DISTURBANCES OCCURRING IN BREAST-FED INFANTS In the first place the microorganisms normally present in the ducts of the mammary glands are in rare cases causes of enteric disease (Moro, von Rosthorn).
Overfeeding at the breast, through too frequent or too prolonged nursing, or both, can produce a number of disturbances, of which the symptoinatology will be described later.
Febrile diseases of the nursing mother can produce injury through marked impairment of the milk secretion, changes in its composition, relapse into the colostrum stage, and excretion of infectious organisms through thc milk. As to the last, the opinion of writers on this subject has recently been greatly modified, since, if infection by contact is avoided, the taking of such infected milk is regarded as doubtful tPerret).
To sum up, we niust consider it assumed that the most rational procedure is that which, apart from the conditions mentioned above, entails the least danger for the function of the infantile digestive organs, and guarantees to the infant a correspondingly thriving growth. Nour ishment at the breast of the mother can alone fulfil these conditions.
The next natural method of nourishment at our command is by a wet-nurse. This method adds a number of other possible causes of disturbance of digestion to those occurring with mother's milk. The first and most important of these conies from the fact that, if a new born infant is put to the breast of a wet-nurse who is already in full lactation, even with proper intervals of nursing, overfeeding with its results easily occurs. This is readily explained physiologically, since a source of nourishment which is already richly flowing is offered, instead of the normal course of development of milk production, in which the child cooperates through the sucking reflex. Thus the child, because it can get its nourishment without trouble, can easily get too much, moreover there can be no doubt that, through the close genetic rela tion between mother and child, the sucking power, capacity of the stomach, and resisting power of the bowel of the infant, are closely adjusted to that particular source of nourishment, which has itself grown to maturity parallel with the ovum, and which has been stim ulated to its full function by the suckling's own activity. IIowever,
the disturbances caused in this way are for the most part slight, and of a transient nature, because of the great generic similarity of (Effer ent human milks,it being granted that the physician in his choice takes into consideration the Vari 011S existing circumstances, and finds a wet nurse closely adapted to the requirements of the child. Nevertheless, in spite of the marked superiority of the natural method of nourishment, one should neither minimize nor entirely neglect its possible evils.
Except in the first days of life, when a very profuse flow fronl the breast can prove a drawback, the period of time since the nurse's con finement does not play a very important part, provided that, as is usually the ease, too great differences between the duration of lacta tion and the age of the child are avoided. Also. to a certain extent, an adjustment takes place, since supply and demand are mutually regulated, and after a time child and nurse become fitted to each other. Indeed too much reduction of the secretion can occur, the effort for diminution going as far as drying up the breast. On the other hand, as experiences in various German Infants' Homes demonstrate, through training, a milk secretion can be attained which far surpasses the nor mal in amount, but which, in my opinion, always suffers in respect to the quality of the product.
The die1 of the 11.0-nurse is only very rarely a cause of disturb ance of digestion in the infant, and what has been said and written on this topic has been largely exaggerated. Violent assaults upon the digestive organs of a mother, or of a robustly organized wet-nurse, are required, to call forth disturbances which shall exercise their in fluence upon the child. I remember that during my hospital service in the Foundling Institution the diet of the wet-nurse, before the in troduction of proper management, was of more than doubtful quality. Nevertheless there was scarcely ever observed any influence from this cause upon the health of the children. These observations are made, not to favor unlimited discretion, but to prevent exaggeration, and useless restrictions in the matter of the wet-nurse's diet.