A HISTORY OF INFANT FEEDINGBY

IAN G. WICKES

PART I. PRIMUTVE PEOPLES: ANCIENT WORKS: RENAISSANCE WRITERS

'All that has been written on the choice of nurses, and the nourishment of children, is hardly anythingmore than a collection of prejudices.'

N. BROUZET (1755)(RECEIVED FOR PUBLICATION DECEMBER 8, 1952)

Infant Feeding Amongst Primitive PeoplesAnthropological studies show that there is a

remarkable tendency to obscure the natural methodof infant feeding. This is more readily under-standable when it is realized that contemporaryprimitive tribes are in fact highly civilized, thoughtheir form of civilization has evolved along differentlines from our own. The known facts have beencompiled by Ploss and the Bartels (1935) in theirhistorical and anthropological compendium entitled'Woman'. The more important points will bereproduced here.Most savage jeoples let several daXs pass before

the mother begins to suckle the newborn baby, andthe time interval varies from tribe to tribe, but theaverage period is four days, and the naximumseldom exceeds nine days. The same kind of tabooon the colostrum is apparent in the writings of bothEnglish and French authors of the seventeenthcentury and it had been handed down to them fromGreek and Roman times. The one exception appearsto be the Maori tribe who attends to the breastsduring pregnancy and begin suckling after delivery(Waller, 1937). Most other tribal wom,en give foodto the infant during the interim period and our ownpractice of giving sugar and water to the newborn isa survival of this custom. In Samoa the whole pro-cedure is highly organized, with an official milktester, usually an elderly woman, who puts thesample of milk in a dish, adds a little water and twohot stones. If curdling occurs the milk is pronouncedpoisonous and suckling is further delayed but asuitable bribe usually results in the test provingsatisfactory!, The duration of the period of lactation varies con-siderably from one tribe to another but the averagewould appear to be from three to four years, thoughadditional foods such as chewed bananas, coconutmilk, bread and intoxicating liquors are often started

from the earliest age. Hottentots seldom feed longerthan about four months, Samoans less than oneyear, Armenians for one to two years, Australianaborigines for two to three years, Greenlanders forthree to four years, Hawaiians five years andEskimos for about seven years reaching a maximumin King William Land of up to 15 years. In thesecircumstances a mother may be suckling two ormore children of different ages at the same time.

Prolonged lactation would seem to be encouragedby maternal love, the pleasurable sensation experi-enced, economy, and belief in its contraceptiveproperty. There would appear to be no moral con-tent for, in breast feeding, the wife of primitive manhas no feeling of merit or duty; she simply does whatshe cannot help doing. On the other hand prolongedlactation would appear to be actually abhorrent tocivilized man; a note in the Lancet (1842) records acase of a woman who suckled a child for three and aquarter years and then developed epilepsy. Theattendant physician wrote: 'The worst symptoms ofdebility at last attended this monstrous proceeding'.The Tyrolese, about 1900, went even further, for atthat time breast feeding amongst them was not onlynot customary but was actually regarded as immoral.Most primitive women nurse the baby in the hori-

zontal position on their lap, and some use the fingersof their free hand to control the flow of milk. How-ever, the Armenians and several Asiatic races leanover the supine baby, often resting on a bar whichruns above the cradle for support. It has beensuggested that in this position less air is swallowed.and certainly it is not customary for these women tolift the baby out of the cradle to eructate after a feed.The Hottentots and Fijians carry the child in a clothon their backs, and having by nature long, pendulousbreasts, they are able to toss one over their shoulderto the baby whenever he indicates by crying that heis hungry. In the accompanying illustration the

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mother is at the same time nonchalantly smoking a Hoffman wrote at the beginning of the eighteenthpipe. In Japan suckling often occurs lying down, century:but older children take the breast by standing or 'The fiercest animals are rendered mild by humankneeling up to the squatting mother. milk, and conversely humans being brought up on

the milk of a wild beast become wild and fierce,witness the example of Romulus and Remus.

The ferocity of Calhgula was attnbuted to the tactthat a drop of blood was regularly put on the nipplebefore he sucked and the bibulous Nero was partlyforgiven because he had been reared by a drunkennurse.The above facts about the breast feeding habits of

various tribes are intentionally recorded withoutembellishment, for speculation upon the remoteeffects of the feeding mode upon the future life,health and temperament of the growing individual,and hence eventually upon the society and cultureof which he forms an integral part, is potentiallylimitless and therefore liable to be misleading.Nevertheless suggestive facts are constantly beingaccumulated by workers in the field who converge

FIG. 1.-An Armcnian sucling her child. Rqxroduced firom 'Woman'Vol. II by Ploss and Bartels by kind permission of Messrs. Wm.

Heinemann Ltd.

Wet nurses seem to have been in use from theearliest historical times and women of high rank inmost communities have employed them but never-theless some tribes consider foreign milk to beharmful for the infant, and if the mother dies-theEskimaux plunge the child into the cold sea ratherthan expose him to this danger. In contrast, someArab communities pass each infant suckling roundto all the lactating women.

In tribes associated with western civilization, suchas in Java, the grandmother is expected to put thechild to the breast whilst the mother goes out towork but there is considerable doubt as to whetherpersistent sucking ever stimulates true lactation inthis way, though there are several reputed instanceswhich suggest that it sometimes may and there areeven reports of fathers successfully suckling.

In Africa and the Cameroons it is customary forthe women also to suckle, if need be, domesticpuppies and piglets, and the converse, of infantsbeing suckled by animals, has been recognized sincethe time of Romulus and Remus, and was stillpractised in France in the last century where babiesat L'Hopital des Enfants Assistes in Paris wereregularly put to the teat of asses which were per- FiG. 2.-A Hotentot throm her breast over her shoulder to suckle

her child. Reproducedfprom 'WoMans. Vol. III by Ploss andBtd nsmanently housed in stalls adjoining the ward. by kind permnission of Messrs. Win. Heiremann Ltd.

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HISTORY OF INFANT FEEDING: PART I

upon the problem from different angles by anthro-pologists, paediatricians, psychoanalysts and socialworkers-and thereby more confidence is beingengendered in those who seek to assess the truedepth and significance of the problem. Psycho-analysts are continually unearthing incidents whichsuggest that many important stimuli acting on thevery youngest of infants are capable of making per-manent and indelible imprints on the psychic patternwhich become more and more deeply buried as theyears go by and yet are capable in favourable cir-cumstances of sending up bubbles, as it were, whichcause ripples of disturbance on the surface. It isreasonable to expect that the emotionally chargedatmosphere which is certain to envelop such a vitalfunction as the feeding of a helpless human infantwould be a stimulus of the most profound signifi-cance capable of moulding the developing characterand, to a greater or less extent, of influencing thewhole life history of the individual concerned.

Margaret Mead, in her recent study (1949) of thesexes entitled 'Male and Female' (pp. 68-72)approaches the problem as an anthropologist whohas lived intimately amongst seven separate SouthSea island communities, and she has attempted tocorrelate feeding habits with community traits. Thusthe cannibal Mundugumor actively dislike rearingchildren, and the mothers push them away from thebreast as soon as they are in the least bit satisfied.Their community spends its time quarrelling andhead-hunting, and love-making is conducted like thefirst round of a prize-fight. On the other hand thelatmul infant (also a head-hunting tribe) is allowedto cry vigorously for a feed, but when at last thebreast is given there is no stinting and in this waythe mouth becomes an assertive demanding organ.In contrast, the Balinese stuff little piles of pre-chewed banana into the infant's mouth whenever itopens, and this assault is followed in later life by atendency to cover the mouth and eating is accom-panied with great shame. The Arapech, a moredocile and contented tribe in New Guinea, suckletheir infants whenever they cry and they are neverleft far distant from some woman who can give themthe breast if necessary.

In our own community there is less uniformity ofapproach to the problem and hence generalizationsare less valid, but there is great scope for a team ofsocial anthropologists to observe a series of infantsfrom -birth with a view to correlating feedingmethods and problems with the later developmentof personality types and psychoneurotic reactions.Until such research is carried out we can only guesshow pervasive an influence infant care can have uponany social structure. It has recently been suggested

that Russia's expansionist behaviour depends upontheir custom of tightly swaddling the newborn andin this respect it may be significant that our ownEmpire building was carried out at a time when thesame practice prevailed in England.

In the pages which follow we shall record ingreater detail the modifications of infant feedingwhich have developed amongst western peoples, thedifficulties which have arisen therefrom, and weshall see the persistence of primitive taboos with thesubmergence of the natural laws; later we shallobserve the impact of science gradually taking effect.The interplay between the primitive and the civilizedsometimes produces grotesque results as typified bythe illustration of a modern Javanese woman carry-

FIG. 3.-Woman from cental Java carrying a suckling of 4 years ofage Reproduced from 'Woman' VoL IHI by Ploss and Bartels by kind

permission of Messrs. Wm. Heinemann Ltd.

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ARCHIVES OF DISEASE IN CHILDHOODing a 4-year-old suckling boy who is smoking acigarette between feeds!

Earliest Writings on Infant FeedingF. H. Garrison, writing the introductory chapter

on the History of Pediatrics in Abt's 'Pediatrics'makes a comprehensive study of the references topaediatrics in the earliest medical writings whichhave been handed down to us from the ancientcivilizations.The Papyrus Ebers (c. 1550 B.C.) is the earliest

medical encyclopaedia from Egypt and it includesa very small paediatric section which contains oneshort prescription concerning breast feeding:

'To get a supply of milk in a woman's breast forsuckling a child: Warn the bones of a swordfish inoil and rub her back with it. Or: Let the woman sitcross-legged and eat fragrant bread of soused durra,while rubbing the parts with the poppy plant.'

From this brief reference we can deduce thatfailure of lactation was a definite problem in ancientEgypt which was not entirely solved by the use ofwet nurses or the adoption of artificial feeding, ahazardous procedure in those days. Later, in thePtolemaic period, Greek influence probably resultedin an increased use of slaves as wet nurses whoseresponsibility it was to breast feed their charge forabout six months and then to use cow's milk. In theCairo museum there is a nursing flask of theAlexandrian period (second century) and perhapsthese were used for the rearing of foundlings who,if they survived, were destined to become gladiatorsor prostitutes.

Indian Brahminical medicine had an excellentand well systematized paediatric section, and in the'Susruta' (second century B.C.) it is made clear thatit was customary to evacuate the meconium bygiving honey and clarified butter during the firstfour days of life whilst the colostrum was expressedand discarded. Normal breast feeding was begunon about the fifth day. If a wet nurse was laterrequired it was recomnmended that a lactating womanshould be selected from the same caste as the infant,with well shaped breasts and with all her ownchildren living. An infant should not be put to thebreast of a woman who was feverish, dyspeptic,hungry or pregnant, and the milk should be testedand found to be easily miscible with water, thin,cold, clear, without froth or shreds and the colourof a conch shell.

In Israel children were regarded as a blessing andbreast feeding as a religious obligation. It seemsprobable that the average duration for suckling wasabout three years (2 Maccabees 7, 27) and the hireof wet nurses was clearly well organized one

thousand years before Christ (Exodus 2, 7). Thecommon belief in purging the newborn is preservedin Isaiah (Isaiah 7, 14) but there is no mention ofartificial feeding anywhere in the Talmud.

In Homeric Greece (950 B.C.) wet nurses were infrequent demand, particularly by women of thehigher classes, in whose households they came tohold a position of great responsibility with authorityover the slaves and often with prolonged care oftheir charges up to adolescence. The writings ofHippocrates (460-370 B.C.) and his school containedlittle about infant feeding apart from some of the32 aphorisms which, according to W. H. S. Jones,have been put together by scribes from later writersunder the general heading 'On Dentition'. Thefirst five are worth reproducing here:

I Of children, those that be well nourished bynature, suck not milk in proportion to theirfleshiness.

II Gross feeders that draw much milk gain notflesh in proportion.

III Of sucklings, they that pass much water areleast inclined to sickness.

IV They that have the belly much moved and gooddigestion withal are the healthier: they thathave scant movement, and being gross feedersare not nourished in proportion are sickly.

V In those that vomit much milky material, thebelly is confined.

Hippocrates believed that the foetus learned tosuck in utero and that this accounted for the passageof meconium and the presence of the sucking reflexat birth. He advised that

'Children and infants for a long time should bewashed in warm water, and for drink should be givenwine diluted with water and not quite cold; thisshould be given because it does not distend the bellyand cause wind. These things are to be done tolessen the liability to convulsions . . .'

The next great writer of importance whose workshave come down from the Graeco-Roman period isSoranus of Ephesus who lived in the second centuryA.D. and who produced a treatise on gynaecologyand obstetrics which included no fewer than 23chapters on mothercraft, infant feeding, teethingand children's diseases which served as a prototypefor the next 1,500 years. Soranus dealt in full withthe choice of a wet nurse, the regimen for nurses,salting of the newborn and many other topics. Heincluded the first description of the nail test whichhe probably did not originate but which has beenhanded down the centuries under his name frombook to book. He recommended withholding thebreast during the colostrum period just as the earlierIndian writers did, and at the age of 6 months headvocated the addition of bread crumbs, dilutedwine, soups and eggs. There is no complete English

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HISTORY OF INFANT FEEDING: PART Itranslation of his works, but his influence upon theRenaissance writers will be plainly disernible in thenext section. There is a full French translation byDr. Herrgoth (1895).Galen (A.D. 130-200) wrote a chapter on infant

feeding which, so far as I am aware, has never beentranslated into English but he is more particularlyimportant for his general influence on mdiicalthought in the Middle Ages. His conception of thefundamental principles of the natural world, orelements (air, fire, earth and water), which wererespectively cold, hot, dry and moist dominated allbranches of medimine for many centuries. A com-bination of one quality from each pair produced acomplexion, and each had its appropriate huiourthus:

ComplexionSanguinePhlegmaticCholeric

QualitiesHot and moit

Cold and moistHot and dry

Melancholic Cold and dry

HunourBloodPhkleYellow or green

bileBlack bile

Children were considered to be phlegmatic atfirst, becoming sanguine and choleric with growth;they had to be treated accordingly.

Oribasius (A.D. 325403) in his treatise toEunapius Lib. 5 was one of the first writers toreproduce Soranus almost in toto, but Galen'sinfluence is also apparent where he advises againstgiving meat to infants because it 'creates phlegm'.The medical writings of Paulus Aegineta (?A.D.

625-690) have been fully translated by FrancisAdams; they comprise seven books of which thefirst is concerned with infant feeding. Most wascopied from Oribasius who in turn plagiarizedSoranus, but it is worth sumnarizing here the mainpoints with which he dealt. In choosing a wetnurse he recommended that she should be betweenthe ages of 25 and 35, with well developed breastsand chest, and have been recently delivered of amale child. She should avoid salty and spicy foods,venery and debauchery, and she should take regularexercise employing the arms and shoulders bygrinding or working at a loom. In addition to thenail test he advised adding rennet to the milk in aglass, allowing the cheesy sediment to settle, andcomparing the serous supernatant fluid with thesediment. They should be roughly equal in quantity,but if the latter exceeds the former the milk will beindigestible, and if vice versa then the milk is tooweak. If on the other hand the milk was too thickthe mother should be given emetics to evacuate thephlegm, and if it was offensive it should be expressedand the mother fed on fragrant food and wines.The Arabian school, which flourished about 200

years after Paulus, was represented by Rhazes(850-932), Avicenna (980-1037) and Averroes (1126-1198) who were more interested in children'sdiseases than in infant feeding but they served tobridge the gap between the Graeco-Roman andRenaissance writers. Rhazes attributed 'MaterPuerorum' to the taking of too much milk andthereby set a precedent for many subsequent writersto cite overfeeding as the cause of numerous dis-orders. Avicenna advised purging the nurse if theinfant ailed.The practice of preventing the newborn infant

from taking colostrum and the giving of sugarinstead, which is plainly contrary to nature, hastherefore been prevalent since the dawn of civiliza-tion and, as we have seen, it is still almost universallyadhered to by contemporary primitive tribes. In thewritings we have so far referred to, there is verylittle mention of artifiial feeding yet the discoveryof feeding vessels from 2000 B.C. onwards suggestsstrongly that animal milk was in fairly common use.Many clay vessels have been found in the graves ofRoman infants and some; from the first to the fifthcentury A.D., have been accurately dated with theaid of coins found along with them. It is difficult toaccount for this widespread omission, but perhapsthe most likely explanation is that the milk was notmodified in any way and hence no instructions forgiving it were required. In any case wet nurses werethe great standby; their employment by the Romanpatricians caused Tacitus to inveigh firmly againsttheir excessive use. Later writers have regarded thispractice as a cause or a symptom of the decline thatwas to follow and have used similar arguments towarn our own civilization of its impending doom.

Aulus Gellius in 'Attic Nights' (translated byJ. C. Rolfe), also records how the philosopherFavorinus called at a Roman's house to congratulatehin on the birth of a son and he relates the argu-ments whereby Favorinus attempted to convincethe grandmother that her daughter should suckle thechild. In a long dissertation he asserted that torefuse the breast was as wicked as to procure anabortion, and he clearly believed in the conveyanceof character via the milk which he used as anargunent against the employment of a nurse.The ancients, therefore, sowed the seeds of many

of the superstitions and practices which embellishinfant feeding even today, but they blossomed moststrongly in the Middle Ages.

Reissance WritersWe can pass straight from the ancients to the

Renaissance period for there is no surviving work

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ARCHIVES OF DISEASE IN CHILDHOODfrom the MiddleAges relevant toour subject nor isit likely that any-thing of impor-tance was wntten.The year 1472marks the begin-ning of the outputof printed workson paediatrics(Still, 'History ofPaediatrics' p. 58),but all the earlierones were in Latinand nearly a 100years were to passbefore the firstbook in Englishon the subjectappeared.Paul Bagellardus

(?-1492) wrote thefirst of the paedi-atnc incunabulawhich was printedin Padua in 1472.It was largely com-piled from theancients and con-tained the usualreferences to thenail test and thecharacteristics of agood wet nurse.Hirr'icrcoPc 1i ar-

attnintobp4ljo j; entrcatcb of allbc )tbicb cbauncecp; tabo;, anD allt5lbibit 4appmnitcz after tlcbebalfoat tlejlatrte -#pDeo; laft boutftIe Conceptton311n botit mnanpeelettco w furtle:5 otblc fruptefullotb appcre II tIle -boolir.

rhoeaand vomit-FiG. 4.-Title page of the Engidsh translarhoea and vomit- Jonas, I40. Reproduced from 'Histoing were all permission of theOattributed to over-feeding while viscous milk gave rise to constipationwhich was to be treated with a suppository madefrom powdered mouse excrement. Ruhrah('Paediatrics of the Past' pp. 34-70) gives a fullquotation from Bagellardus.

E. Roesslin (?-1526), who lived in Worms, wrotethe first printed book on obstetrics and, as was thecustom with the ancients, it included a section onpaediatrics which was mainly a translation intoLatin from Metlinger (c. 1450-1492), who hadwritten the first book in German. Roesslin's'Rosegarten' as it is called was translated intoEnglish by Richard Jonas in 1540 with a dedicationto Katherine Howard, wife of Henry VIII. It waslater reprinted by Thomas Raynalde entitled'Byrthe of Mankynde'; a photograph of the title

tion of Rotsslin's 'Rosegarten' by Richardry of Paediatrics' by Still with the kind)xford University Press.

page is reproducedhere and thefollowing quota-tion comes fromthe First Boke,Cap; X, folio lix;

'Avicen avysethto geve the chyldesucke two yeres /howe be itamonge us mostcommenlye theysucke but oneyeare. And whenye wyll wenethem / then not todo it sodenly buta lytell and lytelland to make for itlittle pills of breadand sugre to eateand accustom itso / tyll it be ableto eate all mannerof meate.'The above

passage is ofparticular interestand value becauseof the fact that theauthor definitelystates that he isdescribing contem-porary custom.All too frequentlythe medical his-torian has toassume that theauthor is describ-ing contemporarymethods whereasin fact he may just

as well be endeavouring to introduce a new schemewhich he considers to be an improvement upon theexisting state of affairs which is too well known torequire further mention. It is for this reason that ahistory of infant feeding can never hope to be verymuch more than a chronological account of the rele-vant bibliography; further extension into the every-day methods of the common people is usually purespeculation. Forsyth, speaking at the Royal Societyof Medicine in 1910, fell into this trap when ad-vancing his thesis that not only was the incidence ofbreast feeding steadily declining, but also that theduration of lactation had been gradually curtailedfrom about two years in Elizabethan times to aboutnine months by 1900. The above quotation from the'Rosegarten' shows clearly how much he was at fault.

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HISTOR Y OF INFANT FEEDING: PART I

Thomas Phayer (1510-1560), generally known asthe father of English paediatrics, wrote the firstEnglish textbook on the subject entitled the 'Bokeof Children'. This was originally bound with his'Regiment of Life' and was, according to Still, firstpublished in 1546 but Caulfield asserts that there is acopy in the Huntington Library, California, dated1544. The last edition appeared in 1654 and the booktherefore held its popularity for a century. It isfreely borrowed from Jonas' translation of Roesslinwho in turn had plagiarized Metlinger, who himselfhad derived his main inspiration from the ancients,relayed largely through the Arabian school.Phayer's description of the nail test and his remediesfor increasing breast milk are copied almost wordfor word from the earlier work. Copies of bothworks can be seen and compared at the WeilcomeHistorical Medical Library; it is interesting to notethat the 'Rosegarten' is paginated as folios, whereasin the 1546 edition of Phayer (variously spelt Phaer,Faer, Fayre, etc.) the pages are unnumbered.Phayer wrote about eight pages on infant feedingbefore passing on to the diseases of children and hispleasing style makes a quotation of the major partwell worth while.He begins by avowing his disinclination to deal

with the hygiene and feeding of infants at all sincein his day these matters were completely dominatedby the midwives, but he summons enough courageto proceed notwithstanding. In the introduction hegives expression to the widespread belief of thatperiod that temperament and morals, in addition todiseases, are conveyed by the milk of the nurse:

'In the meane season for confinitye of the matter,I entend to write somewhat of ye nourse, and of themilke, with the qualityes, and complexions of yesame, for in that cosisteth the chief pointe andsumme, not only of ye mayntenaunce of health, butalso of the fourmyng or infectyng eyther of thewytte, or maners, as the Poet Vergyl when he woulddescribe an uncurteys churlyish and a rudec6dishioned tyraunt, dydde attribute the faute untothe gyver of the mylke ...And, as writeth Aulus Celius, Phavorinus the

Philosopher affirmeth, if ye lambes be nouryshedwith ye milke of goates, they shall have coursewolle, like the heare of goates: and yf kiddes inlyke maner sucke upon shepe ye heare of themshalbe soft lyke wol}e. Wherby it doth appeare, thatthe mylke and nouryshyng hath a marveylous effectein chaunging the complexion . . .'

Phayer then follows this up naturally with thetraditional criteria for choosing a wet nurse, theappearance of sound milk, and of course a descrip-of the famous nail test:

*Wherfore as it is agreing to nature, so it is alsonecessary and comly for the oune mother to noursethe oun child. Which if it maye be done, it shall be

most comendable and holsome, yf not ye shall bewell advised in taking of a nourse, not of yll com-plexion, and of worse maners: but such as shall besobre, honeste and chaste, well fourmed, amyableand chearefull, so that she may accustome theinfant unto myrthe, no dronkard, vycyous norsluttysshe, for such corruptethe the nature of thechylde.

But an honest woman (such as had a man chyldlast afore) is best not within two monethes afterher delyveraunce, nor approchyng nere unto hertime againe. These things ought to be cosidered ofevery wyse person, that wyll set their childMren out tonource. Moreover it is good to loke upon the milke.and to se whether it be thicke and grosse, or to muchthinne and watrye, blackysshe or blewe, or en-clynynge to rednesse or yelowe, for all such areunnaturall and evyll. Likewise when ye taste it inyour mouthe, yf it be eyther bytter, salte, or soure.ye may well perceyve it is unholsome.That milke is good, that is whyte and sweet, and

when ye droppe it on your nayle, and do move yourfinger, neyther fleteth abrod at every stering, norwyll hange faste upon your naile, when ye turne itdowneward, but that whyche is betwene both is beste.Somtime it chaunceth that the milke wasteth, so

that ye nource can not have sufficiente to susteinethe child, for the which I wil declare remediesleaving out the causes for brevity of time.'

Since the problem of the causes of failing lactationis still unsolved today it is disappointing that Phayerhad no time to recount them, but under the heading'Renmeie appropriate to ye encreasyng of Mylke inthe Brestes' he recommends 'parsneppe rootes','fenelle rootes sodden in broth of chicken and after-ward eaten with a little fresshe butter', 'rice soddenin cow's mylke', 'the powder of earthwormes dryedand dronken in the broth of a neates tonge', and'the broth of an olde cocke, with myntes, cynamoneand maces'. If all these fail, the local applicationof plasters of fenell may be efficacious.

Sir Thomas Elyot (1490-1546), a diplomatist inthe court of Henry VIII and author of the 'Castelof Helth', of which there is a copy at the RoyalCollege of Physicians, also gave expression to thepopular belief in the moral danger inherent inemploying a wet nurse (quoted by Still, 1931, p. 307):

'For as some auncient writers do suppose, oftentimes the childe soukethe the vice of his nourysewith the milke of her pappe.'

Thomas Muffett (1553-1604) in his book 'HealthsImprovement' (1584} draws attention to the medi-cinal use of breast milk:

'Neither is women's milk best onely for youngand tender infants, but also for men and women ofriper years, fallen by age or by sickness into com-positions. Best I mean in the way of nourishment.for otherwise asses milk is best.'

He later describes the effect of the nurse's tempera-ment on the ailing Dr. Caius:

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ARCHIVES OF DISEASE IN CHILDHOOD'What made Dr. Cajus in his last sickness so

peevish and so full of frets at Cambridge, when hesuckt one woman (Whom I spare the name) frowardof conditions and of bad diet; and contrariwise soquiet and well when he suckt another of a contrarydisposition-'

Muffett believed that breast milk was 'convertedfrom the superfluity of the blood', and 'seemeth tobe nothing but white blood'. He strongl) favouredbreast feeding and on page 120, Chapter XIII of the1655 edition he warned against the use of animalmilk:

. . . Aegyrthus, who being fed in a ShepheardsCottage only with goat's milk, waxed thereupon sogoatish and lecherous, that he defiled not onlyAgamemnon's bed, but also neighed (in a manner)at every man's wife.'

The rest of the chapter on milk is concerned with along discussion on the qualities of various types ofanimal milk, and the usual description of the virtuesdesirable in a wet nurse, to which he adds, 'Such anurse is sooner wished of than found'.On the continent Simon de Vallambert wrote the

first French treatise on the subject entitled 'De laManiere de Nourrir et Gouverner les Enfans desleur Naissance' (1565) in which he recommendedfeeding cow or goat's milk through a horn after thethird month of life, and he was the first author tomention the possibility of the transmission ofsyphilis between nurse and infant. He attacked theprevalent custom, handed down from Avicenna'sday, of the nurse chewing the food before feeding itto the child because he believed that this generatedworms. In Italy 0. Ferrarius wrote 'De ArteMedica Infantum' in 1577 which contains the firstpicture of a breast pump consisting of a receptaclewith an opening for the nipple, and a long spout

reaching up to the mother's mouth, and H.Mercurialis, the misogynist, wrote 'De MortisPuerorum' in 1583 in which he recorded thatlactation may last for two or three years but mostwomen (whom he described as stupid and alwaysmaking mistakes) gave pap by the third month andstopped breast feeding by the thirteenth in contrastwith the old days when, for example, Plotinus at theage of eight used to run from his tutor to his nurseand clamour for the breast.We have seen enough of the fifteenth and sixteenth

century writings to realize that little or nothing wasadded to that which had been handed down from theGraeco-Roman period, but the advent of printingtogether with the use of the English, French andGerman vernaculars ensured a much wider dis-semination of the older works than had previouslybeen possible.Some historians, such as Forsyth, have noted the

paucity of details about artificial feeding and haveconcluded that animal milk was not used for babiesduring this period. This omission, however, was alsonoticeable in the classical works and since theRenaissance writers followed the ancients so closelyit is hardly surprising that it was perpetuated. Wehave ample evidence of a concrete nature of the useof animal milk in Roman times, and medievalprints depict the use of a cow's horn as a feedingbottle such as de Vallambert describes. We have noknowledge whatsoever as to the details of artificialfeeding, nor do we know what proportion of societywas able to employ wet nurses instead, but there canbe little doubt that breast milk was by no means theonly food commonly given to young infants.

[A full bibliography will be published with the lastsection of this paper.]

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