professor, on differences of morning and evening milk, 144 Bofareira as a galactagogue, 91 (see Pal ma Christi). Boismout, Brierre de, on painful breasts during menstruation, 02 Borago as a galactagogue, 89 Bottle feeding, advantages of using a bot- tle, 50, 211 ; Cooper's, 50 ; the mamma bottle, ib. ; O'Connel bottle, id. Boussingault, quantity of food needed by suckling and laboring animals, 128 Boysson, analysis of goat's milk, 141 Brand's essence of meat, 247 Bread, white bread pap, 176 ; Appendix E. , 246 ; innutritions if exclusively given, 176, 177; brown bread pap pre- ferable, ib. ; white bread pap defective in chloride of potassium, 170 ; may con- tain alum and so insoluble phosphate of alumina, 177 ; sometimes kills by swel- ling in body of child, 178; is defective in cerealin, ib. ; advantage of aerated bread, 179 ; richer in gluten, ib. ; some- times cures indigestion, 180; and dys- pepsia, U>. ; and convulsive attacks in children, ib. ; experience in Samaritan Hospital, ib. ; means of making light bread by mineral ingredients added to, ib. ; evil effects of adulteration with rice flour, ib. Breast-milk food, effect on development, 14 ; facts very rarely, 17 ; want of, aa a cause of mortality, 8; in Ireland. 11 ; England, 12 ; Drs. Merei and Whitehead, favorable reports on use of, in Man- chester, 13 ; children, however, occasion* ally do not thrive on it, 17; Brighton case*, 15 ; favors viability, 39 ; hat a wonderful preservative influence even when other food is given, 40 ; example of Foundling Hospital, lA. / of North Wales, 41 ; quantity needed by a child, 51 ; sometimes full of animacula, Ml BreanU, swelling and painful at nvnstru.il periods, 02 ; hypertrophy as a result of uterine irritation, 64 ; not productive of j defective lactation, 72 ; torpor as a cause of ditto, 78 Breast-pumps, uses of, 78 Brighton, registered cases of mortality from improper food, 15 ; Appendix C., 242 Brinton, Dr., on digestibility of fatty mat- ters in pancreatic juice, 206 Brochard, Dr., on fearful mortality of in- fants in Paris, 30 ; on mercenary suck- ling, 31 Brownlow, Mr., greater mortality of chil- dren nursed by strange nurses, 10; effect of exposure, 25 ; mortality at early periods, 40 Burduch. on warmth essential to young animals, 45 C. Cameron, Dr., on composition of mare's milk. 14C. Carbonate of soda (a snbcarbonate) cause of alkalinity of blood in herbivora. Carminatives, their use, 209 ; dill oil, ib. ; preparation of dill water, ib. ; wine, ib. ; wine whey, i*. and 218 ; brandy. 210 Carpenter, Dr , on galactorrhoea, 63 ; in- fluence of emotions on lactation, 73-75 ; on cutaneous respiration as a cause of fever Carrot as a galactagogue, 100 Casein, nitrogenous element of milk, 188 ; excess in cream, 157; in eggs, 159; pro- portion in milk, Iu3 ; determines buty- ric fermentation in milk, ib. ; effect of diet too exclusively restricted to, ib. ; harder in cow's than in human milk, 1 '''.); insoluble in barley, 175; vegeta- ble, as a ferment in bread, 1 78 Cantor-oil leaves aa a galactagogue, 91 (tft Palma Christi). Cazeaux on galactorrhaea, 61 Cerealin, defect of in bread as a cause of iiuligcHtiim, 178 ; a strong ferment, **. ; especially when mixed with lactic acid, ib. ; effect suspended by a temperature of 140 P., 170; substitute for pcpsine, 207 ; contained in bran tea, ib. Charcoal, animal, to correct flntus. when preferable to carminatives, ib. Chovallier and Henri on influence of food in milk, 145 Chloride of potaasinm in milk, 136; ii 258 INDEX. portant use of it, ib. (see Potassium, Chloride of). ChrystaJl as a galactagogue, 100 Cicer arutinuin as a galactagogue, 99 Cinquefoil, or five-leaved grass, as ditto, 99 Clarke, Dr. Andrew, on potash salts in cell- development, 134 Classification of diseases, 5 Clothing, exposure from deficient, prolific cause of mortality, 25, 85; insufficient to be guarded against, 229 Cocoa and milk paste, Moore's, 190 ; theo- bromine like theine, ib. Cod-liver oil as a galactagogue, 101 ; espe- cially when combined with iron, 102 ; as a corrective to poor milks, 170 ; in diar- rhoea, 234 Colchicum as a remedy in galactorrhcea, (59 Cold as a cause of mortality, 35 (see Expo- sure). Color, influence on development, 43 Combustible elements in milk, fat, 129 ; sugar, 131 (see Fat, Sugar) ; proportion to nitrogenous in various aliments, 175 Common salt as a galactagogue, 100 (see Chloride of Sodium) ; conger-eel soup as ditto, 85 Cooper, Sir Astley, on effect of non-suck- ling, 59 ; of terror in arresting lactation, 74 ; of suction in provoking it, 77 Cooper, Mr., his india-rubber nipple, 50, 212 Coote, Mr. Holmes, on acquired deformi- ties in children, 238 Coronilla juncia, or milk vetch, as a galac- tagogue or polygala vera, 98 Corvisart on digestion of fat by pancreatic juice, 206 Costen, Dr., encouragement to vice by mercenary suckling, 113 Cow basil as a galactagogue, 89 Cows, why milching cows deteriorate, 128, 146 ; how may be prevented if well fed, ib. ; former mismanagement in unheal- thy sheds, 154 ; diseased cows, ib. ; un- healthy sheds, 155 ; mortality of, ib. ; modern improvements in keeping of, 156 Cow's milk, 142 ; characters of , ib. ; com- pared with human, ib. ; chemical com- position of, 143, 145; table of, 145,146; influenced by nature of food taken, 143, 145, 153, 193; by season of year, 144; time of day when drawn, ib. ; by resi- dence in town or country, 142 ; disad- vantage of, 150; adulterations, ib. ; chiefly with water, ib. ; effect in devel- oping typhoid or enteric fever, 151 ; examples, Islington, ib. ; Arnley, ib. ; Moseley and Balsall Heath, ib. ; Mary- lebone. ib. ; Crossbells, ib. ; Keagley, ib. ; milk especially attractive to typhoid impregnation, 152 ; acidity of, ib. ; due to nature of food, 153; and want of ex- ercise, ib. Cream, should be added to ass's milk, 149 ; as a substitute for human milk, 157; composition resembles milk, ib. Croft, Sir R., influence of emotions on lactation, 74 Crossbells, typhoid fever is produced by watered milk, 151 Cumming, Dr. Henry, quantity of milk consumed by a child, 51 Cytisus as a galactagogue, 98 D. Danby, Mr. Stephen, on cerealin as a fer- ment in bread. 178 Daucus carota as a galactagogue. 99 Dauglish, Dr., on pure white aerated bread,' 178 De Chateauneuf, Benoiston, on increased mortality from hired wet nurses, 16 Defective hygiene as a fertile cause of mortality, 19, 200 Defective lactation, proportionate to amount of life's comforts, 71, 84 ; pro- portion among nurses, 71 ; cause of, ib. ; age, ib. ; atrophy of breast, 72 ; hyper- trophy, ib. ; obesity, ib. ; sore or in- sufficiently-formed uipplts, 73 ; bad air, ib. ; paralysis or torpor of breast, ib. ; mental emotions, ib. ; cases, treatments, 1st. Mechanical: (a) appliances to nip- ples, 75 ; suction, 76, 77 ; breast-pumps, 78 ; electricity, ib. ; (b) to genitalia, 81. 2d. Hygienic, 84. 3d. Dietetic, ib. ; nitrogenous food, ib.; whiting-soup, INDEX. 259 85 ; conger-eel soup, ib. ; special meats, ' ib. ; special vegetables, lentil or reva- lenta, ib. ; mushrooms, 86 ; drinks, ib. 4th. Medicinal, by galactagoguea, 88; viper's bugloss, 89 ; borage, id. ; cow basil, ib. ; lettuce, 90 ; sow-thistle, ib. ; rocket, ib. ; palma Christi, ib. ; tapioca, < 96; winter green box or berry, 97; sweet basil and basil thyme, ib. ; cytisus, 98 ; halimon, ib. ; milk vetch, ib. ; cicer arutinum, 99 ; marsh-mallow ,ib. ; creep- ing cinquefoil, ib. ; gith and pulsatilla, ib. ; anethum or fennel, 87, ib. ; with parsnips, 87 ; common salt, 100 ; chrys- tail. ib. ; sakeik, 101 ; fesire, ib. ; iron and cod-liver oil, ib. Deformities, congenital, are few, 237 ; ex- amples of, Lying-in Hospital, Dublin, ib. ; most are acquired, ib. ; Holmes Coote on proportion, 238 ; statistics in England, 237 Devergie, a rough test for judging of good milk, 122. De Watteville, M. , enumeration of books written on infant mortality, 3 ; mortal- ity in France among enfant* trvurea, 9 ; effect of removal into country, 26 ; mor- tality during first year, 29 Dewees, Dr., on position of child when feeding, 49 ; Deyenx and Parmentier (tee Parmentier and Deyeux) ; digestion normal in infants, as proved by exaraina- ; tion of faeces, 138 Diarrhoai: 1st. Dietetic treatment of caused by spoon meat, Dr. Dubois on, 215 ; arrested by sugar of milk, 216 ; lime-water, 217 ; rice-water, ib. ; gen- eral treatment of, 218 ; little food and often, ib. ; wine whey, ib. 2d. Medi- cinal treatment of, 232 ; nitrate of sil- ver, ib. ; opium, ib. Dill as a galactagogue, 99 ; oil an a carmi- native, 209 ; water, ib. ; preparation, ib. Distillers, refuse slops of, as a galacta- gogue to cows, 86 Diuretic effect*, occasional, of palma Chris- Dounc, Dr., on increased mortality from mercenary suckling, :!0 Drinks, galactagogue, 86 Drugging children, 116; sometimes ef- fected through suckling a drugged moth- er, 117 Dubois, Dr., on spoon meat as a cause of diarrhoea. Duuglison, Dr., on suction reproducing milk in breasts of old women, 76 Early hours and sleep essential to children, 230 Ebertiburgh, Countess Lersner, on Liebig'a malt extract, 180 ; her experience of it, ib. Echium Yulgare, or viper's bugloss, as a galactagogue. 89 Edwards, Dr. Mime-, on influence of light on development, 42 Eggs as substitutes for milk, 158 ; analogy to milk, ib. ; chemical composition, ib. ; table of, 159 ; Bern Marteuy on artificial milk made with, ib. Electricity to breast as exciting a (low of milk, 78; Becquerel's cases, 71); Al- thaus' cases, ib. ; Skinner's cases. 80 Emmenagogue properties, occasional, of palma Christ i leaves, 94 Erdmann, analysis of ashes of wheat, 176 Eruca sativa as a galactagogue, 90 Exercise, deficiency as a cause of mortality of infants, 27; should be daily. 228; want of cause of disease among cows, 153 Exposure of infants as a cause of mortal- ity, .': . French returns, ib ., 26 ; English ditto. 24 ; Mr. Brownlow, 85 (M Cold). P. Feoes of infants. Dr. Wegscheider on. 188 ; color, ib. ; reaction, ib. ; composition. ib. ; conclusions from, as to animal diges- tion, 138 ; green stools results of admix- ture of water and milk. 215 ; produced by spoon meat. ib. ; conclusions as to indigcsiibility of farinaceous food, Quil- let. 174 Falkland, Dr.. on preparation of artificial milk resembling human. 1 7 1 Fat in milk as a combustible element, 129 ; 260 INDEX. nature of, 130; importance as an ali- ment, ib. ; origin, ib. ; quantity in milk, ! ib. ; deficiency in ass's milk, 149 ; color- : less blood-globule made up of it, ib. ; \ chemical condition in which it exists in milk, as fatty acid with oxide of lipyl, 130 ; emnlsed in milk by excess of fatty acid and also of phosphate of soda, 131 ; assists digestion, ib. ; effect of diet too exclusively fatty on economy, Magendie's experiments, ib. ; on eye and urine, ib. ; advantages in cold climates, ib. ; occa- : sionally excessive in blood, ib. ; in i cream, 157 Fatty acids, 130 ; readily absorbed. 206 ; in cream, 157, 205 ; cod-liver oil, 200 Fatty matters, how made digestible, 205 ; in three ways : 1st. By artificial pancrea- tic juice, ib. ; Bernard's experiments as opposed to Frerichs', Lehmann's, and \ Leng's, ib. ; produced by conversion of starch into sugar, 206 ; slightly dissolv- ' ing also nitrogenous matters, ib. ; anal- ogous effects of pancreatine, ib, ; of Dobell's pancreatic emulsion, ib. 2d. By exhibition of fatty acids, ib. ; cod- liver oil, butter, cream, ib. 3d. By ex- I hibition of phosphate of soda and ernul- , sified fat. 207 Farr, Dr. William (see Registrar- General). 1 Farre, Dr. Archer, on artificial gastric juice, 162 Fennel or anethum f cenicnlum as a galac- tagogue, 99 ; as a drink with parsnip roots, 87 Ferris, Dr. , on effects of non-suckling, 59 ; on absence of ammonia in volatile prin- ciples of milk, 194 Fesire as a galactngogue, 101 Fifield, Mr., on action of belladonna in galactorrhoea, 66 Flour: Baked, 183 ; gluten made there- by more porous, ib.; is defective in chloride of potassium, 176, 183. Lentil or revalenta, 182, 223 ; contains same principles as milk. 223 ; is laxative, pref- erable to pea flour, 182 ; checks vomit- fagi *'* / wonderfully nutritive powers of, 183. Rice used to adulterate flour, 180 ; increases power of. to absorb water, ib. ; is defective in nitrogenous ele- \ ments, 181. Wheaten, often adulter- ated with alum, 176 ; used entire with bran richer in gluten and cerealin, 178 Food, elements of, 44 ; animal essential to infants, ib. ; comparison with vegeta- ble, 174 ; examples from comparative anatomy of necessity of animal food, 45, 190 ; confirmed by anatomical and physiological structures, 46 ; to be effec- tive for nutrition should be taken in semi- erect position, 47 ; and child kept warm, 49 ; example of needful warmth to young animals from comparative anato- my, 47 ; mammary or feeding bottles to be used, 50 ; influence of food on goat's milk, 142 ; cow's milk, 144, 145. 146 ; conditions of cows themselves, 123, 146 ; on different nations, 179 ; frequency cf, needed by infants, 224 ; improper, cnuse of death at Brighton, 15 ; Appendix C. ; at Bast Wymer. '-2i!0 Food Varieties for children : IlantnilVx, 182, 187 ; chemical composition, ib. ; preparation, ib. ; Liebi^s nwlt extract, 182, 184; wonderful efficacy of, 184; preparation of soup, ib. ; Dr. Kas- salTs remarks on, 185 ; analysis of, ib. ; Countess Ebersburgh's experience with, 186; cooked food, ib. ; uncooked, 185; Dr. Hassall's directions how to employ it, ib. ; Nestles milk, 184; composition, 183; preparation, 184; Wells, Mrs., tegeto- animal, 183, 223 ; Yorkshire, 188 ; mineral elements in, ib. ; RobVs biscuits, 188, 223; other kinds of, 223, Hard's farinaceous, ib. ; tops and bottoms, ib. ; biscuit powder, ib. Foundling Hospitals : Mortality in, 9 ; Ap- pendix B., 241 ; De Watteville on, 9 ; Villerme's account of Rheims, Paris, Lyons, ib. ; greater mortality in, 19, 30 ; London Foundling Hospital, Mr. Brown- low on, 40 ; Emperor Napoleon's disap- pointments with, 409 ; the appointments of a well-regulated foundling hospital required, 198 Fourcault, Dr., his experiments on dogs, proving cutaneous asphyxia as a cause of death, 233 ; and importance of cuta- neous respiration to infant life, 234 INDEX. 261 Fox, Dr. Tilbury, on the causes of rickets, 237 Frerichs, Dr. , on the necessity of pancre- atic juice for digestion of fats, 205 Fungi as galactagogues, 91 G. Gaillard, Abbe", effect of removal on mor- tality of infants in France, 26 Galactagoguea : Electricity, 78; nitroge- nous foods, 84 ; whiting and conger-eel soups, 85 ; special meats, ib. ; vegeta- ble food, ib. ; lentils, fungi, 80 ; drinks, ib. ; fennel and parsnip roots, 87. Medi- cines, as (*ee Defective Lactation, Medi- cinal Treatment) basil, cow, 89 ; sweet, 97 ; thyme, ib. ; berry, winter, ib. ; green-box, ib. ; borago, 89 ; chrystatt, 100 ; cinquefftil, creeping, 99 ; ctcer, aru- tinura, ib. ; eod-lirer oil, 101 ; cytitus, 98 ; fennel, 87 ; fetire, 101 ; gith and pttltatilla, 99; halimon, 98; iron, 101; 'ice, 90; marsh-maUow, 99; parsnips, 87 ; palmn Christi, 90 ; rocket, ib. ; saktik, H)l ; soic-thutle, 90; salt, com- mon. 100 ; tapioca, 9G ; vetch milk, 98 ; worms, earth, Appendix G. Galactometcrs, uses of, 169, 208 Galactorrhcea, cause*, 61 : 1st. Pallid per- sons affected with local congestions, ib. 2d. Persons with meaorrhagic tenden- cies, ib. 3d. Persons with vicarious menstruation, or affected with a stop- page of other habitual secretions, 62 ; from other organs besides the breast, 63. 4th. Immoderate suckling, ib. ; case, ib. 5th. Irritation of womb. 61. Trtatmnit of: 1st Dietetic. 65 ; Medicinal, ib. ; iodide of potassium, 66 ; belladonna, opinions of various authors on, 66 ; somewhat contradictory evi- dence, 68 ; reconciled, ib. ; oolchicum, ron, ib. ; nux vomica, 70 Gardner, Dr., on treatment of gnlnctor- rhoua, 66 Gastric juice, aa an add in digestion, in defective assimilation. 204 ; liquor pep- ninis. 0>. ; Joulin'n success with it, 20T Gaul' umbens, or winter green- box berry, as a galactagogue, 97 Gibb, Sir Duncan, diseased milk in breasts, 105 Goats, may be used directly as wet nurses, 141, 149, 192 ; case, 214 ; if well treated lose all smell, 141 ; and milk specific taste, ib. Goat's milk, characters, 141 ; compared with human milk, ib. ; influence of food on, 142, 193 ; chemical composition, 14:} Gobley, composition of eggs, 159 Goolden, Dr., on uses of belladonna in galactorrhoea, 06 Greenish, Mr. Thomas, sen., his liquor palma Christi as a galactagogue, 93 ; his oases referred to, 95 Grimsdale's desiccated milk, 157 (*ec Con- densed Milks). Gnilliot, Natalis, and Lamperiere on the quantity of milk consumed by a child, 27 ; on indigestibility of starchy mat- ters by young infants, 17 Y Guillot and Leblauc on casein in blood, 133 H. Halimon as a galactagogue, 98; which plant is meant is doubtful, ib. Hall, Professor, on males as wet nurse*. 77 Haller, on evil effects from non-suckling, 59 Hand-feeding of children, method, 198; dangers prior to eight months, ib.; spe- cially with illegitimate children, ib.; Mr. Acton's views on, ib.; conditions of successful, 195 Hard's farinaceous food. 888 Barley, Dr., on digestibility of fatty mat- ters by pancreatic juice, 206 ; his pan- oreatine, ib. Hartmann, Dr., on diseased milk in breast*, 105 HassaH. Dr., his infant's food, 188 (set Food' ; strictures on Liebig's malt ex- tract, 185 ; on adulterating milk. 144, 150 ; on unhealthy sheds, 154 ; on alum in oread. 176 Head, protection of infant's, 889 Heritier. analysis of milk of blonde* and brunette*, 186 262 INDEX. Hermanstadt, influence of quality of food on cow's milk, 145 Hervieux, his views on abuse of recum- bent position as cause of mortality of infants, 27 ; producing cold and starva- tion, ib., 230 Hillier, Dr., on adulteration of milk with water, 150; state of cow-sheds in St. Pancras, 155 Hogarth's essence of meat, 163, 247 Hopkins, Dr. , on raw meat, 222 Horsford, Professor, on addition of an acid phosphate of lime in bread, 180 Humboldt on employment of males as wet nurses, 77 Hunt, Mr. T., on adulteration of milk with water, 150 Hunter, Dr. W., on evil effects of non- suckling, 59 Husson, on mortality of infants from mer- cenary suckling, 30 Hygiene (see Defective Hygiene). Infanticide, as a cause of mortality, 28 ; encouraged by employment of hired wet nurses, 113 Injections, nutritive, in defective assimi- lation, 234 Inunctions with oils in feverish states in defective assimilation, 233; rationale of its action, ib.; by cod-liver oil. 234 Iodide of potassium in galactorrhcea, 06 Iron as a remedy in galactorrhoea, 69 ; as a galactagogue, 101 Ischigalactics, Dr. Gardner on, 70 Islington, enteric fever in, produced by watered milk, 151 J. Jackson, Professor Samuel, on application of acid phosphate of lime in bread, 180 Jatropha manihot as a galactagogue, 98 Jellies and bone soups, 160 ; are innutri- tious, ib. ; may be prepared from refuse beef after making raw beef juice, 161 Jenner, Sir W., on rickets, 493 Joulin, M., on employment of pepsine in inanition of new-born babes, 236 Juice, simple raw meat, 161, 223, 248 ; less liable than raw meat itself to contain trichinae, 167. 223 ; pepsinized raw meat, 161, 248 ; properties of gastric, 162 ; preparation of artificial gastric, ib.; Dr. Archer Farre's gastric juice, ib. K. Knapp, composition of tea, 189 L. Lactation, defective from hyperaemia, 56 ; anaemia, ib.; irregular suckling and ad- vanced age (see Defective Lactation); vicarious, 62 ; influence of emotions on, 73 ; effect of electricity on, 78 ; induced in virgins, 70, 77 ; old women past change of life, 76 ; in men, 77 ; cases, ib. Lactuca sativa as a galactagogue. 90 Laycock, Dr., influence of light on devel- opment, 43 Lehmann, Dr., on mineral constituents of blood-cells, 137 ; and Elsasser, fat assists digestion, 149 ; digestion of fatty matters without pancreatic juice, 205 Leng on digestion of fat without pancrea- tic juice, 205 Letheby, Dr., mortality in city in first year of life, 2 Lettuce as a galactagogue, 90 Leverett, Dr., on uses of raw meat, 164, 219 Lewis, Dr. Caspar, on ditto, 164 Liebig's malt food, 182, 185 (see Food) ; his opinion of tea, 189; beef tea, 160; Appendix F., 248 ; table of proportion of nitrogenous to combustible elements in food, 174 ; Countess Ebersburgh on, 185 Light, essential to good development of children, 42 ; insolation, ib.; as influ- enced by color, 43 ; papers to be used in a nursery, 230 Lime, plioxjrfiate of. 134 ; makes carbonic acid more soluble, ib. ; and through it carbonate of lime in fluids, ib. ; uses in skeleton, ib., 208 ; quantity in milk, 134 ; table, 135 ; on uses of an acid phosphate of in bread, 180 Lime, carbonate of, dissolved by sugar, INDEX. 263 131 ; and excess of carbonic acid in fluids, 134 ; to correct acidity in milk. 170 Lime -water, as an adjunct in milk, 217 quantity needed, ib. ; made more solu- ble by addition of sugar of milk, 131 ; to correct acidity of milk, 171, 2U8; quantity needed with cream, 157; pro- motes formation of gastric juice, 208 ; easy mode of preparation, ib. Livingstone, Dr., on induction of lactation in old women by suction of breast, 76 Lobb, Mr. , on electricity as a galactagoguc, 78; on ass's milk, 149; preparation of milk resembling human, 171 ; mincasea, ft Ludwig, Dr., on electricity as inducing lactation, 78 M. Magendie, effects of exclusive diet of but- ter, 131 ; on development of scrofnla, 178 ; experiments on dogs showing fatal effects of white bread, 176 McWilliam, Dr., on induction of lactation in unmarried women, 76; castor-oil leaves. 01 Malva sylvestrin, or marsh mallow, as a galactngogue, 99 ; on cnbeze, ib. Mammary bottle, advantages of one. 50, 129, 211; Mr. Cooper's, 49; Mamma bottle, 50 ; O'Connel ditto, ib. Marcct, Dr. , effect of fatty acids on chyle, no Mare's milk, 146 ; composition, 147 ; case where successfully employed, 213 Markham, Dr. P., on quantity of alum used in white bread. 176 Marsh mallow t*te Malva). Marteny Berne on eggs, 159 Marylebone, enteric fever from watered milk, l.M ; Ma hhoffner on mortality of illegitimate children in, 112 Mayer, Dr., on acidity of milk. Mental emotion* as a cause of defective lactation, 73 ; frettinp, 71 ; sometimes produces death of suckling, ib. ; convul- sion of ditto, ib. Meat, Mr. Roberton's extract, I'- garth's essence of, 16. / Appendix F , 247; Brand's, 163, 247; preparation, 163 ; raw, as an aliment. 164, 248 ; Drs. Weisse and West on, 164 ; Dr. Levcrett on, ib. ; experience of Dr. Caspar Lewis with, ib. ; of Drs. Morris and Thomas, 105 ; dangers of, ib. ; Trichinatons para- sites, ib. ; essences (* Meat, 161 ; Ap- pendix F., 247); in diarrhoea, 220 Merei and Whitehead, Drs., mortality from abdominal diBeases, 7, 199 ; on breast- milk, 11, l:{ ; n suits on children. 13, 14, 53 ; some children do not thrive on breast- milk, 17 ; as a cause of viability, 39 ; proportion of over-suckling women, 54 ; on defective lactation, 56; diseases of sickly mothers, 57 ; on correction of inferior milks, 169; order of appearances of teeth ns an indication that vegetable food may be given, 191. Milk, acidity of cow's, 152; causes. 153 Milk, adulteration with \\.itcr, l.Y>: effect in developing typhoid fever, 151 ; exam- ples, ib. Milk, ass's, 141 ; chemical composition, 140 (** Ass's Milk ; also Milk, Substi- tutes for Human). Milk baths in defective assimilation, Dr. H. Wright on, 234 Milk, cow's. M'J ; < '.icmical composition, 113 (v$ Cow's Milk; also Milk, Substi- tutes for Human). Milk, <'>! dented, 157; Aylesbnry and An- glo-Swiss Company, if> ; Norwegian, 158 ; not liable to infection fnun typhoid fever, ib. Milk, correction of inferior, 168; Drs. Min- chin and Mere! on, ib. Milk, desiccated, 157; Moore's, ib.; Grims- dale's, ib. Milk, goat's, 141 ; chemical compov 148 (f Goat's Milk; also Milk, Substi- tutes for Human). Milk, human, normal quantity secreted, :,I. :..'. consumed by a child. 51. 127; voked occasionally in breast by a men- Htrual period, (11 ; vicarious seer tion of. ft., 03; in urine and expectoration, 08 ; characters of good human, 123; micro- scopical characters, ib. ; chemical com- position, 188; v.'l rilr. principles in. diseawd, 124; occasional acidity, 264 INDEX. animalcular impregnation, 100 ; varies with age, 125; temperament, 126 ; how to detect insufficiency in breast, 118, 128; artificial, 171; Lobb's process, mincasea, ib. ; Falkland's, ib. ; Turner's, 172 Milk, inferior (see Correction of), hurtful from deficiency or excess of one or more | ingredients, 134 Milk, influences which affect, age of ani- mal, 125 ; season, 144 ; time of day, ib. ; transport, 194 ; boiling, 171 ; keep- ing, 123 ; temperament, 120 ; mental emotions, disease, 73; quality of food, 142, 145, 146; quantity of food, 123 Milk, nutritive properties, 129; depend on combined presence of (a) combustible, (b) nitrogenous, and (c) mineral ele- ments, ib. ; (a) combustible. 1st. Fat, 1'JO ; nature of it, ib. ; importance as ' an aliment, ib. ; sources derived from i in food, ib. ; quantity in milk, ib. ; is ' nucleus of coil-growth, ib. ; forms color- 1 less blood-globules, ib. ; exists free as a fatty acid, ib. ; with oxide of lipyl, ib. ; j this excess compensates for inaction of ' pancreas in a child, 131 ; also assisted ; by phosphate of soda to form an emul- sion, ib. ; assists digestion, ib. (see Fat). 2d. 811 gar, 129, 131 (see Sugar) ; (b) nitrogenous element in, 133 ; as casein, ib. (see Casein), (c) saline or mineral in- gredients in, 134 ; phosphate of lime, ib. ; of soda, 135 ; absent in cow's milk, 131 ; phosphoric acid, 135 ; chloride of potassium, ib. ; ashes of milk, ib. ; table of, ib. (See for Salts under separate heads.) Milk, substitutes for human : (a) Animal (see Human Artificial Milks ; Ass's. 141 ; Goat's, ib.; Cow's, 142 ; and Mare's Milk, 14G ; Eggs, 158, 159). (b) Vegeta- ble, 173; arrowroot, 175; barley, ib.; wheat flour, 176 ; bread, 178 ; lentil powder, or revalenta, 182 ; baked flour, 183; Robb's biscuits, 188; Yorkshire! food, ib.; tea, ib.; Mixed animal and \ vegetable : Liebig's malt extract, 184 ; Wells' vegeto-animal food, 183 ; Nestle's milk food, ib.; Hassall's food, 186 Milk, mixtures of, prejudice against falla- cious, not dangerous, 40, 41, 210 ; how it can be safely done, 216 ; great preser- vative influence of human breust-milk combined with other milks, 40, 210 Milk weed, or vetch, as a galactagogue, 98 3Iiuchin, Dr., on correction of inferior milks, 168 Mineral ingredients (see Milk, Saline Ingre- dients of) ; proportion greater in animal than vegetable, 173 Mortality of Infants: Greatest in first month of life; Qu telet on, 1, 33; in eany periods, 1, 2, 9, 21, 30, 33; under one year old, ib.; in England, 1, 21, 22, 34; France, 21, 34; Dr. Watteville on, 2G ; in early months, Eugland, 1842, Appendix D., 245; in lying in hospitals, 19; Registrar-General on, 1, 22; Lethe- by on City of London, 2 ; Yorkshire, ib.; Eugland, 22 ; Paris, fearful in. 30 Mortality of Infants: Causes which favor, 8 ; early months of life (see Mortality of in early months, Appendix D., 245) ; want of breast- milk, 8 ; in Ireland, 11 ; in England, as compared to deaths from developmental diseases, table, 12 ; de- fective hygiene, 19; Dr. Payne's expe- rience, ib.; want of maternal care more fatal, as opposed to want of fresh air, 21, 22 ; increased by exchange of a mother for another wet nurse, 16 ; sta- tistics, 16, 17 ; increased by mercenary Buckling, 30 ; fearful in France, ib.; Brochard on, 31 ; neglect, 28 ; town residence, as opposed to country, 22, 35 ; diminished by out-door living in Ireland, 22 ; exposure, 25 ; cold, influ- ence of season winter, 35 ; autumn, 36 ; illegitimacy, England and Wales, 111; Marylebone, 112; St. Pancras, 113 ; Mr. Acton on, ib.; infanticide, 114 ; developmental diseases, 199 ; faulty or defective nutrition, Muir and White- head at Manchester, 7, 39; elsewhere, 199 ; abdominal diseases, 7, 199 ; Brigh- ton, 15; Appendix C., 242; endurcwe- ment cellulaire in France, 10 Monot, Dr. , on mercenary suckling, 30 Moore, Mr. S. D. , desiccated milk, 157 ; cocoa and milk paste, 190 INDEX. 265 Morris on raw meat as an aliment, 165 ; cases, 220 Motions of infants, as diagnostic of dis- ease (see Faeces . Motions of infants, as indicative of normal digestion, 138 (see Faeces). Mouries, M. Mege, on cerealin and vegeta- ble casein as ferments in bread, 178; activity of cerealin destroyed by a high temperature, 179 Mulder on soluble matters in tea, 189 Murcbison, Dr., and Dr. Whitmore, on typhoid fever produced by watered milk in Marylebone, 151 K Napkins, nursery, mode of dealing with, to avoid disease. I Napoleon, Emperor, on founding hospi- tals, 196 ; his error in judgment, ib. Nasse, on composition of the blood. 137 Neglect increases mortality of children, M Nestle's milk food, 182, 183 (see Food) ; Appendix E., 24'i Newman on belladonna in gnlactorrhcea, G7 Nigella sativa, or gith, fennel flowers, devil in a bnsh, as a galactagoguc, 99 Nipple*, s. !-. produced by non-suckling, treatment of, 82 ; sore, or imperfectly formed, an a cause of defective lacta- tio; ; sore, as preventive of a mother suckling, 107 ; Mr. Cooper's in- dia-ruM>er, 'Jl'J; improved many- holed, if' ; should be kept scrupulously clean, may cause disease, 213 uckling mothers, injurious effect* of the practice, 5b ; diseases engendered, Normandy, Dr., on state of Clerk en well dairies, 154 Norwegian condensed milk, 157 (we Milk, Condensed). Nursery, appointments of a well-regulated, 885 ; temperature, 22ft ; ventilation . ablutions, 227 ; powder, ib. ; soups, :n. faulty, chief cause of mortality of children, 7; statistics, Appendix A., 241 ; in Brighton. 15 ; Appendix C., 242 (*ee Mortality, causes which favor). O. Obesity of breast as a cause of defective lactation, 72 Over suckling, injurious effects of, 54, 57 P. Palma Christi as a gnlactagogue, 90 ; dis- covered by Spaniards, 91 ; employed in England, 1850, ib.; Dr. McWilliam's notice of it us bofareira. ib. ; two varie- ties, one galactagopue, the other eramen- agogue, ib. ; mode of employment in Cape Verde Islands, ib. ; experiments repeated by Dr. Tyler Smith with, 92; by Dr. Konth, 94 ; occasional objections to, 9:3 ; Mr. Thomas Greenish's prepa- ration. 93 ; effect on non-suckling wo- men, 94; occasionally emmenagogna, ib. ; Mr. Robinson's cases, ib. ; general effect as a galactogogue when exhibited internally, 93 ; cases, ib. Pancreatic emulsion, Dr. DobeH's, 162, 200 Pancreatic juice, artificial, 205 ; pancrea- tine, 206; emulsion, ib. (tee Fatty Mat- ters) ; uses in emulsifying fats. Bernard on, 205; yet not essential, Frerichs, Lehmann, Lcng on, ib. Parker, Dr. Langs ton, on uterine syphilis, 109, 124 Panncntier and Deyeux. influence of food on milk. 145 ; causer of acidity of milk, ; from unhealthy sheds, ib. ; disad- vantage of boiling milk. 171 ; on vola- tile principles of milk. !'.>: Parsley, or apium mtivnm, as a galactft- gogue, 99 Payne, Dr., on defective hygiene M ft cause of mortality, 10 Pcligot on soluble matters in tea, 189 Pcpnine. 804 ; liquor pepsinis, Joulin's, in inanition of infants, ib. (* Gastric Juice, ib.). Perambulators, uses and abase*, 889 Phosphite of lime. 1.'14 ; one of mineral in- gradient* of milk, ib. ; 266 I:N T DEX. ton, ib. ; an acid phosphate makes bread lighter, 180 ; makes carbonic acid more soluble in blood, 134 ; and, secondarily, enables it to hold more carbonate of lime in solution, ib. Phosphate of soda, 135 ; alkaline reaction, ib. ; solvent of blood in carnivorous ani- mals, in lieu of carbonate of soda in herbivora, /!>., 173 ; assists in emulsion of fatty matters, 131, 207 ; absent in cow's milk, and sometimes may explain why cow's milk disagrees, 131 ; predomi- nates in serum of blood, 137 Phosphate of potash, predominates in blood -cells, 137 Phosphoric acid, acid of flesh, 135 ; in eggs, 159 ; in inilk, 136 Playfair, Dr., influence of food on milk, 145 Polygala vera or coronilla juncia, or milk vetch, as a galactagogue, 98 ; perhaps same as milk weed, ib. Porter as a galactagogue, 86; combined with milk, ib, Position, recumbent, abuse of during feeding, 27, 129 Potash, phosphate of (see Phosphate of Potash). Potassium, chloride of, 135 ; in soups and ashes, ib. ; may be useful partly as sub- stitute for chloride of sodium, 136 ; but cannot supersede it, ib. ; Robin and Verdeuil on its uses, ib. ; dissolves car- bonate of lime, ib. ; excessive in cell- growth, ib. ; and muscle, ib. ; defective in blood, ib. ; injection into blood kills, ib. ; exists in large quantities in milk, t&., 138; predominates in blood-cells, 136 ; and in gastric juice, 137 ; and eggs, 159 ; present in lentil powder, 182 ; ab- sent in baked flour, 183 Powder, lentil, 182, 223 (see Lentil Pow- der ; Taylor's civolia laevigata, 227 Public institutions, mortality in, of Ire- land. 20 Pulsatilla, or anemone pratensis, as a ga- lactagogue, 99 Q. Quetelet, mortality in first months of life, 1, 33 ; increased by hired wet nurses, : 16; mortality first year of life, 29, 33; greater mortality of male children, 37 ; on viability of man, 319 Quinquefolium vulgaris, or potentilla rep- tans cinquefoil as a galactagogue, 99 Raw meat, simple juice, or beef, essence of, 161 ; preparation, ib. ; pepsinized juice of, ib. ; preparation, 162 ; compo- sition, ib. ; in constant retching, 219 ; in diarrhoea, ib. , 221 ; Dr. Morris's cases, 220 ; in secondary syphilis, ib. ; in extreme debility, ib. ; on adults, 221 (see Under-done Meat) ; in gastrodynia, ib. ; in typhoid fever, 222 ; in sequelae of scarlatina, ib. ; pulp of, Trousseau on, ib. ; antipathy to, may be overcome, 221 ; Leverett's experience of, 164, 219, 222; Caspar Lewis on, 164; Morrison, 165, 220 ; Hopkins on, 222 Registrar-General, classification of diseases, 5 ; mortality from, ib.; from want of breast-milk, 11 ; mortality in first months of life, 33 ; Appendix D., 245 ; first year of ditto, 34 ; on influence of season on mortality, 35; of cold, ib.; on infanti- cide in London, 115 Removal of children a cause of mortality, 26 Retching, constant, tea as an adjunct to milk in, 218 ; cases. 21!) ; raw meat in, ib.; prussic acid in, 235 ; nitrite of amyl in, ib. Richardson, Dr., of Tunbridge Wells, iron in galactorrhoea, 69 Ricinus communis leaves, 90 (see Palma Christi). Rickets produced by too frequent child- bearing, 60 ; other causes, 236 ; by men- struation during lactation, 237; varie- ties of the disease, ib.; treatment, 238 (see Deformities). Riossey, Baron B., on influence of light on development, 42 Roberton, Mr., powder of meat, 163 Robinson, John, on the occasional diu- retic effects of palma Christi, 94 ; cases, ib. Rocket as a galactagogue, 90 IXDEX. 207 Sakeik as a galactagogue. 101 Saline ingredients (see Milk, Saline Ingre- dients of). Salter, Dr. Hyde, on adulteration of milk with water, 150 Salts, inorganic, table of, in blood and plasma, 137 ; in wheaten flour, 177 ; ad- dition of makes bread light, IbO (see Milk, Saline Ingredients of). Sanderson, Dr., on adulteration of milk, 150 ; unhealthy cow sheds, 155 Saponaria vaccaria as a galactagogne, 89 Savage, Dr., on use of tea in diarrhoea, 219 Schmidt on analysis of food, 137 Schwnnn and Viborg, on cutaneous respir- ation, - J '::l Schwartz, composition of human milk, 134 Sea-bathing for wet nurses, Z'-ll Season, intim-nce on mortality, 35 Sedgwick. Dr. Leonard, injurious effects of yellow arsenical papers in rooms, 2ol Simpson, Sir James, on oily inunctions with cod-liver oil, 2:J4; in emaciation, ib. Skinner, Dr., on electricity in defective lactation, 80 Smith, Dr. Edward, on tea, 190 Smith, Dr. Tyl- r, on palma Christ! as a galactagogne, 93 Soaps, uses of, in a nursery, 228 Soda, phosphate of, \-'>~> ; nub- phosphate, 1 T:! (tee Phosphate of Soda) ; carbonate of, ib. (tee Carbonate of Soda). Sodium, chloride of, l:!'5 (*ee Common Salt and Chloride of Sodium) ; in measure compensates for chloride of potassium, ib.; but cannot supersede it, ib.; pre- dominate* in blood. /' : I -tit not in blnnd- cell*, l-! s ; in small quantity only in muscle, ib. Sonchns arvensis as a galactagogne, 90 Soaps, whiting and conger eel as galacta- gognes, 85 ; pea and bean, ib. ; bone, and jellies, 100 : units which enter into composition of Stark, Dr., influence of color on develop* rnent of children, 43, 930 Stewart, Dr., of New York, on exhibition of farinaceous food to infanta in Paris, 174 Stranger, Dr., on courtesans as we tnurses, 110 Sucking, Dr. Ballard on fruitless, 76, 2U ; danger of, ib. Suckling, mercenary, danger of, and mor- tality of children from, 16, 116 ; Douuc on, 30 ; Monot on, ib. ; Brochard on, 31 ; Husson on, ib.; Plon on, ib.; London Foundling Hospital, 40 Suckling, nan-, danger to mothers, 58 ; abscess, fever, cancer, 58, 59 ; leading to permanent enlargement of womb, nl- oeration, and other womb diseases, 59 ; danger to children, leading to rickets, GO Suckling, ocer-, dangers of, 54, 57 ; to child, (JO Suckling, circumstances under which should be prevented, 103 ; specific dis- ease in mothers, ib.; consumption, ib.; insanity, ib.; cancer, ib.; scrofula and syphilis, 104 ; where milk disagrees with child, 104 ; bnt great care should be taken to be sure of this, ih. ; may be allowed with one breast only, 105 ; where milk is diseased in both breasts from presence of animalcnla, ib.; in cases of incurable sore nipples, 107 Suction of breast as productive of flow of milk. 76; in virgins, 76. 77; in old women, even past change of life, 76 ; in grandmothers (Dr. Livingstone's experi- ences in Africa), ib.; Dr. P. 8. Waddy on ditto, 77 ; on men. ib. ; oases, ib. ; faculty of once lost not recoverable by an infant, 211 ; temporary loss from ex* hnuHtion, ib.; sometimes prevented by use of improper nipple, ib.; of raw meat in substance in diarrhoea, 938 Sugar, ft combustible ingredient in milk, 129, 131 ; two varieties found in body, grape or liver sugar and sugar of milk, ib.; dissolves carbonate of lime, brings about vinous sad butyric fermen- tation. 182; not secreted but separated by mammary gland, ib.; increased by feed- ing on starch sad sugar, ib. ; evil effects of a diet too exclusively sswcbsrlne, 182, 268 INDEX. 148; quantity in milk, 133 ; absent in cream, 157; as a corrective of poor milks, 170 ; advantages of sugar of milk, ib.; allays diarrhoea, id. T. Tapioca as a galactagogue, 96 ; mode of . growth, ib. Taylor, Mr., his civolia laevigata powder, 82, 227 Tea, mountain, as a galactagogue, 97 ; too'sie, as ditto, ib. ; beef (see Beef Tea) ; sweet-bread tea as pancreatic emulsion, 1(;2 ; ordinary tea, 188 ; resembles juice of flesh, ib. ; chemical composition, 189; advantages of, ib. ; Dr. Savage on, 219 ; in diarrhoea, ib. ; iii constant vomiting, 218; case, 219; Dr. E. Smith on, 189; increases transformation of other foods, specially carbon, ib. ; prevents increase of perspiration, 190 ; bran tea as a sub- stitute for cerealin, 207 Teeth, growth in children is evidence of good development, 191 ; also as to power of digesting vegetable food, ib. ; order of appearance, ib. Temperament, influence on milk, 127 ; blondes and brunettes, ib. Temperature, low, as a cause of mortality of children, 25, 35 ; proper, of a nur- sery. 226 Temperature, Jdgh, young animals require it, 47 ; proofs from comparative anat- omy, 48 Test paper should be kept in a nursery, 208, 217; to note alkalinity of milk, ib. Theobromine, 190 (see Cocoa). Thomas, Dr. Gaillard, on treatment of galactorrhoea, 66 Thompson, Dr. R. D., on adulteration of milk with water, 150 ; table of combus- tible and nitrogenous matter in food, 174 Thorwarth, Dr., on influence of fear on lac- tation, 75 ; on suction of breast in defi- ciency of milk, ib. Thudichum, Dr., on effect of fatty acids on chyle, 135 Tilt, Dr., on painful breasts during men- struation, 62 Tops and bottoms as an aliment, 223 Town and country, influence of cold on mortality in, 35 Trichina) in raw meat, 165 ; dangers of, 166_ Trousseau, Dr. , on raw meat, 222 ; antipa- thy to, may be overcome, 221 ; cases, 221, 222 Tubercle in children, 238 ; varieties, ib. ; as phthisis, ib. ; scrofula, ib. ; causes which develop, 239 Turner, Mr., preparation of an artificial milk resembling human, 172 Typhoid fever produced by admixture of bad water with milk, 151 , 208 ; example, Islington, 151 ; Leeds, ib.; Moseley and Balsall Heath, ib. ; Marylebone, ib. ; Crossbells, ib. ; Keagley, ib. U. Under-done meat preferred by some, 221 Uterine syphilis in a wet nurse, Mr. Lang- ston Parker on, 109, 124 Uterus, diseases of, induced by non-suck- ling, 59 V. Vegetable substitutes for human milk, 173 (see Milk, Vegetable Substitutes of) ; food not digestible by young infants, 174, 203; Stewart and Guillot on, 174; in- jurious effects of, 175 ; of arrowroot in particular, ib. ; when to be given to children, 190 ; general rules, Appendix E., 246 Vegetable mixed with animal food (see tinder head of Milk, Substitutes for), 184 Vegeto-animal food, Mrs. Wells', 183 ; ad- vantages of it, 223 ; Appendix E., 246 Ventilation, effects of bad, 19 ; needed in a nursery, 226 Viability of infants in early years, Quete- let, 39 ; breast-milk favors it, ib. ; has great preservative powers even when mixed with other food, 40 ; favored by light, 42 ; influenced by color, 43 Viborg and Schwann on cutaneous respi- ration, 234 INDEX. 269 Vicarious lactation, 62 Villerme, M., description of Lyons, Rheims, and Paris foundling hospitals, 9 Viper's bugloss as a galactagogue, 89 Virchow, Dr., on trichinae in raw meat, 166 Vogel on vibrionic milk in the breasts. 105 Volatile principles of inilk, 123, 194, 210 ; disadvantage of boiling, 171, 194 ; Par- mentier and Deyeux on, 194 ; are essen- tial to children, 190 Vomiting, constant presence in defective assimilation, 234 ; treatment, ib. (tee Retching). W. Waddy, Dr., on induction of lactation by suction, 77 Wakefield, Mr. , effect of removal on chil- dren's mortality, 26 Wardrop, Mr., influence of terror on lacta- tion and in producing convulsions in the child, 7o Warmth essential to a young infant, 47 ; evidenced by example of lower animals. Water as an aliment, 207 ; adulteration of impure with milk, cause of typhoid fever, 151, 208 ; cholera, 207; should be boiled before used wherever doubtful, ib.; mix- ed with milk sometimes produces diar- rhoea, Dnbois* views, 215; green stools, 216; sometimes causes constipation, ib. ; explanation of apparent contradiction, ib. Weaning, danger to mothers, 58 Wegscheider, Dr.. on normal digestion of infanta a proved by fasces, 188 Weight gained by a child first year of life, 52 Weisse. Dr. . on raw meat in defective as- siraiku: on. i<;i Wells, Mrs., vegeto animal food, 183, 238 West, Dr. , on r.iw meat in defective assim- ilation of infanta, 104 Wet nnrae (> Mercenary Ruckling); sub- stitution of a hired wet nunte for a mother increase* mortality of children, 16; Benoiston de Chateanncuf on, ib.; Browulow on, \b.; cleanliness to be in- sisted on, 231 ; objections to unmarried or fallen women as ditto, 109 ; reasons usually assigned for preference of them, ib.; (a) benevolent ; (b) selfish ; (e) some married women worse than unmarried, 118 ; difficulties and danger of selection, 109 ; presence of latent disease, ib.; oases, ib.; injurious influences on a household, 110; on the mistress of it, ib.; on the servants of it, ib.; case, ib.; incentive to crime. 111; may induce death of nurse's child, ib. ; may encour- age murder, 112 ; has a close relation to infanticide, 113; Mr. Acton's statistics on, ib.; Registrar-General on ditto, 114 ; danger to foster child, whose viability is thereby diminished, 15, 116 ; want of ex- perience of nurse, ib.; case, ib.; possible misconduct of ditto, ib. ; drugging by, ib. ; cases, 117, 118; starving the child, ib.; case, ib.; influence on future moral state of child, 120; physical qualifications of a good wet nurse: 1st. As to her milk, i-JI ; should be good milk, ib.; general characters of good milk, 122; microscop- ical characters of ditto, ib. ; chemical composition, 123; volatile principles of, especially, ib.; there should be a suffi- cient quantity, 127 ; amount of milk needed by a child, ib.; owing to his rapid growth, wl.ile suckling, amount needed varies with iU age, ib.; analogy of lower animals. 128; how to d deficiency of milk, ib.; 2d. As to//rra#- tary preditporitioru. \'2.\ ; should be good, ib.; special taints of disease to be a . ed, ib. 3d. As to age, 124 ; should not exceed thirty, ib.; should bo M near child's mother 1 * age aa pomible, 125 ; ef- fect of age on milk. ib. 4th. Aa to tem- perament, 12ft ; melancholic to be pre- ferred, ib.; difference* between blonde's and brunette's milk, ib.; lymphatic and nervous to be avoid. (1. 127 Whey, WM, 87, 200, 818, 847 ; milk. * I Whitehead and Mere! (awMflrei and \\ head) on frequency of abdominal die- eaaea in childrm. 190 ; on treatment of aenile atrophy in infanta, 808 Whiting soup aa a galactagogae, 86 270 INDEX. \Vhitraore, Dr., on typhoid fever in Mary- lebone induced by watered milk, 151 Wine, sweet, aa a galactagogue, 87 ; whey, 209, 218 ; Appendix E., 246 Worms, earth, soup of, as a galactagogue, Appendix G. , 249 Wright, Dr. Henry, on milk baths in dys- pepsia of infants, 234 Wymer, East, improper food as a cause of mortality among infants, 200 Y. Yorkshire food, 182, 188 (see Food, Appen- dix E.,24U. You.ng, Dr., on injurious effects of non- suckling, 58 Z. Zenker on trichinae in meat, 166 Ill 1034 DATE DUE NOV 1 5 1977 BPU OCT 2 3 1983 HKD NOV 3 1977 MAY 1 ic 86 fe. DEC" | 3 13/7 orrn NDV 1 4 1Q77 RECD JQM ! 1985 nCvlS !VJ * * 3P(j fl p R ?.9 7997 I rr IfN 3 1979 0\ AN 8 1979 DEC 8 1987 v/Ur --. --; -y ffci JVN : 1980 ULU 5 , , -, iQnf\ RECD M* ^10 "3"^ JUh RFCD JUN 1 'I 1980 9 isao It OC r 2 1981 W net JUN 1 "a r~ JAN 7 1983 iECD DEC 10 1982 MAR 71983 RECD Mflp 9 JED OAVLOMO PNINTCD IHU A 3 1970 00288 0034 n r. : SOUTVCTN REGOML UORAflY FACUTV ^^" ^ fm i^ OTM ^B HUB A 000 883 589 4 - 1 ! . . '-. \ . ' -