When physicians in the US decided at the end of the nineteenth century to put their minds to making safer infant formula, they really threw themselves into the task.

Rima Apple’s history of infant feeding in the US: Mothers and Medicine, describes the complexity of the task of modifying cow’s milk to make it ok for little babies.

Possibly for many many years, cow’s milk was diluted with water as a simple substitute for breast milk.

From what I can gather, it seems like most babies would have had as much breastmilk as could be obtained from mother or other(?), with top-ups of cow’s milk or combinations thereof.  The almost official medical view was that most women were incapable of producing an adequate breastmilk supply, and that most breastmilk was of dubious quality (diet, exercise and sweetness of temperament were essential ingredients for ideal milk production).

The solution was to offer a cow’s milk substitute. Sound familiar?

I can only guess that the ill effects of tiny babies drinking raw watered-down cow’s milk were usually counteracted by the benefits of whatever breastmilk they were also receiving. Or not.  In some US cities in the 1890’s more than one third of babies died before their fifth birthdays. Somewhat complicating this was the widespread public view that bottle feeding was indeed dangerous for babies.

Understandably, there were concerns about the bacterial load in cow’s milk that arrived in urban centres from rural areas: raw, unrefrigerated and in open vats. Customers were often seen to take a sip of milk from the dipper to check for freshness and even home delivery of cow’s milk saw the milkman using the same dipper to fill household vessels (clean or cleanish) for every household on his delivery route. The milkman delivers!

So began campaigns to make cow’s milk safer for everyone: promotion of home pasteurisation, legislation that meant lids for milk vats were compulsory, milk stations positioned in urban centres with quality control standards and educational pamphlets for mothers…. and eventually, refrigeration for transport vehicles carrying cow’s milk.

But the real science was in the way cow’s milk was changed to suit a baby human’s digestive system. Complex percentage systems of adjusting the cream and water and milk sugar were devised by physician Thomas Morgan Rotch. He also added lime water (calcium hydroxide) to make the rather acidic cow’s milk more suitable for baby’s digestion.

For family doctors and paediatricians he recommended a chart be used that had 30 different combinations of cow’s milk formulae for babies up to 12 months old. Mothers were expected to consult regularly with their doctor for feeding adjustments in their baby’s first year.

Ironically perhaps, this multitude of different concoctions was designed to reflect the way mothers’ breastmilk varied over time.

And breastmilk continued to be recognised as the best way to feed a baby.But if there was difficulty with breastfeeding, there was little medical understanding of how problems could be remedied, part from offering bottles.

Rotch was influential in his work, but ultimately public health officials demanded simpler systems of devising baby formulae.  Importantly, the medical profession insisted that they be the first point of contact for guiding the mother in feeding her baby.  Manufacturers of baby milks or modifiers usually encouraged this too, or at least with some of their milk products.