Dr. Sansom on the Diet of Infants up to Twelve Months old: - Mother's Milk; "Wet-nursing; Artificial Feeding; Cow's Milk; Condensed Milk; Ass's Milk; Goat's Milk; Artificial Human Milk; Partial Suckling; Starchy Foods. - Dr. West on the Food for a Child of Eighteen Months old - Obstetrical Society's Rules for the Management of Infants: - Washing; Clothing; Ventilation; Sleep; Air and Exercise; Feeding; Diet for a Nursing Woman; Mixed Feeding for Children; Weaning; Food of grown up People bad for Children; Hand Feeding. - The Weight of Infants. - Quantity of Food required by Infants.

On The Diet Of Infants

Contributed by Dr. Sansom, Senior Physician to the North-Eastern Hospital for Children, etc., etc.

As soon as possible after birth - that is, directly after the proper cleansing - the infant should be put to the mother's breast. This measure tends to the well-being of both mother and child. It is objected sometimes that it is fruitless, because the breasts are not yet supplied with milk; but it is well proved that the stimulus to the nipple promotes a proper muscular contraction of the uterus of the mother, and the action of sucking is of infinitely greater value to the child than the administration of the messes that the past generation of nurses has been in the habit of enforcing.

It cannot be too strongly urged that the only proper food for a young infant is the breast-milk of its own mother. It is, however, often objected that the mother cannot suckle her offspring. She is said to be too weak; the recent struggle has exhausted her will, and the solicitations of sympathetic friends induce her to yield to the policy of abstention. Let it be explained to her that there is frequently a greater danger to herself, a still more pronounced cause of weakness, if the natural secretion of milk be checked; and, as regards the infant, the comparative danger of artificial feeding is simply incontrovertible. A healthy mother should suckle her child, and give it no other food whatever, for seven months; so far as possible it should be put to the breast at regular intervals every two or three hours.

Supposing the maternal suckling to be impossible, the best substitute, at least theoretically, is a wet-nurse. She should be a healthy woman, brunette preferred, not over thirty years of age; but the age should assimilate as far as possible that of the child's mother. She should be carefully examined to exclude all taint of disease, and should have good milk of sufficient quality. If these conditions be fulfilled, and the equally important moral qualifications be all that can be desired, then wet-nursing is the best substitute for maternal nursing. It is unnecessary, however, to say that such desiderata are rarely forthcoming; it is only in a small minority of cases that wet-nursing is possible.

We come, then, to artificial feeding. If the child must be brought up by hand, it should be fed with warm milk, properly diluted, out of a bottle. No farinaceous substance whatever, no "thickening" of any kind, should enter into the composition of an aliment destined for a young infant; the infant is as yet wholly unprovided with the physiological machinery requisite for the digestion of starchy foods: these are far worse than useless.

The most important question is - what kind of milk? Cow's milk is the most easily procured and, on the whole, the best adapted. It differs from human milk in containing more casein, more butter, and more saline matter, but less water and less sugar. The difficulties are for the most part met by adding to cow's milk water and sugar. For a month it is well to give equal parts of milk and water, with a small lump of white sugar added to the quantity necessary for each meal; after the infant is a month old two parts of milk should be added to one part of water. All care should be exercised to obtain uniformity of the milk; as far as possible it should come from one cow; all vessels containing it should be kept scrupulously clean, and the slightest souring should be avoided. The use of condensed or Swiss milk prevents the danger of souring and of contamination with germs of recent infectious disease; it is, however, too sweet for continuous use, though it may be given with advantage till the infant is three or four months old - that is, in cases in which artificial nourishing is unavoidable. Ass's milk is thinner than human milk; it contains more water, more sugar, and more saline matters, but only about half as much casein and butter. Goafs milk closely resembles human milk, but is more variable and has a peculiar odour. Very little water should be added, about four per cent., to make it suitable for the infant. In the dilution of all milk for the infant, very pure (distilled or boiled) water should be used.

The Aylesbury Dairy Company supply an artificial human milk, carefully prepared to resemble human milk as closely as possible.

The diluted milk is to be given by means of the feeding bottle, which should be kept scrupulously clean. Each time the nipple should be examined to see that it "draws" easily before it is given to the infant. Directly after use the bottle and tube should be rinsed out and then placed in a vessel of clean cold water, in which a pinch of carbonate of soda has been dissolved. It is well to use two bottles, so that one remains in the weak soda solution while the other is in use.

While the baby is under a month old the quantity for a meal should be half the ordinary feeding-bottleful; afterwards the bottle nearly filled. It is estimated that a nursing mother furnishes her infant with from one to two quarts of milk daily. The quantity of artificial milk (of the proper dilution for age) should at first be about a quart, afterwards rather more.

Although complete suckling by the mother is the best possible plan, there is no insuperable objection to partial suckling. This is decidedly to be preferred to completely artificial feeding where the health of the mother permits it. The ancient objection of mixing milks is, for the most part, a bugbear. Where the maternal supply is short in quantity it is a very good plan to advise that a good draught of milk be taken by the mother each time shortly before putting the child to the breast. If still the supply be insufficient, or there be evidence that the mother's milk disagrees, the animal milk substitutes may be given, at first to the partial exclusion of the mother's milk. Before concluding, however, that the mother's milk is wholly unsuitable, it is advisable to make many trials - let complete abstention be a "dernier ressort." Hygienic, dietetic, or medicinal treatment of the mother may overcome great difficulties.

At the age of seven months the infant begins to require something more than is afforded by the maternal milk; the capability of digesting starchy foods now commences; the question of thickening the milk food by some farinaceous substance has to be considered. The substances most commonly employed are arrowroot and the various forms of corn flour, wheat flour, lentil flour, bread, biscuits, and farinaceous food artificially prepared for digestion, such as the malted foods.

Of these it is to be borne in mind that arrowroot and the various corn flours, consisting almost entirely of starch, have scarcely any nutritive value whatever. They are sometimes useful as demulcents, but not as foods; when given in early infancy they are often provocative of diarrhoea, the intestines being irritated by the undigested starch.

Wheat-flour contains, besides starch, a considerable proportion of nutritious (nitrogenous) principles. Moreover, it is rich in alkaline and earthy phosphates, which are of high value. The fine white flour is far inferior to the "entire wheat flour" obtained by pulverising the whole of the grain. So prepared the flour is richer in phosphates and gluten, and contains besides a valuable digesting ferment - cerealin. Baked wheat-flour when the infant is seven months old may be used to slightly thicken the milk. It is advisable, however, occasionally, to substitute isinglass or gelatine for the thickening material for it is very easy for the child to get more farinaceous food than it can digest. Lentil-flour is the basis of many of the advertised foods; it is of high nutritive value and is of especial usefulness in infants whose tendency is to constipation.

Cooked wheaten-flour in the form of bread or biscuits may be used as the thickening material, great care being taken that a very uniform, creamy mixture is made, thin enough to pass through a fine sieve. Robb's biscuits deservedly enjoy a considerable popularity.

A very valuable agent is Nestle's milk-food: this, which is in the form of a powder, is a combination of milk and farinaceous food. The milk, obtained from the cows of a fertile district of Switzerland, is carefully evaporated and mingled with farinaceous food and some sugar. It is imported in tins. The preparation of it as a food for infants is very simple, for a tablespoonful is merely to be mixed up with water and boiled for a few minutes. For infants who are just becoming able to digest farinaceous food it is very valuable.

The malted foods have had a very considerable trial, and, according to many, are of a very high value. These were introduced by Liebig for the purpose of presenting to the infant elements of nutrition which should ultimately resemble those contained in the milk of the mother. The farinaceous food is so acted upon by malt that its starch is transformed into soluble dextrine and glucose - it is, in fact, artificially digested. Whether this is, on the whole, preferable to a form of food which proximately, if not ultimately, more closely resembles the natural milk, is by no means certain; but in some cases of difficulty where other foods have disagreed this has been successful.

The child, after having been partially weaned by the use of some of the foods described, should be wholly weaned between the ages of nine and twelve months. No child should be at the breast after it is twelve months old.