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SUBSTITUTEJ4   '
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HUMAN      MILK.

          WILLIAM H. CÜMMING,  M.D.
   Artificial lactation is the subject of this paper.  In order to prepare
 our minds for its proper consideration, it will be well to examine the
 natural function in its normal state.
   Lactation exists as a function only among the Mammalia.  These
 derive their  title as a class from the existence of the organs of this
 function.  Whether they spend their liyes iu tbe water or on the land,
 whether they swim or creep, or walk or climb, or fly, they all have
 milk-producing organs; they all suckle their young.
   And yet there are foreshadowings of lactation far down the scale
 of being.  The bees and wasps and ants prepare a supply of food for
 their young, and the larva on bis emergence from the egg, finds this
 provisión near at hand and amply sufficient for his wants.
   Many birds bring insects and worms to  their yet unfledged young.
 The swallow and the wren are familiar  examples of this.   Nothing
 can exceed the diligence and  assiduity with which they devote them-
 selves to  this important  work of artificial lactation.  The pigeon
 comes still nearer to the mammalia in  this matter, for it supplies to
 its young an abundance of partly-digested food.  The fact has not
 escaped notice, and "pigeon milk" is the ñame of this article of diet.
  The truth is, that  most animáis leave  the egg or the womb in a
 state  of development iu which they are  unable to obtain and use the
 ordinary food  of their kind.   In most cases their organs of locomo-
 tiou do not enable them to  obtain this  food.  The larva of the bee
 cannot fly, the puppy cannot walk, the  monkey  cannot climb, the
 beaver cannot swim.   Ñor can they in most cases mastícate and di^est
 such food as their pareuts  use.   The teeth are ordinarily still  within
the  gum, and do not appear for some time after birth.   Most of these 
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animáis, therefore, absolutely require for their sustenance and growth
a peculiar food suited to their actual condition.
  What then is lactation?  It is the secreting from their own blood,
in organs  then and then only active, and the furnishing to their new-
born young, a liquid food suited to the various degrees of their devel-
opraent at birth, and the continuing to furnish the supply, until the
young animal has become able to use the ordinary food of his race.
  This secretion is  continued much longer in some  animáis than in
others.  The young are not born in the same state of development.
The young of the Marsupials leave the womb while yet in an embry-
otic state.  The ruminants stand at the other extreme.  Between these
the other orders range themselves.   In order to  fix this fuct in our
minds, let us compare those animáis with which we are most familiar.
Compare the rat, the  puppy, the kitten,  with  the colt, the lamb, the
calf.   Blindness, weakness and deformity mark the former; while the
latter are able to see and  hear and walk.  How soon do the young
ruminants follow their dams, skipping and running as they go.   The
states of development at birth are thus seen to vary greatly.
  The nature of the future food of the young animal has an important
connection with the length of  lactation.  The digestión of grass and
grain  and roots requires more  gastric  energy  than  that of worms
and insects and  flesh.   In conformity with this, is the fact, that the
graminivorous animáis furnish  milk to their young until the latter are
very much more developed  than the carnívora are  when  they  are
weaned.
   We have  used  the word Milk.   What is  Milk ?   It is  a general
term for  the various products of the maramary glands of  different
animáis.  It is the ñame for the food furnished by these mothers to
their young.   Milk is a white, opaque,  oily  liquid.   Its  color is not
puré white, but  verging on yellow.   In some animáis it is sweet, con-
 taining notable quantities of sugar.  But iu all it contabas three great'
constituents—butter, cheese and water.
   We have said that milk  is suited to the wants of the young  ani-
 mal.  It consists universally of two classes of food;  oily materials
 containing no azote, and caseous  substances  holding in combination
 mineral salts, and admirably adapted to the growth of the body.
    It is suited to the wants of the young animal.   What is the first
 want  of a new-born animal  of this class?  Warmth.  He has been,
 during the previous stage of his existeuce, surrounded by tissues of the
 temperature of 100°.   He is  now out in the open air, or in still cold-
 er  water, the heat of his  body rapidly radiated or conducted into 
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these cooler media.  This loss of heat does not lower his temperature,
for there is an infernal supply.   At the momeut of his birth, respira-
ron commenced, and the oxygen of the air combiníng with the oil of
his body, evolves heat  sufficient to replace that which is lost.  But
this consumption of oil cannot be long continued, unless the supply
be renewed.   The body will be soou  reduced to a state of  extreme
emaciation, and death from cold must follow.
   A supply of oil is then the  first want of the young animal.  The
lamp of life must be fed, or it will speedily go out.  The  milk con-
tains oil in proper proportion for this purpose.   This oil is butter.
   But not only must the vital heat be maintained, the tissues of the
child must grow.  The materials for the growth of the tissues are sup-
plied by the caseiu or albuminous portion of the milk.   The ñame
casein is applied to a group of  substances having  an almost idéntica!
chemical composition.   Indeed  it has until recently been supposed to
be identical.  But it has been  ascertaiued by Quevenne, that while
their organic composition seems the same, they hold in  combination
different proportions of mineral insoluble salts.   Thus, phosphate of
lime  (the  bone earth)  exists in different proportions  in  suspended
casein,  in dissolved casein, in albumen, and albuminose.   These four
substances also differ  iu  the effects produced upou them by  different
agents.  Thus,  while suspended casein is coagulated by a small quan-
tity of rennet,  the dissolved casein, the albumen, and the albuminose
are  unaffected  by it.  Thus, while  the  albumen is coagulated  by
ebullition of the milk, the other three constituents of the casein are
unaffected.   Nitric acid produces the same effect without the agency
of heat.
   In the present state of our knowledge on this subject, we can only
say that these four substances, by the action of the gastric juice, seem
to be all couverted into albuminose, and to be in this form absorbed
into the system.
   Thus constituted, having both azotised and  unazotised elements,
the milk is suited to supply the  wants  of  the animal, and to  promote
his growth and development.
   These general statements concerning lactation  are applicable to
the function as existing in the woman.  An element which is not uni-
versally but very generally found in milk, exists in human milk in the
proportion of 0.075, we refer to the sugar.  Of the uses of the sugar
we are  not so well informed.  There is reason to believe that it con-
tributes principally to the maintenauce of the heat of the body.
   We come now to the subject  of artificial lactation.   Sometimes by 
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the death  of the  mother, more  frequently by her failure to secrete
enough milk, the child is deprived of the needed supply.  Something
must be done for the famishing infant.  In a few cases, we may have
recourse to another woman for the needed food.  Few good uurses,
however, can be found.  In the cities, there are by no means euough
to supply the demand for human milk; in the country, they can scarce-
ly ever be  obtained.   In this country we can find  no  permanent, reli-
able supply of milk, except that furnished by the cow.  The  question
is, Can artificial lactation be successfully performed by meaos of the
milk of the  cow?   This  is a question of  great interest to medical
practitioners, as well as to pareuts.
   In  using cow's  milk as a substitute for the natural food of infants,
great difficulties are found.  These  arise from the difference of  com-
position of the two kinds of milk—thus:
                f Butter,   38.59     While Human [ ButteT>  2(U6
   Cow's Milk is I Casein,   40.75  ^-Yv           A  Casein,  14.34
        »  r    io        to n>r  Milk  is composed-  c     '  ,.-„(,
composed of     | Sugar,   53.97   f         r      bngar,   (O.02
                ( Water,  866.69  0J              [ Water, 8S9.88
   If we so dilute cow's milk as to reduce the butter to 20.76, weshall
have 21.92 of casein, or 50 per cent,  more than in human milk.  This
excess of casein leads to serious  indigestión, with  consequent gastric
and intestinal disorders.
   If, on the  other  hand, Ave reduce by still farther dilution the caseiu
to 14.34, we shall  have ouly 13.58 of butter, or less  than two-thirds
of the  proper proportion.   This deficiency of butter does not produce
such immediate disturbance as we have stated to follow the  excess of
casein, but its permanent  influence is most injurions.
   First, because there is a deficiency of  the  material needed for the
production of heat.  If the temperature  of the  body be  lowered, all
the functions languish, and the child is  uuable  to resist the hurtful
influence of atmospheric changes.
   Secondly,  this deficiency of butter implies a  corresponding  defi-
ciency of the phosphureted oil (lecithine) of the  milk, the proper and
peculiar nutriment of the nervous system, which exists in butter in the
proportion of 8 per cent, or one-twelfth.   If there be a deficiency  of
onc-third of the butter, there will be of necessity, a corresponding de-
ficiency of one-third of this phosphureted  oil.   As the child, during
the first year of his life, should take from 1,000  to 1,400 lbs. of  milk
containing from 20.76 to  29.06 lbs. of butter, the annnal deficiency
of  this phosphureted oil would be from 0.5536 to 0.7749 Ib.; that is,
from nine  to twelve ouuces.   The uatural consequence of  this defi- 
5
ciency of nervefood is failure of nervous tnergy, and imperfect perform-
ance of nerve functions.   The various processes languish, and calorifi-
cation, circulation, absorption, digestión and secretion  all feel the
depression.
  The proper remedy for these evils, is to provide a milk much richer
in butter than the ordinary milk of the cow.   If we leave a quautity
of cow's  milk at rest for four or five hours, and then carefully remove
aud examine the upper third, we find that it  contains  about 50 per
cent,  more butter than at first,  In round numbers, the butter is to
the casein as 57 to 40, or as 100 to 70.  Now this is the relation be-
tween these two substances in human milk.  If we then so dilute this
new milk as to reduce the  casein to  14.34 thousandths, we shall have
20.76 thousandths of butter.  This is just what we need (with the
addition  of sugar) as an  accurate imitation of  human milk, and, there-
fore,  a good substitute for it.
   Take, then, ordinary cow's milk and let it  stand  for four  or five
hours.   For a  child three months  oíd,  2| quarts will be needed.
Take the upper third,  (1|  piuts,) and  add to it 2^ pints of water;
sweeten  it with  the best sugar, oí which 2| ounces will be required.
It should be made somewhat sweeter to the taste than ordinary cow's
milk.
   A  child three  months oíd  will  take from  48 to 60  fluid ounces,
daily, in  six or seven doses of a half pint each.
   It  should be given from  a bottle—suction being the only proper mode
offeeding for a young child.
   Its temperature should be from  100° to 104°.  It should be Avarm-
ed again if it becomes cool while the child is taking it.
  The child should be early trained to pass  6 or 8 hours at night
Avithout  feeding.
  The kind of bottle, which for cheapness and convenience is mostad-
vantageous, is a plain 8 ounce vial, of an elliptical form.  The artifi-
cial nipple is best made by rolling a  quill in soft muslin and forcing
this into  the neck of the  vial,  leaving about three  fourths of an  inch
projecting from the neck.   The eáse  with which the muslin may be
unrolled  and thoroughly  washed, gives this arrangeraent a superiority
over every other, especially in warm weather.    The quill also may be
readily cleaned.
  The child should be fed  at intervals of three or  three and  a  half
hours. Regularity in this  respect is very advantageous.
  During the first mouth,  the child needs food of different composi-
tion.  There should be more butter in proportion to the casein.  In 
                                6

order to obtain this increased  proportion of butter, let the upper
eighth of the milk be taken instead of the upper third.  This milk con-
tains from 70 to 80 thousandths of butter.   It should be diluted with
2.6 parts of water.
For a	child from 3 to 10		days oíd.	Milk 1000	Water 2643		Sugai	■243
;i	"	10 to 30	o	•'	i<	2500	ii	225
«	u	1 month oíd.		"	n	2250	ii	204
I(	«	2 3	u n	ii u	ii ii	1850 1500	ii ii	172 144
.<	<(	4	a	ii	ii	1250	ii	124
«	K	5	ii	"	ii	1000	ii	104
u	"	6 7	n	;i	u u	875 750	ii u	94 84
II	a	9	n	:t	ti	675	u	78
II	ii	11	"	ii	ii	625	ii	73
(1	«	14	n	ii	ii	550	ii	67
II	ti	18	u	u	i<	500	ti	63
  By thus gradually diminishing the proportion of water, we furnish
  the child a milk coutaining an ever-increasing proportion of nutri-
tive matter.
  How long should artificial lactation be continued?  The only an-
swer to this is, " until the child has  become  able  to  use ordinary
human food."   The child should be fed with milk until  his organs of
mastication and his powers of digestión render it best for him to  have
other food.   And at what  age  does this condition exist?  Children
vary so much in the rate of their development, that no answer can be
given applicable to all cases.   In a vigorous child the  first dentition
is usually  completed at two years of age.  Sometióles this appearance
of the full complement of teeth takes place six months earlier, and
sometimessix monthslater.  Whenever this first dentition is complet-
ed, the child has  the full masticating apparatus of childhood, and may
receive other food than milk.   In  many cases, lactation must be con-
tinued until the age of three years.  And it may be safely presumed,
that no food will be found so suitable  for the tardily-developed  child
as that Avhich divine wisdom  has prepared for the purpose of promot-
ing this development.  As au article of food for  adults, milk is of
great  valué.   Entire  races of men rely upon it, and it seems,  when
thus largely and permanently  used, to promote  strength and  vigor.
For the formation of teeth and bones, its phosphate of lime is  indis-
pensable, and no other food suited to a feeble child contains so  much
in intímate unión with organic elements.
   Nothing  has  been  said of any other mode of artificial lactation.
This omission is not  accidental.   The truth is, that milk is the only 
1
material  that inspires  or  even warrants any  hope of real stíccess.
By this is not meant to say that all children reared otherwise die, but
that good, physiologically good results do not follow the use of any
other  food.  Children may survive months of arrow-root or  other
farinaceous food, but a normal, healthy, happy, vigorous, steady, ever-
advancing development was never yet attained in this way.  The hu-
man stomach has no creative power.  The materials must be furnish-
ed, or the building cannot rise.   Lecithine must be given, or the nerv-
ous  energy declines.  Without phosphate of  lime, how  shall the
teeth and bones be made?
   If we  examine  the constitution of  the  blood, we shall find what
materials go to make the human body.   What are  these ?  Oxygen,
hydrogen, carbón,  azote, chlorine, fluorine, iodine, sulphur, phosphor-
us, silicon, potassium,  sodium, calcium,  magnesium, iron  and  manga-
nese.  Of these sixteen substances, all are found in milk.   And not
only so, but they exist in the milk in the same combinations as in the
blood.   Not only have we chlorine and sodium, but we have chloride
of sodium; not merely phosphorus and calcium, but phosphate of lime
already prepared for use.   Not only  have we oxygen  and hydrogen
and carbón, but we have ten  different oils already existing in the,
milk.  We have four different protein compounds, each holding  in
combination a  definite proportion of phosphate of lime.  Thus, and
in all  probability thus only, can this  invaluable, but insoluble salt  be
introduced into the tissues,  and give  strength and firmness  to the
frame.  Why, then, with this evident adaptation of milk to the develop-
ment of the body, should we look for other articles of food?  Among
all the substances now used, none can make any such claim.   Indeed,
it may be safely said, that milk is an article standing alone, prepared
expressly for this one purpose,  and challenging all competition.
   If the attempt made in this paper to show that the milk of the coav
may be so modified as to suit the peculiar wants and condition of the
infant, has been at all successful, there is ground for hope that much
suffering may be relieved, and  many lives saved.  The subject  is one
of great  importance, and  demands the earnest consideration of the
medical  profession.  To  them the eyes  of  anxious  and sorrowful
parents are turned for help; if aid can be given, let it  not be with-
held. 
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