This relationship was described as “enlightened self-interest and co-operation” between the manufacturer and the medical profession.
There is no doubt that concerns about infant mortality rates in the USA at the end of the nineteenth century played a role in motivating the medical profession to find new, safe ways of providing nourishment to small babies.
I just can’t work out why there was so little effort to try and work with human lactation. Wet nurses were (perhaps rightly) widely condemned, but lactation advice seemed to consist solely of offering something else to feed the baby. This complementary feeding almost inevitably led to weaning because of reduced ( or further reduced) feeding at the breast and then reduced stimulation to make more milk.
What about human milk banks? They seem not to have been thought of … formula was the substitute.
Milk sharing must have been endemic, just from the view of infant survival. And it’s a different phenomenon to wet-nursing: a trusted friend or family member provides the milk (and perhaps the breast), rather than a financial transaction. It is an act of trust between mothers. And then there’s the safety of having milk provided to your baby, that another mother is giving her baby. Many of you will know of the special “cousin” or sibling relationship that milk-sharing confers on babies as they grow up in Islamic cultures.
Dr Virginia Thorley is a Lactation Consultant, ABA counsellor and historian who has written about milk sharing:http://www.virginiathorley.com/Links.html
A pervasive and general mistrust of the functioning of women’s bodies was certainly at play: breastmilk couldn’t be trusted to be consistently wholesome (not surprising given the prescribed conditions necessary for this), women’s bodies were unlikely to be able to produce enough of the stuff, and if there wasn’t enough, you had to give something else instead.
The parallels with men managing childbirth are obvious. Why trust nature when intervention could help so much? Also consider the manipulation of nature with regard to the regulation of rivers and mechanisation of agriculture…
Formula was apparently more attractive because medical practitioners were able to manipulate its contents according to “the baby’s needs”. The implication is that mothers were harder to manipulate! You bet.
But also there was a fundamental distrust of mothers’ ability to care for their babies in general. “Maternal education” was seen as vital to improving infant survival. This was done by means of pamphlets and booklets being produced. But the paediatrician or family physician was seen as the authoritative key to infant well-being. And as he knew little about lactation physiology, most mothers would be bottle-feeding before long.
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.
I’ve just spent a good many hours reading a book about the history of infant feeding in the USA.
Mothers and Medicine: a social history of infant feeding 1890-1950. By Rima D.Apple
It has been interesting to learn about the way breastfeeding was viewed at the end of the nineteenth century, just as artificial baby formula was being developed. Although this is definitely a history of the US experience, we can allow reflections on breastfeeding in Australia where many broad cultural themes were similar, such as the role of science and medicine in everyday life, and the lived experience of women.
The “cult of true motherhood” or the “cult of domesticity” described how women were viewed in the latter part of the nineteenth century: women were defined by their role as mothers, and were entirely responsible for the well-being of their children. Kind of nice to have the recognition, but at times it would have been a tough load to carry.
In the nineteenth century in the United States, breastfeeding was generally seen as the best way to feed a baby, but the lactating breast was also seen as a sensitive and unpredictable organ: milk supply could be effected by anything from a “fretful temper” to a “fright”, and breastfeeding was likely to overtax the mother’s well-being, causing a “general weariness and fatigue”. Lactating women were encouraged to eat well, exercise a little and cultivate a serene disposition(!).
Go on…breastfeed…just make sure you do it perfectly. Oh, and good luck.
The second best way to feed your baby (should your unpredictable breasts not do your asking, despite your serenity) was for another woman to feed your baby. But wet-nursing was also problematic: how to ensure that this woman from the working class would be eating well, maintaining some serenity and not wasting her precious milk on her own infant? Never mind the enduring view of character being conferred by a baby’s food source.
Infant mortality rates were alarming, criticism of wet nurses widespread. The medical and scientific solution to the problem was to further develop baby formula. Bottle feeding was seen as a thing able to be manipulated by science, unlike the vagaries and uncertainties of that most female of activities: lactation.
And so began an era of medical advice for infant feeding. While mothers were very special people who were expected to take responsibility for their children’s upbringing, they would need a little bit of help from medicine if breastfeeding wasn’t working. That help would be in a bottle of baby formula, perhaps suggested by a doctor qualified in the newest of medical specialties: paediatrics.