The enormous importance of natural feeding, and the extent of the difference between artificial and natural feeding, are manifested by the following examples: The statistics of child mortality invariably show that in those European countries in which most children are suckled by their mothers, child mortality is lowest. In Sweden and Norway, where even the wealthiest mothers suckle their own children, mortality during the first year of life hardly amounts to 10 per cent., whereas in other European countries the infantile death-rate is 12 per cent. to 15 per cent., or even more. It is erroneously believed that there is a law in Sweden making it obligatory upon mothers to suckle their children. No such law exists. During the siege of Paris, in the years 1870–71, the infant mortality in that city fell from 30 per cent. to 17 per cent. The reason for this fall was that the Parisian women were forced to suckle their own children, for, owing to the siege, cow’s milk was unattainable, and the usual supply of wet-nurses from the country was cut off.
Natural feeding is not only better than artificial, but also cheaper. Of course, in considering the question of the cost of artificial feeding, the method employed has to be taken into account. For example, artificially-fed infants are often given much more milk than they really need. But artificial feeding is artificial, and whereas instinct prescribes the methods of natural feeding, it gives no guidance in the matter of artificial feeding. The changes occurring in the female breast in consequence of pregnancy and childbirth draw a woman’s attention to the fact that she has certain maternal duties to fulfil. The neglect of nature’s commands commonly entails disorders to health. It remains uncertain whether disease germs can be transmitted to the infant through its mother’s milk. It is still more questionable whether, in the act of suckling, vitally important maternal qualities can be transmitted from mother to child. There is some doubt whether the continuance of lactation is a fairly sure preventive of the occurrence of a fresh pregnancy. If this question can definitely be answered in the affirmative, there can be no doubt that for a mother to suckle her infant gives an increased chance of life not to that infant only, but to the other children in the family, because thereby these children are relieved of the dangers entailed by too large a family.
History of Artificial Feeding.—It is uncertain during what respective periods of human history the practice of rearing infants by means of wet-nurses, and the practice of rearing them by artificial feeding, first made their appearance. To-day, certainly, both these methods of rearing infants prevail very widely—far more widely than at any former time. No official statistics exist showing the proportion of all infants born alive that are suckled by the mother, suckled by wet-nurses, and artificially fed, respectively. According to some private investigators, in large towns less than half of all infants are suckled by their own mothers, and in France the proportion of those which are otherwise nourished is said to range from 60 per cent. to 70 per cent. Certainly, the conditions with regard to this matter are worse in France than they are elsewhere.
Many physicians believe that the constitutional incapacity of women to suckle their children is increasing. They point out that an unused organ tends to atrophy; and they consider, not merely that the incapacity to suckle is transmitted by inheritance, but that when so transmitted, the incapacity persists throughout all subsequent generations. But this view, whose soundness would deprive us of our most effective weapon in our campaign against excessive infant mortality, is erroneous. The recent investigations of various medical practitioners especially interested in the diseases of children have shown that (even in districts in which for generations mothers have almost completely abandoned the practice of suckling their children), when properly advised, 90 per cent. of all women proved capable of suckling, if not for the full nine months, at any rate for a considerable period, before it was necessary to have recourse to cow’s milk. There are doubtless women who are really unable to suckle their children; and there are others who could do so, but in whom suckling is contra-indicated, either in their own interest or in that of the child. For example, a woman who is pregnant cannot give suck, for the human organism is not adapted to bear the common strain of pregnancy and of lactation. In the interest of the child that is being suckled, it is necessary that weaning should be effected directly a new pregnancy begins. Women suffering from chronic alcoholism and those addicted to morphine should not suckle their children, for the reason that a comparatively large quantity of the alcohol ingested, or of the morphine, as the case may be, is excreted in the milk. A child suffering from an infective disease, such as syphilis or tuberculosis, should be artificially fed, owing to the danger of infection.
Causes of the Failure to Suckle.—The reasons for a mother’s failure to suckle her infant may be classified under two main heads: she will not, or she cannot. Unwillingness plays a great part among the upper classes of society. Dread of inconvenience, laziness, fear of the loss of physical charms, social duties and pleasures to which such women devote a great deal of time, and which they are unwilling to renounce—such are the considerations operative in these cases. Inability to suckle is a more frequent cause among women of the proletariat. In consequence of their poverty, such women are often forced to work away from home the whole day long. It is not yet definitely ascertained whether constitutional inability to suckle is commoner among proletarian women than among women of other classes. It is a greater evil for a proletarian mother to fail to suckle her infant than it is for a mother of the upper classes similarly to fail. The proletarian mother cannot afford to pay a wet-nurse, and the child must therefore be artificially fed. In this event, the proletarian mother is likely to feed her child less well than an upper-class mother who also adopts artificial methods of feeding, for the former is too poor to obtain the best milk, and she lacks time to prepare the milk properly, and to give it to her child in suitably small quantities and at suitably short intervals.
The idea that a smaller proportion of mothers of the poorer classes suckle their children than among the well-to-do is erroneous. But it is a fact that of those children who are not suckled by their own mothers, among the upper classes a much larger proportion are suckled by wet-nurses than among the lower classes; it is also the case that when children of the upper classes are not suckled by their own mothers, they commonly have wet-nurses in their own homes, and are not entrusted to the care of foster-parents; and finally, when we come to hand-fed children, among the upper classes a greater proportion of these are comparatively well fed than among the lower. A smaller percentage of illegitimate than of legitimate children are suckled by their own mothers; a larger percentage of the illegitimate than of the legitimate are artificially fed. The unmarried mother is in most cases poor, the birth of the child makes her poverty extreme, and by no means always does she receive a maintenance allowance from her child’s father. To be able to live, she must either act as wet-nurse to another woman’s child, or must go out to work.
Wet-Nurses.—Poverty not only makes it impossible for many women to suckle their own infants, but forces them to suckle the child of another. The great majority of wet-nurses are recruited from the ranks of the proletariat, and, indeed, for the most part, belong to the class of unmarried mothers. Married women are less inclined to sacrifice their own child for the good of the child of another woman. The readiness of many mothers to renounce the duty of suckling their children is perhaps referable to the fact that wet-nurses may be procured so easily and at such small cost. Thus poverty is also an indirect cause of the fact that many upper-class mothers fail to suckle their children. The children of wet-nurses are either fed artificially, or suckled by another woman. The sad position of such children, and their enormous death-rate during the first years of life, are only too well known. When a woman takes employment as a wet-nurse, two children suffer—(a) the child she suckles, and (b) her own child, which would otherwise, in all probability, be suckled by its own mother. In favour of the traffic in wet-nurses, it is frequently maintained that the children of wet-nurses, owing to the good wages earned by their mothers, are well cared for, whereas otherwise they would be badly cared for. The sophistical character of this argument is sufficiently obvious.
If a child is not suckled by its own mother, it is either suckled by another woman, or else artificially fed; and the child may either remain in its maternal home, or it may be sent to be reared elsewhere. If the infant is sent elsewhere, either its relatives or some benevolent society may arrange for its care. Wet-nurses are thus resident or non-resident. In foundling hospitals, those wet-nurses who give suck to children in the institution are known as resident wet-nurses. From the standpoint of civil law, resident wet-nurses have entered into a contract of service with their employer, and the latter undertakes to provide in return for their services a stipulated remuneration. A non-resident wet-nurse, on the other hand, undertakes to provide in a certain manner for the infant boarded with her. It is obviously preferable that an individual child should be suckled by a resident wet-nurse, since in such conditions the wet-nurse can be supervised much more strictly than when she receives the infant in her own home. But in the case of children in a foundling hospital, it is preferable that they should be boarded out with non-resident wet-nurses, for in the present condition of medical science, the institutional care of infants is a very difficult matter to carry out with success.
But the choice of a wet-nurse involves other considerations in addition to those just stated. A woman can safely be employed in this capacity only if her own confinement has taken place some little time before. By suckling the child of another the wet-nurse deprives her own child of its natural nourishment. The wet-nurse may be suffering from some infective disorder, and may transmit this disorder to her nursling. Conversely, the nursling may be suffering from congenital syphilis, or from tuberculosis, and may infect the nurse. It is very difficult in infants-in-arms to recognise syphilis with certainty. For these reasons it is only to healthy wet-nurses, for whose own children a proper provision can be made (for instance, when the wet-nurse’s child has already been suckled for six months, or when it has died), that the local authorities give permission to suckle the child of a stranger. This applies both to resident and to non-resident nurses. In the case of the latter, in view of the fact already mentioned, that they cannot be properly supervised by the child’s relatives, supervision by the local authority is indispensable. There are no physiological difficulties in the way of suckling two infants, either simultaneously or successively. The latter procedure is, however, to be preferred. In all civilised countries baby-farming has been subjected to legal regulations. Although these regulations vary greatly in different countries, they relate not only to infants, but also to older children. The age at which supervision of such children ceases is a very variable one. As an example may be mentioned the French law of the year 1874. This law deals with children boarded out by foundling hospitals, but only to those under two years of age received for a money payment. It is becoming obvious to-day to most persons that children boarded out by their relatives require official supervision, even if the children are received gratuitously.
Cow’s Milk.—Pure cow’s milk is the best substitute for the maternal milk. Where milk is to be used for infant-feeding, it should be drawn in a properly-kept cowshed, it should be cooled, placed for delivery in vessels of a suitable size for an individual infant’s meal, diluted or otherwise prepared as demanded by the age and special necessities of the case, and used as soon as possible. To-day the price of cow’s milk suitable for infant-feeding is so high that the lower classes find it almost impossible to obtain it. It is a matter of very great importance that good milk should be rendered available for the lower classes at a low price. Recently much attention has been paid to the improvement of the technique of milking, of the transport of milk, and of the care of milk when delivered. The local authorities supervise the production and transport of milk as a part of their public-health administration. Improvements in cattle-breeding, a thorough organisation of the cowsheds and dairies and of the methods of milking, and an organisation of the entire dairy business have effected much improvement. Both private associations and the local authorities begin to lay stress on the supply of milk for infants, especially in towns, in which the provision of good milk is even more important than it is in country districts. We must leave the question open whether infants can be infected by the milk of cows suffering from Perlsucht or bovine tuberculosis; it certainly cannot be a matter of indifference whether the milk contains tubercle bacilli. At the present time, unfortunately, in the anything but hygienic dairies of our country districts, many of the cows are suffering from Perlsucht.