Dr. A. S. Fleming: I would like to ask if in the case of the healthy infant the mother’s diet would modify the constituents of the milk otherwise than in the facts stated. For instance, will it modify the character of or the percentage of the sugar, or will any of the aromatic constituents disturb the infant’s digestion?
Dr. M. J. Jensen: Dr. Huenekens dealt with the feeding of the healthy infant only. I would like to ask if it is not true that nearly all infants born alive, are born as healthy and sound as any infant ever is, so far as the functions of its organs and tissues are concerned? Nature frequently decides on producing premature births and “still”-births, rather than running the risk of producing a sick or sickly infant. In young infants it is very often difficult to determine when to classify them as healthy or unhealthy, realizing the conditions of their environment and usual care that is given in the homes.
In regard to the sterilization or boiling of cow’s milk: I do not think that children fed on pasteurized or boiled milk develop as well as those who are fed upon raw milk as it comes from the cow. Dr. Palmer, of Chicago, fed seven hundred children on raw milk during the midsummer months and only lost three of the number. The miserable, atrophied children began to live the moment treatment with raw milk was begun. If the process of milking was carried out in a sanitary manner, or by means of a suction apparatus, then cooled, and placed in sterilized bottles, I believe we would prohibit the development of bacteria, and save the food which exerts so marked a protective influence upon the infant’s organs.
When raw milk free of all objections cannot be obtained, it is sometimes advisable to use another milk product namely, buttermilk.
Dr. S. Marx White: There is just one point I have been thinking about in the discussion on the question of infant-feeding, and that is whether Dr. Huenekens really means us to believe that in practically all cases the mother can furnish sufficient milk for the child. He passed that over in saying that in nine out of ten cases the mother gave as a reason for discontinuing the milk that the milk gave out. Is it not true that in a good many instances the mother needs treatment quite as much as the infant? I do not mean medical treatment, but management. Is it not true that an overworked, tired, nervous, worrying mother is unable to supply sufficient milk for the child? It has been my impression from a very limited experience in this field, that the mental and nervous and physical state of the mother is a very large factor in the production of the milk. When upset and under deleterious influences she is really not a proper producer for the child; and the management of the mother is often quite as important a factor as any other.
Dr. W. H. Aurand: In such cases as Dr. White just mentioned, what are we going to do to increase the supply of milk? Also, I would like to ask Dr. Huenekens if he means to feed to the new-born baby 200 c.c. at a feeding?
Dr. Huenekens (closing): As regards lime-water: I cannot recommend its use. Wherever there is a specific demand for calcium, as in premature infants or spasmophilic cases; or where it may help to produce a firm stool; or, as in diarrheal disturbances, it may be of great value, but in the normal healthy infant it is of no benefit whatever.
Dr. Bryant mentioned the giving of meat in exudative diathesis: His statement that such infants can probably have meat once a day at fifteen months, and show normal stools, is beside the question. A normal macroscopic stool does not necessarily mean that the meat has been digested. However, I am now working on this problem, that is, to determine whether an early solid diet produces an earlier digestion of meat.
I would classify eggs and egg albumin as proteins, and therefore not digestible until the beginning of the third year: but, over and above this, there is danger of anaphylaxis from the absorption of the unchanged egg albumin into the blood-stream.
What Dr. Weston says of the feeding intervals is very interesting. I do not want to be considered an enemy of the four-hour feeding, for I use it wherever possible, and I think it the best interval; but when the infant cannot get enough in that period, we have to choose between two evils. I think the lesser evil is to give the child more milk at shorter intervals, and take the risk of a slightly poorer digestion. We should, also, wherever possible, control the amount of breast-milk by weighing the child before and after nursing. It is highly important to determine whether the baby is getting too much or too little.