GENERAL CONSIDERATIONS CONCERNING THE NOURISHMENT OF THE INFANT The fietus receives all substances necessary for its development through the mother's blood, and these substances enter the blood of the foetus without coining into contact with the digestive tract. The or ganism of the infant is separated from that of the mother at birth, and with this act a sudden and great takes place. The little new comer has to dispense with protecting cover and is exposed to the dangers and injuries of its new surroundings. particularly to a consid erable undercooling. The needed oxygen has to be supplied through the hitherto inactive lungs and blood circulation. The food requirement increases very much, and the food introduced from without has to be prepared for utilization through the activity of the stomach and the intestine. The great majority of newborn infants are exhausted by hardships undergone at birth, and some are injured considerably. It is really not surprising, therefore, that of those who die within the first month of life about one-fourth do not survive the first day.
A great many newborn infants would not have many chances to escape, emerge victorious and unscathed from this serious struggle for life, if nature had not provided a food perfectly adapted to their require ments and their powers of digestion. For in spite of the separation of the bodies of the infant and the mother, the mother is capable of pro viding the nourishment for the newborn for several months, in the form of mother's milk. It is well known that the great majority of infants receiving the natural food from the mother's breast do well and rela tively rarely suffer from disorders of nutrition. On the other hand, the mortality among artificially fed infants, particularly during the first month of life, is exceedingly great, and this mortality is due in great measure to disorders of nutrition. The health of many of the surviving infants may be unmistakably impaired for a longer or shorter period of time, so that it is easy to distinguish the breast-fed from the bottle-fed simply by their appearance. This empirical observation finds its explan ation in the investigations of more recent years. It was shown that the milks of various animals differ considerably. Bunge expresses the view that for suckling purposes the milk of one animal can never completely replace that of another. Although some of Bunge's assumptions have been shown to be untenable, his views as a whole are justified and have received confirmation through the biochemical investigations of recent years.
While there is no doubt that the mother's milk is the best food for the newborn infant, there are several reasons why, in Germany at least, only a minority of infants receive breast-milk exclusively. The majority of infants are raised partly or entirely artificially. The noblest and most satisfying duty of the physician and hygienist is to alter this state of affairs, and to insist that as many newborn infants as possible shall receive the benefit of the breast-milk. Within the last few years a cer
tain improvement has crowned the efforts undertaken in this direction. and to show how much can lie done, the. following example is cited. llerdegen, in 1882, inquired into the nursing ability of the women de livered in the school of midwifery in Stuttgart. These women remain in the institution for twelve days after parturition. Only 23 per cent. were able to nurse their infants. the same institution in 1004 Martin made observations regarding the same problem, and the interesting fact was found that nearly 100 per cent. of the women were able to nurse their infants. The material was furnished in both cases from about the same classes. No doubt the ability to nurse did not increase to such an ex tent in this short period, and it must be assumed that the figures of Iler degen did not give a true picture of the conditions. The number of \ able to nurse increased only because it is insisted on more vig orously now that all women able to nurse must actually do so. This example illustrates clearly, moreover, how little we can rely on statis tics, particularly on old ones, with regard to the ability to nurse, and how careful we have to he in their use. A comparison of the figures given by Herdegen with those of previous years form the mainstay for the argu ments of Runge concerning the increasing inability of women to nurse.
Alany physicians do not show the necessary interest and under standing in the effort made to increase maternal nursing. It frequently happens that obstetricians pay more attention to the welfare of the mother than of the child, and do not lay sufficient stress on nursing:: or they even advise against it without having any valid reason to offer. Not infrequently, physicians claim that artificial infant feeding has reached such a high degree of perfection that it is not inferior to the breast-feeding, while in certain respects it is even more convenient to carry out. It must be conceded that at present artificial infant feeding can he carried out on understood principles and with the prospect of good success. In former times it was a dangerous experiment, in the execution of which the physician had to grope in the dark or had to rely on trials for which there were no due indications. hut often artificial feeding does not succeed in spite of all efforts, to say nothing of the num berless cases where the want of care or insufficient understanding is followed by severe impairment of health or even death.
On the other hand, the fanatic advocates of nursing go entirely too far when they affirm that artificial feeding cannot be but injurious, and that the species is bound to degenerate even if some children seem to grow up strong and healthy, so that after a number of generations the evil consequences \will be distinctly manifest. Nevertheless, artificial feeding can never completely replace the breast-feeding, for it cannot be carried out with the same certainty of success and it requires a greater expenditure of time. labor, and money.