PHYSIOLOGY AND LESIONS OF INFANTILE NUTRITION.
THE most remarkable circumstance connected with the young infant is its rapid growth. In comparison with the very great activity of its nutrition, in a state of health, most of its other functions seem nearly dormant. And it follows that most of the disorders of the young infant are either direct lesions of nutrition, or the consequences of such lesions.
A brief notice of the normal physiological growth and development of the young infant will prepare the way for a more intelligible account of the disorders which are but deviations from such growth, – and at the same time afford opportunity for explaining the causes of such deviations. Just after the birth of her child, and before the secretion and flow of milk sufficient to nourish the babe, the mother is in a condition of temporary rest. The same is true of the corresponding period in the life of the babe. Before birth it had been nourished directly through the sanguineous circulation of the mother. After its birth comes that brief interval of repose in which its system may be supposed to consume all the last remaining elements supplied through the mother’s veins. To this succeeds a state of hunger, in which the system becomes prepared to receive its necessary food in a form entirely new and by means of an organization equally different and distinct.
Next to her blood itself, the mother’s milk is the simplest and most nourishing form of food, and one that requires to undergo the least possible change in order to be capable of assimilation by her child. The milk contains all the elements which enter into the composition of the blood and of course into the construction of the body. And in maternal lactation this is freshly prepared as needed; and imparted to the babe from time to time in small quantities, and under the beneficent influence of physical and moral circumstances which in a remarkable manner tend to promote its kindly reception into the infant’s system; its grateful assimilation; and the consequent exceedingly rapid growth and development of the infant itself. For the animal heat of the mother’s body, imparted to the babe in her arms, is not more necessary and more grateful to the infant’s physical system, than is the moral influence of the cherishing kindness and tender affection of the mother’s love essential to the whole spiritual, intellectual and physical growth of her offspring. The grosser material life of the babe is indeed sustained by the abundant supply of milk which it receives from the maternal fountain; yet even this material supply will be found to have been deprived of a large part of its efficient vitalizing force, when it loses the indwelling spirit of the mother’s love, – of which it naturally forms the material body, and of which in great part it constitutes the medium of communication between the mother and her child. This is some measure accounts for the great mortality of those who are attempted to be brought up by hand instead of being nursed by their own mothers as intended by nature. “The infant whose mother refuses to perform towards it a mother’s part, or who, by accident, disease, or death is deprived of the food that nature destined for it, too often languishes and dies. Such children you may often see with no fat to give plumpness to their limbs, no red particles in their blood to impart a healthy hue to their skin, their face wearing in infancy the lineaments of age, their voice a constant wail, their whole aspect an embodiment of woe. But give a such children the food that nature destined for them, and if the remedy do not come all too late to save then, the mournful cry will cease, the face will assume a look of content, by degrees the features of infancy will disclose themselves, the limbs will grow round, the skin pure red and white; and when at length we hear the merry laugh of babyhood, it seems almost as if the little sufferer of some weeks before must have been challenging, and this the real child brought back from fairy-land. (*West, Diseases of Children)
The mortality of infants in foundling hospitals is vastly greater than that of those who, although deprived of their natural mothers, are still brought up in private families. And yet these extreme cases will serve all the more plainly to show the mischievous results produced by a violation of the laws of nature in this most important respect. The following statement of the course pursued and results obtained in the three principal foundling hospitals in France, compared with the subsequent statement of the almost universal mortality in the largest foundling hospital in America, will fully explain itself. At Lyons, each infant on its reception is given into the charge of a wet-nurse, and its stay in the hospital does not exceed a very few days, after which it is sent to be nursed in the country. At Rheims, the stay of the infant in the hospital is equally short; but neither while there nor afterwards when at nurse in the country, is it brought up at the breast. At Paris, the stay of the children in the hospital is often very much longer; but they are usually though not invariably suckled by wet-nurses. The mortality under one year of the children admitted into these institutions is: At Lyons, 33.7 per cent.; at Paris, 50.3 per cent.; at Rheims, 63.9 per cent. At the Foundling Hospital on Blackwell Island, New York, the pastor in charge states, “that of the five hundred motherless infants that he had baptized within the two years preceding January, 1867, only abut twenty-five were living, most of the balance having been returned dead within about twenty days after their admission. Their food was cow’s milk only. On the first of November the same reverend gentleman informed me that he had baptized one hundred and sixty since the first of March, of whom only six remained living; the most of them having died within twenty days after arriving at the hospital. (*Hahnemannian Monthly, vol. ii., p.357) These children were fed upon milk obtained from cows kept and fed upon the island.
Other unfavorable influences, of the sea air, the cold and damp east winds, in addition to the usual unhealthy circumstances inseparable from extensive hospital establishments, must have contributed very largely to the production of this almost universal and unprecedented mortality. Still the remarkable and very early fatality itself, after making all due allowance, deserves attention in part from its relation to the quality of the food best adapted to support life in these little ones, when they cannot be nursed. And the question becomes a very practical and important one, in many cases in which the poor health or the unsound constitution of the mother gives reason to conclude that if the child’s life can be preserved in its tenderness months by other means, its whole constitution and future health may be very much benefited by the same method. But this will be again considered subsequently; and yet it may be proper to remark here that, even in those cases in which it may be impossible or inexpedient for the mother to nurse her child entirely, it is well very important for her to suckle her child for a while, – however short the time in which she may be able to do so; and that her own milk should be the babe’s only food during this period. Although this is contrary to the opinion commonly entertained among the people, the young infant will thus obtain a start in life in the right direction; and be better able to be nourished by foreign food, should that subsequently become inevitable. Just as the mother’s milk is found to adapt itself to the changing condition of the babe as it becomes older and stronger, so during the first few days after infant’s birth, the milk possesses peculiar qualities, and not merely abounds in fatty and saccharine matters, but presents its caseine in a more easily assimilable form than subsequently. So delicate and peculiar are the digestive organs of the young infant, and so especially adapted is the mother’s milk to their comparatively feeble digestion, that it becomes no easy task to provide a substitute which shall in like manner be constantly suited to the varying conditions and wants of the infant’s daily growth.
But since there will always be cases, owing to the sickness or death of the mother, or to her inability to nurse her children from other causes, in which it will also be impossible to procure a wet-nurse, and in which therefore it becomes necessary to provide the next best substitute, particular directions for this purpose will now be given. The milk of cows is the most accessible; and in many instances forms the only substitute which can be procured. (The following table, from the most reliable authorities, will show the composition of several kinds of milk:)
-Constituents Cow. Ass. Goat. Ewe. Woman.
Water 86.28 91.65 86.50 85.62 89.20
Butter 4.38 0.11 3.32 4.20 2.60
Sugar of Milk 5.27 6.08 5.28 5.00 6.00
Caseine 3.80 1.82 4.02 4.50 2.00
