Diseases Related to Infant Feeding
Infant nutrition is intimately connected with health. Breast feeding was always recognized as the ideal method of nourishing infants but was not always practicable. If a mother was unable or unwilling to suckle her baby, wet nursing was a socially acceptable alternative until the beginning of this century.
In poorer families, however, nursing could be replaced only by artificial feeding. A fourth option, direct suckling from an animal, commonly the goat, was sometimes adopted on the European continent.The literature on infant feeding is enormous (for comprehensive historical studies, see Wickes 1953; Cone 1976; Fildes 1986). By the nineteenth century, physicians in the United States and Britain tended to discourage wet nursing because of the adverse effects on the nurse’s own infant, who was usually abandoned to foster care and the bottle. Efforts were directed toward increasing the safety of bottle feeding, perceived as the most important cause of high infant mortality. In 1867 Justus von Liebig, the renowned German chemist, marketed an infant food prepared on scientific principles (Drummond and Wilbraham 1958). It was not as perfect as he assumed (vitamins were then undreamed of), but it was the forerunner of an endless variety of proprietary infant foods. Many contained only powdered carbohydrates and thus, if not made up with milk and supplemented with other foods, could not begin to nourish an infant (for a discussion of interactions between physicians, infant food companies, and mothers, see Apple 1981).
A somewhat different situation prevailed in France, where it had become common practice by the eighteenth century for infants to be sent into the countryside to be wet-nursed together with the foster mother’s own baby (Sussman 1982). Infant mortality was even higher than in English-speaking countries, the fertility rate was lower, and in part because of the threat of depopulation, concerned French physicians finally introduced novel methods for improving infant survival.
In 1892 Pierre Budin, professor of obstetrics, organized a “Consultation de Nourrisons" at the Charite Hospital in Paris. Women who had been delivered at the hospital were advised on breast feeding and infant care; after discharge, the babies were examined and weighed weekly until weaned, then less frequently until they were 2 years of age. Great emphasis was placed on breast feeding, as well as on weight and height. Also in 1892 Gaston Variot, a pediatrician, organized the distribution of sterilized milk, at reduced prices, at the Belleville dispensary. Two years later, Leon Dufour, a medical practitioner in Normandy, opened a milk station, called the “Goutte de Lait,” at Fecamp. Here also babies’ growth was carefully supervised, and when breast feeding proved impracticable, sterilized milk was provided free or at reduced prices (McCleary 1935; Blake 1953).At first there was friction between Budin and Dufour because the former felt that the Gouttes de Lait, rapidly being established all over France, encouraged artificial feeding. But soon the two men compromised and together organized the first international conference on infant welfare (Congres International des Gouttes de Lait, 1905) held in Paris. Similar movements were developing in other countries. As early as 1893, the philanthropist Nathan Straus began organizing the distribution of pasteurized milk for children under 5 years of age in New York City (Straus 1917). At about the same time, Henry L. Coit arranged for the production of certified milk in Newark, New Jersey (Blake 1953). These pilot schemes demonstrated the possibility of ensuring a clean milk supply, although because of the expense involved city authorities only gradually adopted similar methods to ensure safe milk for all inhabitants. Rapidly disappearing, however, was the nineteenth-century conviction that breast feeding was the only safe way of nourishing infants. The new century ushered in greater professional acceptance of bottle feeding, spurred on by the availability of methods of checking the purity of milk and its bacterial content and of sterilization and pasteurization. Also novel was the awareness that incipient illness was often indicated by the failure of a baby’s height and weight to increase, measures that were easy to monitor on a regular basis.
However, as will be discussed in the next section, not until the 1920s was it understood why infants fed sterilized milk, or proprietary foods, might not thrive unless also given supplements such as orange juice.