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SECTION ON OBSTETRICS AND DISEASES
OF CHILDREN.

1. The Underlying Principles of the Nourishing of Infants. Jas. H. Bute, A. B., M. D., Houston.

2.

The Treatment of Acute Entero-Colitis.

J. W. Scott, M. D., Houston.

J. G. Erwin, McKinney.

3. Reflex Irritation from Congenital Phimosis.

4. Occipito-Posterior Positions, with Special Reference to an Unusual Method.

5.

J. A. Rawlings, M. D., El Paso.

Does Maternal Mental Influence Have Any Constructive or
Destructive Power in the Production of Malformations or
Monstrosities at Any Stage of Embryonic Development?
J. M. Frazier, M. D., Belton.

THE UNDERLYING PRINCIPLES OF THE NOURISHING OF INFANTS.

JAS. H. BUTE, A. B., M. D., HOUSTON.

Two controlling factors are present in all life; heredity and environment. At the birth of the individual, the first has done its best or worst and can not be reckoned with in the sense of being influenced. Its activity has been through long reaches of past time, and the laws of its operation are but imperfectly understood. The question of environment, being of the present and to a certain extent possible of control, assumes the greatest importance. While, from a purely biologic standpoint, heredity may appear to be the most important influence, yet, in the scheme of evolution, the higher the animal, the more important environment. This is specially emphasized in man by the prolongation of the period of infancy. John Fiske was the first to elaborate this fruitful view of one of the fundamental laws of higher evolution, that not only throws a strong light on the methods of evolution, but lays the greatest importance on the period of infancy as influencing the future development and usefulness of the animal. This long period of helpless infancy is a time of extreme plasticity, when the career of the individual is no longer predetermined by the career of its ancestor. One generation of the lower animals is almost an exact reproduction of the preceding one. The young animal is born pretty fully formed and can look out for itself almost from the beginning, independently of the parent. The longer the infancy of an animal becomes, the greater the period of its teachability, and a slow growth means an increase in capacity for development and all the higher prerogatives. Thus the higher apes have a helpless babyhood, when for two or three months they are unable to feed themselves or move about independently of the parent. The human infant is distinguished from the highest of the lower

animals by the very long duration of helpless infancy and the marked increase in the size of the brain and particularly in the extent of its surface. There is here a great increase in the size and complexity of brain organization that takes place largely after birth. Accompanying the rapid growth of the nervous system is that of the skeleton and various visceral organs. During the first two years of life, the brain not only doubles in weight, but increases marvelously in its convolutions and complexity. The infinite distance between man and the lower animals consists in the fact that in the former natural selection confines itself principally to the surface of the brain and requires a long period of helpless infancy for this highly plastic work to be properly started and developed. Inherited tendencies are present, but the proper environment counts for much in this work so potent in future possibilities. It is evident that, correlated with his long period of helpless infancy, there must be a time of maternal care and watchfulness if the race is to exist in health and vigor. Knowledge is required as well as care, for mistakes made at this time can never be completely corrected. The first few years of life are, biologically speaking, the most important ones we live. The beginning organism has at this time stamped on it the possibilities of future vigorous life or of early degeneration and decay. Hence a careful study and understanding of all the phases of infancy are of the greatest importance alike to physicians and parents. At a period of such rapid growth and development, it is evident that proper nutrition must play the leading part. All competent observers are agreed that the best nourishment for a baby naturally comes from its own mother. Unfortunately, a large number of mothers, from physical or social causes, are unable to give this proper nutriment. It appears to be one of the penalties of modern civilization that an increasing number of women can not or will not nurse their offspring.

Hence it is that in recent years a large amount of study and labor has been expended upon substitute infant feeding. Great advances have been made, but it must be confessed that the results

are not always proportionate to the labor expended. The tendency appears to be to a greater degree of complexity and elaborateness than the average practitioner and mother can understand or apply. Hence discouragement is apt to follow, and a return to old and haphazard methods if the immediate results are fairly satisfactory. Proprietary infant foods also profit by this feeling of confusion as they often agree with the baby for the time being, although not containing the proper ingredients for healthy growth and nutrition.

The effort to place the food principles of milk in their proper ratio has led to "Percentage feeding," which represents a decided advance, but has been pushed to an extreme that is difficult, if not impossible, to apply. I have long thought that some of the benefits of this method of feeding came more from the care and cleanliness with which the milk is handled than from the minute changes in the percentages that are often advised; indeed, analysis sometimes shows that these fine changes are more on paper than in the ingredients of the milk. It is well to think in percentages and be as exact as possible in feeding a baby, but the problem has not thus been completely solved, when we are putting the milk of one species of animal into the stomach of another species having a different digestive apparatus.

The greatest problem in the life of any animal is that of securing sufficient food. All forms of animal life demand the same ultimate food elements, so that really their great diversification is along the lines of methods and organs provided by nature for securing and digesting food. While the outward forms of animals are apparent to every casual observer, their digestive systems, which are hidden, are as much diversified as their more apparent shapes, and are as much adapted for the digestion of particular food as the outward organs are for securing it. Hence the milk of each type of animal must be studied from the standpoint of its special adaptation to the digestive tract for which it is intended: a hard curding milk is intended for a polygastric digestive tract that can properly deal with it; a soft curding milk for a monogastric digestive tract. These differences assume the greatest importance when

the milk of one species of animal is fed to another species. While percentage feeding and the physical differences in the same ingredients of the milk of different species are of great importance, the preliminary question of how to get clean, fresh cow's milk is the fundamental one. It calls for knowledge on the part of the physician or sanitarian that can easily be conveyed to the farmer and dairyman. This is the first requisite in successful infant feeding.

Any one called on to feed an infant during the period it is normally nourished by its mother has a great responsibility thrust upon him, and one not to be assumed lightly or without preparation. Too many are satisfied when something that is retained in the stomach and causes a gain in weight, no thought being given to whether the food contains material out of which healthy tissue can be formed.

It has often been stated that an artificial food for infants should contain nothing that is not found in mother's milk, and that it should contain just what is found in mother's milk. To prove the suitability of various substitutes for mother's milk, chemical analyses of both have been published, to show how closely the substitutes approximate mother's milk. At first sight this seems a rational procedure, but when it is remembered that there is no difference between a diamond and a piece of charcoal, chemically, and that mixtures of butter, cheese, sugar, salts, and water, or of beef suet, raw beef, sugar, salts, and water can be made which, when analyzed by the usual methods, will show the same composition as mother's milk, the fallacy of judging the suitability of a food for an infant, or for an adult for that matter, by its chemical analysis only will be apparent. Physiological chemistry has not advanced sufficiently to make it a safe guide by itself.

In feeding an adult, it is only necessary to furnish enough food to repair waste. In feeding an infant, not only must waste be repaired, but material to build up new tissue must be supplied, or the infant can not grow normally. The whole future of the infant may depend on what kind of food is supplied it up to the

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