Aside from the foregoing precautions, the healthy development of the infant at this period depends upon rational nourishment.
It remains, at this point, to advance all the rules and measures pre senting the greatest advantages in the rational feeding of infants, this being the best prophylactic against disturbances of the digestive appa ratus, and consequently an agent in reducing infant mortality. These rules and measures may be found in detail in the chapters on "Milk" (Raudnitz) and "The Nourishment of the Healthy Infant" (Camerer). I should like to proclaim but one thing, which is of supreme importance in the study of the feeding of infants and the prevention of gastro intestinal diseases at this age, and that is that there is only one rational food for the baby, and that is the natural mother's milk. All our efforts and striving have given us but a very inferior substitute. When the truth of this proposition is recognized, the physician who is interested in the hygiene of children and the prophylaxis of their diseases will do his best to promote this phase of infant feeding wherever he can. He must also work to the end that the young and rising generation of women may be properly trained to their future destiny of motherhood through plenty of healthful exercise and through the abandonment of tight clothing which may press upon the breasts and interfere with the func tions of the mammary glands. By instructing the mother, in the later months of pregnancy, as to the proper treatment of the breasts, the physician may accomplish much in the way of developing them and obtaining richer milk. It should also be his duty, whenever the oppor tunity presents itself either in his practice or in other circles, to urge the desirability of this method of feeding the infant, so that those inter ested may be made to realize that mother's milk is the only proper food for the baby. and one which it is almost always possible to provide. The young mother should be told that it is her sacred duty to nurse the child, and the physician should exert all his energies in assisting her to this end; and he should protest with equal energy against the not uncommon inclination to avoid this duty for social or supposed esthetic reasons.
The physician should make his field for spreading this teaching as wide as possible by preaching the great benefit of natural nourishment, and by making sure that midwives and nurses acquire more experi ence and a clearer understanding of the importance of this question; and he should see that the authorities energetically insist upon the enforcement of their duty in this regard, by bringing them under greater and stricter control. He should also exert his influence with the author
ities, urging upon them the necessity of proper pecuniary provision for poor women who are willing and able to nurse their own infants, but whose poverty forces them to go out as wet-nurses, and thus to sacri fice the health and life of their own infants in caring for the children of wealth. Here is an opportunity for philanthropic societies, to provide these "wet-nurses" with sufficient means of support for at least several months, not in the way of charity, but as proper compensation for the maternal duties which they assume. As a good beginning for the spread of this propaganda, the physician should establish stations for the care of infants, thus arousing the interest of the municipality, the state, and private societies, in the questions of infa'it feeding and the causes of high infant mortality. As time goes on and his teachings spread to a larger and larger public, his task will become lightened, and wider attention will he directed to the mother's prime duty.
But as the possibility for breast-feeding is not present in every case, the artificial feeding of infants must always remain as a necessary evil. In such case the watchfulness of the physician must be many sided, for the fact is that mortality and morbidity are far greater among artificially-fed children than among those nourished at the breast. In order to prevent the ills induced by artificial feeding, the physician him self must wield all the experiences gained and advances made during the last twenty years in the study of the organs of nutrition and of the metabolism of the infant. Simply stated, success depends above all upon our ability to give an unimpeachable (aseptic) milk. The step next in importance is to preserve the aseptic character of the milk from the moment of milking until it reaches the child. This is accomplished by keeping it cold, by handling it in the proper manner, and by protect ing it from contamination. In this matter also well trained midwives and nurses can prevent much trouble, and the physician can he of great assistance through his advice given at the stations for the care of infants (Fiirsorgestellen). The physician must, of course, possess the experience necessary to enable him to cope with the difficult problem of properly arranging the food formula for each individual case. This done, everything depends upon the proper quantity and frequency of the feeding.