Tuesday, 18 December 2012

Infant Feeding, Past and Present

I have in front of me a tattered book entitled Modern Methods of Feeding in Infancy and Childhood. It was first published in 1926 and was still selling well in 1941. It was written by two doctors and aimed at trainee nurses and doctors. It is fascinating to flick through and discover a bit more about the lives of mothers and babies in the not so distant past.
Then, as now, breastfeeding was strongly recommended with several advantages to the baby:
It is the perfect food for human babies; it contains immune bodies "which help the child in its early struggle for existence";  the child "thrives better and has good motions, a good digestion and sleeps well; "it is five times less likely to die during the first year of life" and it is better off being" thrown into the company of its mother" than being cared for by "some disinterested person".
In case this message needs emphasising the authors remark on the first page: "In the first six months of life the mortality is largely among those who are artificially fed."
Breastfeeding contraindications are few: open tuberculosis in the mother is the only complete prohibition while mothers with syphillis are advised to breastfeed, as the baby will already be infected. Mothers with malignant diseases and insanity should, the authors say, be encouraged to breastfeed if at all possible but the doctor should make the decision.
Regular feeding times should be strictly adhered to, using either a three or four-hourly schedule.
For those mothers who opted for artificial feeding (i.e. bottle feeding), and for those who were weaning, there was a wide range of options - tinned evaporated milk, sweetened condensed milk, fresh milk, dried milk and a few peculiar mixtures. Virol and Milk, for instance, contained: malt extract, eggs, marrow fat and red bone marrow, along with "salts of lime" iron and dried milk. 
Fresh milk could not be relied on as being safe at that time. Since 1922 there had been attempts to improve the safety of milk, but this was still a work in progress. Of course raw milk would still be a dangerous food today, even though hygiene in the cowshed has improved a great deal. 
The authors recommend that fresh milk for a baby should be from a "mixed herd" and not a single animal. Their reasoning is that if this single cow was diseased it was likely to prove detrimental to the child.
Smoking in excess while breastfeeding is discouraged as "it has a definite toxic effects on the infant." But the authors go on to say: "It is claimed that up to seven cigarettes a day can be smoked without upsetting the infant."
Then, as now some mothers made their own weaning foods. Strained broth made from bones, vegetables and a range of other ingredients (e.g. the occasional piece of liver) is strongly recommended.
There was much concern about rickets and giving babies cod liver oil was strongly advised. There were a number of alternative Vitamin D preparations available at this time, including Radiostoleum, RadioMalt and Viosterol. These names might sound strange today but they were intended to convey that the product was prepared in a scientific way. In the pre-Hiroshima years, radiation was viewed as an entirely beneficial product of science. We are still encouraged today to buy supposedly beneficial products with sciency sounding brand names and ingredients, dreamed up during meetings of the marketing department.
Many things were very different then. The amount of serious disease in the mothers for instance. This was the period just before the invention of antibiotics when infant and young adult mortality were still high. Powdered milk production had not been standardised. It is also interesting that, despite the scientific approach in the book, the physiology of breastfeeding was not fully understood and putting the newborn to the breast in the first six hours is seen as undesirable.
The French have a saying: "Plus ca change, plus c'est la meme chose" - the more it changes, the more it stays the same. So apart from sciency marketing and brand names what's the same? Breastfeeding is still, of course, much better for babies, despite the improvements made in commercial baby milks. There has, it seems, been a recent swing back to putting babies on schedules. And there is, again concern about vitamin D levels. This week the Royal College of Paediatrics and Child Health have been highlighting the fact that there are worrying levels of vitamin D deficiency in the British population and that rickets is again on the rise. We now know that vitamin D plays many roles within the body and that deficiency can predispose people to a range of diseases.
When one of the Royal Colleges is sufficiently alarmed to urge us to give babies vitamin supplements, we should all take it very seriously.

Modern Methods of Feeding in Infancy and Childhood, Paterson and Smith, Constable, 1926 and still reprinting the seventh edition in 1941. 


  1. Is it known whether the current low vitamin D levels are a result of over-protection from the sun, or to a dietary lack?

  2. I think it is a combination Nellyb. We evolved to be out of doors all the time, and our ancestors probably ate a fair bit of fish, other seafood and animal fats.