In spite of everything, artificial feeding,—to use a term coined by Schlossmann, although the process is really far removed from art,— has been more and more widely adopted. It has increased under the influence of heredity, of the passion for unlimited enjoyment of life, of social requirements, of pernicious advice from persons around the mother, among whom midwives must be particularly mentioned, and finally- of exaggeration as to how much can be accompl:shed by physi cians with this method. We will here only refer briefly to the injuries resulting from the method of artificial feeding, which, according to general conviction, represents the most fruitful source of tliseases of the digestive organs in early life.
The following figures, from both earlier and more recent times, prove that we are guilty of no exaggeration, when we assign to artificial feetling the leading role in. the pathogenesis of such lliSCaSC processes.
According to Boeckh, the former competent director of Hie Berlin statistical department, Hie mortality of artificially, nourished infants is twenty times as great as that of breast-fed infants. In Munich the mortality of breast-fed babies amounted to 11 per cent., of bottle babies, S9 per cent. In Paris the figures were 1S.2 per cent. and 43.7 per cent. according to Eery. Shutt states that among 2000 cases of acute gastro enteritis collected by L. E. IIolt, only three exclusively breast-fed children were included. I will not quote any further figures, since those cited are sufficiently convincing, but will limit myself to showing that the introduction and improvement of the method of milk sterilization also, has had no noticeable influence upon infant mortality. According to Nobecourt, in all 24S5 infants died of enteric diseases in Paris in the year 1SS5, while in the year 1899 the number was only lowered to 2106. Also Fliigge could not demonstrate from statistics any diminution in the mortality of the first years of life s]nee the more general use of sterile or approximately sterile food. Caerny's results are the same, and iny own experience in the university poly-clinic ditl not result in my perceiving any lessening of the number of gastro-enteric cases in recent years.
The next question is, What is the nature of the damage which ar tificial feeding does to the digestive organs, and what is the unfavorable action upon the general health of the infant? We will begin with cow's milk and the disturbances caused by it, as it is the most widely used substitute for human breast-milk. The causes are partly digestive, partly biologic, partly bacterial. These etiologic factors, each of which has been in turn placed in the foreground as tbe sole guilty one, really are interlocked with one another, and their suni total is the cause.
If we take up first the chemical differences between human all (I COW'S Milk, we find that they' consist both in the quantitative percent age and qualitative structure of the several constituents. This matter has been so thoroughly- treated in former books, to which I can refer, that I need touch upon it only briefly here. The higher proteid and salt content and lower fat content ; the different percentage of the several varieties of proteid, the more easily assimilated proteicls being present in cow's milk in smaller amounts; the different chemical combinations of the salts, w-hich present thetnselves mainly as inorganic compounds; the different composition of the fat,—all these differences explain the fact that the digestion and assimilation of cow's milk must place a greater burden upon the immature digestive organs of the human infant. In spite of all assurances to the contrary (Oppenheimer, Budin, and others), which were somewlmt modified as the result of closer observation, the giving of cow's milk to an infant in the first weeks of life will always be a risky proceeding, even granted that the product is pure, and the feeding intervals exactly regulated.
The differences extend further than can be proved by chemical tests, anti a number of interesting works, which comprise chiefly com parative studies of the proteids of different kinds of milk, have taught us to recognize the specific character of proteid substances. This has been established by means of Bordet's method of the demonstration of the formation of a specific precipitin in the blood (Schlossmann, Moro, et al.). Indeed, by means of a comparatively simple clinical method, w-e are supplied with a possible proof that the admitted diffi culty of digestion of cow's milk is due to its heterogeneous character, since Moro and Gregor could demonstrate the appearance of a leucocy tosis after the first administration of cow's milk, whereas breast-fed children in the height of digestion show a leukopenia. If we consider in addition the fact demonstrated by Ganghofrer and Langer, that the entrance of a foreign proteid into the circulation of young children is followed by the formation of specific precipitins, and if we realize the associated processes in the organism, which, according to the pre vailing theories, must precede the formation of such antibodies, we will understand completely how the giving of cow's milk even to older infants can at times be follow-ed hy severe and even actually dangerous symptoms, and how it exacts a great deal from the functioning power of the organs of digestion and assimilation (Schlossmann, Finkelstein).