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The following is a paper by Frank Howard Richardson, MD, published in 1950 in the Journal of the American Medical Association
In this paper I give a brief history of breast feeding and discuss some of its disputed features, in the hope of "rescuing breast feeding from its present somewhat neglected state"  by showing that the literature establishes it as a sound scientific procedure which has at last come of age.
The earlier contributions to the literature on breast feeding were largely hortatory, scolding physicians and mothers alike for their readiness to wean the infants and praising breast feeding.  This almost religious fervor is understandable to the physician who remembers when dirty milk was the rule rather than the exception and when breast-fed babies in New York tenements had better chances for life and health than their bottle-fed contemporaries on Fifth Avenue. [2b] Not until 1930 was a writer willing to state that he considered artificial feeding as good as natural. 
In spite of this preaching, until 1919 breast feeding was looked on by the average physician as a providential occurrence. If the mother could not nurse her infant so-called "scientific" artificial feeding was begun, and the sooner the better. Like the well known comment on the weather, everybody talked about breast feeding but no one did anything about it. In 1919, however, Sedgwick started a movement that brought the possibility as well as the advantages of breast feeding to the attention of the mother of every baby born in Minneapolis from January through May of that year.  Featuring manual expression, he taught medical students, physicians and mothers that almost every mother can nurse her baby, provided she and her physician wish it and learn the technic. But there were many who claimed that this was possible only with sturdy women not far removed from the farm and that sophisticated Eastern city women would never be able to give similar high percentages of breast feeding.
A convincing reply was furnished to these objectors when a similar demonstration was put on in Nassau County, a suburban section just outside the city of New York, by the state department of health in 1925 and 1926,  with results that were almost identical. Even better figures were obtained in demonstrations that followed in smaller cities throughout the state."
These various demonstrations proved convincingly that "almost any mother who wanted to, and whose doctor understood a simple technic, could breast feed her baby as long as she and her doctor desired,"  with a distinct reduction of mortality and morbidity percentages, [2h] enhanced immunity to gastrointestinal and respiratory diseases,  and the emotional benefits claimed by the psychologists for mother and baby alike. 
Whereas all that physicians knew about artificial, feeding had followed the studies of Biedert in 1869,  Fritz Talbot's work on human milk in 1919  was another serious study. This showed the fallacy of condemning mother's milk on the strength of a single specimen tested with Holt's cream gage and lactometer. [2b] And in 1923 Turner, a pediatrician who had been a farm boy, called attention to the similarity of milk formation in two mammalian mothers, the human and the bovine, and drew interesting conclusions on increasing milk production in mothers by methods similar to those in use in the dairy. 
Various opinions whether colostrum is laxative, nutritious and germicidal in the human being as it is in the calf  are held by various authors.  Although earlier studies were limited to estimation of percentages of protein, carbohydrate and fat, interest later widened to include mineral content as well as vitamin potency. 
A careful study of human milk flow by Icie Macy and others to find out whether nervous, chemical or glandular agents operate to start the flow of milk led to the following conclusions : all are helpful to the physician who is trying to increase milk production:
Present day trends in infant feeding were well summarized by Milton Senn.  Knowledge of the structure of the lactating breast is helpful in understanding its function ls and the influence and effect of suckling on the development of the infant's mouth.  One study of 900 cases showed that 87 percent of mothers attempting to nurse their infants will have an adequate supply on the fifth postpartum day for part or full time nursing and about 70 per cent will achieve full time nursing, varying with their age and parity and whether the baby is nursed from both or alternate breasts.  Another study noted how suckling rhythm changes from regular, steady, uninterrupted cadence when breasts are full to irregular spurts later.  Others described the mother's subjective symptoms, as of "the milk coming in," prickling, tension, tickling, itching 
and what English observers call "the draught."  The effect of fatigue and of insufficient rest and sleep in decreasing production have frequently been mentioned. 
Aldrich noted four reflexes concerned with the actual getting of food—rooting, sucking, swallowing and satiety. He described the way that the nursling turns his head toward the breast when he feels it against his cheek or smells the milk.  Other observers have confirmed this behavior. 
The foregoing survey of the voluminous literature on breast feeding and the structure, function and hygiene of the lactating breast of the nursing mother show a healthy difference of opinion on many points. Further study of the literature reveals sharply differing opinions on almost every one of the cardinal points concerning the actual technic of breast feeding. Although I shall make an honest attempt to present both sides in the argument concerning each of these cardinal points, I shall indicate plainly my own preference in each instance and justify my own technic. I believe that every man who wishes to make breast feeding a useful tool should similarly evolve a method of his own. Not until this becomes fairly common practice can it honestly be claimed that breast feeding has really come of age.
The first of these cardinal points in breast feeding is manual expression, which in the human being is analogous to milking, with the forefinger and thumb employed instead of the whole hand of the milker. Simple as this procedure is, and most valuable for reasons to be discussed, manual expression is seldom practiced, to judge by the keen interest manifested whenever it is demonstrated before a group of physicians, and their evident surprise when they see jets of milk spurting 6 feet (183 cm.) or more. The technic of manual expression has been explained by various writers in many terms, some of which make it seem difficult and complicated.  It is shown to be simple by the following description :
The proper way to empty a breast is to "milk" it. ...Grasp the breast just back of the areola between the thumb and the first finger of the opposite hand. Close the thumb and finger on the (portion of the) breast tissue (lying between), drawing them forward with a slight milking motion. ... At first the milk may come in drops; but after a few manipulations a spurting stream may and should be obtained. This has a tre mendous psychologic effect on the mother and her relatives. 
The technic can be mastered by any physician and taught to any mother in a matter of minutes.
(a) Manual expression is useful for making sure of the complete emptying, or "stripping," of the breast that most authorities agree is essential to continued optimum production,
(b) It is also valuable as a means of determining whether and when the breast has been completely emptied, so as to save the baby from useless effort and the mother's nipples from needless and painful trauma.
(c) Two physicians stated that they instruct expectant mothers to empty their breasts of colostrum by this method at frequent intervals three months ante partum, believing that this promotes breast feeding. 
(d) Manual expression has a tremendous psychologic effect on mothers who doubt their ability to nurse.
The old-fashioned breast pump is still advocated by some writers, though there is general disapproval of its use. The easiest form of mechanical expression is by means of the Abt electric breast pump. [26d] Waterpower breast pumps, depending on a water suction apparatus like that used for cleaning pipets in the laboratory, may be improvised and are satisfactory.  Hot applications or massage are as ridiculous and ineffective as they would be if applied to a cow's udder. 
Now considered an almost indispensable feature of successful breast feeding, complementary feeding greatly lessens the worry and mental strain of every mother when she fears that her supply of breast milk is insufficient for the infant and that her baby will starve if she does not have some help in nourishing him.
Although some authors still make the distinction between complete breast feeding and so-called "mixed feeding," most of the enthusiastic proponents of breast feeding would feel badly handicapped in caring for mother and child if they could not depend in time of trouble on complementary feeding.  ("Supplementary feeding," alternating breast and bottle at successive feedings, is generally discredited, because such infrequent stimulation of the breasts would mean speedy weaning of the infant for most mothers.)
Perhaps One of the most vigorously contested points in the whole technic of breast feeding is the length of time the infant should remain at the breast. It is so closely related to the possibility of overfeeding that the two may be considered together.
The older writers made much of overfeeding as a common cause of trouble. One modern writer, Charles Hendee Smith, made an equally emphatic statement : "The baby gets about 75 per cent of his nursing in the first two to four minutes. Six to eight minutes is usually adequate. If the supply is overabundant, three to five minutes. One of my patients got all he needed in forty seconds!"  This writer stated his belief that the overfed baby gains too much, has too many loose green or yellow stools with curds, cries after feeding, has tense skin and contracts eczema."  Another allowed only seven minutes."" Still another permits feeding for fifteen minutes, believing that after that time the child swallow's air, which causes colic, crying and sleeplessness. "Their gums become painful, raw, inflamed and angry looking."  (I have still to see such results of overlong feeding! )
One author stated that the time at the breast should vary with the baby's nursing vigor and degree of wakefulness. [2d] My own position is strongly against any arbitrary time limitations, which I believe to be the cause of many unnecessary weanings, especially the time-honored but evil hospital limit of twenty minutes. [2d] I have never seen anyone with patience and perseverence enough, to overfeed a baby.
A baby needs to drink an amount of milk that equals one seventh to one sixth of his body weight per day.  Twenty-five calories and 1 1/2 to 2 ounces (44 to 59 cc.) of fluid per pound (0.5 Kg.) of body weight are needed for the first week, while 45 calories and 2 to 2J/2 ounces (59 to 74 cc.) of fluid per pound are necessary throughout the first year. 
It would seem logical to weigh the infant before and after feeding in order to determine how much breast milk he is getting if it were necessary to know this, as some authorities believe that it is. Smith and Merritt have even done what they call "fractional weighings," by which they mean weighing an infant every two minutes throughout an entire feeding. They have thus accumulated valuable data on the rate of secretion of breast milk. 
Although many authorities place much dependence on this method of determining the amount of food taken by the infant, others believe that this may be misleading unless the intake is measured for an entire twenty-four hours. Brennemann advised that weighing before and after feeding may be used, but he counsels that it "should be discontinued after it is once established that the baby is getting enough." He adds that "too much weighing of a thriving baby is a meddlesome, unscientific procedure" and that "mothers have emotions . . . that have a direct influence upon the amount of milk secreted when the scale records a smaller amount of milk secreted." Another author devised a mathematical formula as a substitute for before and after weighing. 
I agree with Brennemann to such an extent that I am strongly against relying on such an artificial and unreliable method of determining whether and when a baby has had enough. I rely on the baby himself to indicate to me and his mother when he has had enough.
Although many hospitals and a great many physicians who are not especially successful with breast feeding favor allowing but one breast at a feeding, experimental evidence is greatly in favor of two-breast feedings.  Another observer has noted that "When one (breast) is being stimulated, the other is also, and if not emptied there will be some absorption, and usually the milk diminishes. The dairyman would not think of milking one half of the cow's udder at one time and half at another." 
It is my own firm conviction that the standardized hospital limitation to one breast at a nursing, and that other equally orthodox but equally unnatural limitation to twenty minutes at a nursing, are responsible for a vast number of entirely unnecessary weanings.
Although many mothers nurse their infants while lying down, most writers advocate the 45 degree angle naturally assumed by a baby in his mother's arms, with an occasional shifting to her shoulder for 'burping." Smith and LeWald's roentgenologic studies showed an immense air bubble in a baby nursing in the hornizontal position, which disappeared immediately when he was held upright. The crying and evident discomfort and pain disappeared at the same time. They concluded : "The erect posture favors eructation of (swallowed) air; the horizontal posture prevents (such eructation)." 
Others have advocated keeping the infant as upright as possible during nursing  (so-called "orthostatic sucking," [19a] as in savages, ancient sculpture and among all other mammals. [19b]).
All the older textbooks, and many a physician and mother today, take for granted that indigestion in babies is commonly caused by fermentation and the "gas" that results. Although it is difficult to conceive that fermentation could create enough gas to cause the distress that so many infants manifest shortly after eating, this idea persists. Smith and LeWald, however, definitely disproved this by roentgenologic evidence, and Smith stated: "Swallowed air accounts for gas in the large majority of cases. Air is constantly present in the larynx ; and some is forced down with the food and with saliva or nasal or bronchial mucus between feedings." 
McQueen Salley offered an ingenious explanation for this immediate bubble that could not come from fermentation. He said flatly : "I do not believe the nursing baby ever swallowed air. I do know that the action of dilute hydrochloric acid on certain liquids does produce gas (immediately), and that is what happens with the baby."  Farmers who have treated the colic of so-called "cribbing" or "air swallowing" horses by massaging their bellies with a broomstick may take issue with what Dr. Salley says about babies !
Is colic a clinical entity? Or is the "six weeks colic" or the "three months colic" insisted on by the old ladies merely a myth? Many of the older writers and some of the new ones have insisted on its existence, some of them citing "enterospasm" [2d] and "hypertonic" infants.  Rosamund  has insisted that "hunger and colic are synonymous." My own experience convinces me that so-called "colic pains" are usually due to hunger or to overdistention with swallowed air. This does not take into consideration the colicky pains of intussusception, pyloric stenosis, pylorospasm, appendicitis or peritonitis, which have other accompanying symptoms confirming the diagnosis. If eructation or the passage of a stool, followed by the chance to take more food, does not make the "colic" disappear, then these more serious organic causes should be considered.
Prelacteal feeding is an attempt to circumvent nature's plan of having the baby lose weight (sometimes as much as y¡ pound, 226 Gm., or more) during the first few days of life by offering him a sugar solution or a substitute formula until lactation is fully established. Brennemann asked whether physicians were "to accept ... an initial three-day period of semistarvation with a 10 per cent loss in weight or to proceed at once to feed the newborn infant." He stated that he gave prelacteal feeding as a routine. [2d] But he said elsewhere : "No other food should be given at this time except water." [2e]
While many physicians see no objection to prelacteal feeding, far more are strongly opposed to it.  Grulee, finding that only 48 per cent of the babies at one hospital were still breast fed at the end of the lying-in period, ordered that nothing but water be given them in addition to breast milk. "At the end of six or eight months," he stated, "these figures were changed to approximately 90 per cent." [2f] In my practice I forbid everything but water until lactation begins.
Shall the infant be fed at the familiar, regular three or four hour intervals, or shall one advise the "demand" or "self demand" regimen on which the baby is fed whenever he cries? Spock has called it "the experiment of going back to Nature." [26e] A Detroit group, the "Cornelian Corner," has urged that the infant be given "opportunity to nurse whenever . . . hungry or anxious," for "relief of tensions so incident to feeding, toilet training and child discipline." 
The majority of physicians and mothers still prefer regular three or four hour feeding intervals.  Since the baby usually discontinues his 10 p. m. feeding in a few weeks, if not awakened for it, and the remaining night feeding around the end of the second month, the same result is obtained by either method. A regular schedule not too rigorously followed is probably the most sensible course to adopt, avoiding both unbending punctuality and the laisses faire self demand.
Contraindications for breast feeding are not nearly as numerous as they were formerly. The following list is sensible:
Infantile eczema [8b] and changes in color of stools are no longer considered cause for weaning. (Other authors list some of the ridiculous excuses given by mothers for stopping nursing.)
To prevent trouble with nipples, they may be pulled out and held so, if inverted ; they may be toughened with alcohol during two or three months ante partum, as advocated by most writers, though one expressed a preference for use of wool fat rather than alcohol.  (Another writer advocated examining girl babies for inverted nipples and giving them the same treatment of pulling out and holding the nipples, to make them fit for nursing in their adult years. ) Prevention and treatment for sore nipples vary with different writers - castor oil and a bismuth compound on a square of waxed paper, "aeration" by sewing a metal ring with semicircles of wire into the brassiere, [26a] and plastic nipple shields. 
For prevention as well as treatment of caked breasts, "uplift brassieres" or other elevating measures are advocated.  One author has suggested antepartum manual expression, to be continued two or three days postpartum, to forestall caked breasts. [18a] If the condition occurs, the surgeon usually takes over; even so, many insist that "breast abscesses are not cause for weaning, provided no sinus is discharging." [2h]
Most formidable of all obstacles to breast feeding is the indifference, and at times the actual opposition, of a large segment of the medical profession. Next comes the attitude of the hospital personnel in so many institutions, especially the nurses and supervisors, who naturally take their cue from those above them.
How discouraging their cynicism as to the feasibility of nursing can be to the mother who wants to nurse her baby is seen in two articles in a national women's magazine. They should be read and pondered by those physicians who deny that there exists such active opposition to breast feeding, as well as lack of interest and faith, on the part of a great many physicians, especially in the East. 
I would call to the attention of any physician who is still dubious about breast feeding as the most scientific method of feeding infants the words of a pioneer in this field. J. P. Sedgwick wrote in 1917: "We know enough now to save the breast milk for most of the babies who need it. It has become a question of getting the information to the profession and the nurses and the public." 
An unsolved mystery has always been the willingness of so many physicians to abandon breast feeding with out a serious effort to conserve it. A study of some four hundred titles has revealed as many differences of opinion, quite as ardently held, as were some of the various theories on bottle feeding for which physicians used to do battle so valiantly a generation or more ago.
If physicians who deal with infants will check these various views against their own experience and will develop individual technics, just as anyone must who employs artificial feedings in the care of infants, then it can truly be said that breast feeding has fully come of age.