Breastfeeding Papers

History of Breastfeeding

The Nursing Mothers' Association of Australia picked this piece up and published it in their Newsletter for Christmas 1998 (Vol 34, number 6, pages 4-5). Ted Greiner, PhD

Can the study of the history of infant feeding help us understand today's patterns? Obviously breastfeeding has been going on since mammals existed on earth. It is very difficult to find out much about infant feeding practices in ancient history. Something as "commonplace" as breastfeeding was rarely described even by those few ancient writers interested in infant health. The ancient Greek and Roman medical writings from Hippocrates, Soranus, and especially Galen included infant health and feeding to some extent in their broader treatises on health. These beliefs were carried into the Middle Ages by the Arabian School (Rhazes, Avicenna and Averroes), were picked up in the Renaissance medical writers (Bagellardus, Metlinger, Roesslin, Phayer, Muffet, and de Vallambert) and continue to be repeated throughout pediatric literature. Presumably these beliefs spread in the same way as the humoral ("hot-cold") theory of disease causation through much of Asia and the Middle East, via the Moors to Spain, and via the Spanish conquerors to Latin America. These beliefs received a wider audience in Europe with the advent of printing and the use of vernacular languages in the fifteenth and sixteenth centuries. They may lay behind the remarkable similarity of many "traditional" beliefs about infant feeding found throughout the world today.

Breastfeeding duration

In a rare comment on the duration of breastfeeding accepted in ancient civilizations, it is said that "Plotinus at the age of eight used to run from his tutor to his nurse and clamour for the breast" (1). Wickes does not assume that "primitive" peoples of his day reflect ancient practices but are "in fact highly civilized, through their form of civilization has evolved along different lines from our own." Still, he cites Ploss and Bartels' (2) review of the anthropological literature of the time that estimates an average duration of 3-4 years among "primitive" peoples (although some breast fed much less than this). Hawaiians were said to breast feed for five years and Eskimos for about seven years, "reaching a maximum in King William Land of up to 15 years." Ford (3) wrote that breastfeeding continued for three years or longer in 15 of 45 "primitive" cultures for which he could find clear data, for two years in 16 of them, for 18 months in 13 of them and for 6 months in one culture.

Renaissance writers usually provided advice about infant feeding, assuming the reader was familiar with existing practices of the day. Wickes (1) did, however, locate one source from the late 1400's suggesting that it was by then normal to breast feed for only about one year in Germany. In Italy in 1583, Mercurialis (4) wrote that women gave pap by the third month and stopped breastfeeding by the 13th month. During the 1800s, sustained breastfeeding seems to have been considered harmful. In 1842, a physician writing in Lancet about epilepsy which developed in a child who happened to have been breast fed for three years, concluded, "The worst symptoms of debility at last attended this monstrous proceeding." By 1900, it was considered immoral in Tyrol.

Issues in lactation management

The discarding of colostrum and use of honey and clarified butter to evacuate the meconium and the delaying of breastfeeding until the fifth day was already practised in India according to Brahminical medical literature in the second century BC. The Old Testament (Isaiah 7:15) refers to curds and honey to be given to the son born of a virgin "until He knows how to reject the evil and choose the good." The colostrum taboo was carried into the seventeenth century English and French pediatric literature via ancient Greek and Roman sources (1). Ettmuller in 1699 (5) and Smith (6), however, recommended that colostrum be given.

Galactagogues, and various devises to increase breast milk production, though very rarely actually needed, have long been common in many cultures, going back to around 1550 BC (1), prompting Jelliffe and Jelliffe (7) (p. 164) to speculate that failure of the let-down reflex may have commonly occurred, perhaps as a result of "fears of bewitchment or guilt over non-observance of taboos, especially of a sexual nature."

Rhazes in the tenth century set a precedent for many writers over the years, claiming that many ailments are caused by "overfeeding" (1). This has led many to insist that the mother must discipline the child not to take the breast too many times or for too long a period each time or at regular intervals. One of the first books on infant feeding was written by Guillemeau (8) and translated in 1612 into English. It recommended regimented discipline of the child. This was followed up on by Pernell in the second English pediatric textbook in 1653 which stated, "Let not the child suck so often, nor so long" (9). Pechey's "General Treatise of the Diseases of Infants and Children" in 1697 listed many diseases that could result from the baby sucking too greedily (10). The German Ettmuller's "Practice of Physic was translated into English in 1699 and included the now common warning that, "nothing is more apt to disorder the child than suckling it too often"(11). Cadogan (12) recommended four feeds per 24 hours for infants. Smith who, in 1792, published the first mothercraft manual, advised that four hourly feeds be followed by about one month of age, since "frequent suckling stimulated lactation" (6). While the intervals (and thus numbers of feeds per day) have changed back and forth since then, this concept breastfeeding by the clock persisted in much of the industrialized world up to the recent past. Professional articles calling for demand feeding are quoted by Wickes (13) starting from 1930, but most moving is this poem he quotes from de Sainte-Marthe (14):

And I, for suckling, no fix'd hour prescribe; This Nature teaches best the nursing tribe: Let her our mistress be; and when, with cries The hungry child demands his due supplies, Forbear not you the wish'd relief to bring; Nor then be loath your snowy breast to bare, That he may suck, and streaming fragrance share.

Artificial feeding

Feeding vessels dating from about 2000 BC have been found in Egypt. A mother holding a very modern-looking nursing bottle in one hand and a stick, presumably to mix the food, in the other is depicted in a relief found in the ruins of the palace of King Sardanopolis of Ninevah--who died in 888 BC (15). Clay feeding vessels were found in graves with infants from the first to fifth centuries AD in Rome. Wickes (1) speculates that ancient pediatric writers never mention artificial feeding because there was no advice to be given as to mixing it: the milk may not have been modified in any way.

"Hand rearing" was criticized already by Soranus of Epheses, a Roman physician of the second century AD who chided those foolish people who begin artificial feeding too early (16). This concern first shows up commonly in writings from the Renaissance. This is hardly surprising, since records from foundling homes in England and France show that the vast majority who were artificially fed died. Sir Hans Sloan wrote that the mortality of suckled infants in Britain in 1660 was 19%; for dry nursed infants it was 54%. In Rouen, France data from the two-year period 1763-5 showed that of 132 foundlings fed diluted cow s milk, with pap, soup and cider added at three months, only five survived (17). In 1753, the governor of the Vasa District in Sweden received permission for the King to fine those mothers who did not breast feed (18).

Bottle feeding began to work somewhat better as technology for evaporating and canning milk (reducing its curd tension and sterilizing it) was developed in the mid nineteenth century. Pediatricians from the very beginning became commercially involved in artificial feeding, as obstetricians pointed out at the first international congress on Gouttes de Lait in Paris in 1903 (13).

Wet nursing

Though wet nursing declined and nearly disappeared by the end of the nineteenth century, it has been utilized by wealthy families since the dawn of civilization. The Biblical passage describing how a wet nurse was obtained for Moses (Exodus 2:7-9) suggests that this was a common practice at least in the Pharoanic household in ancient Egypt. Nearly all early writing on infant feeding paid great attention to the choice of wet nurses, presumably a concern among the wealthy since the dawn of civilization. Milk of wet nurses was to be examined for color, viscosity, taste, etc to see if it were good for the infant or "poisonous." The character of the wet nurse was believed to be transferred through her milk. Wet nurses in France were highly organized from the twelfth century, according to Drake (19) and there were four employment bureaus for them by 1715. Concern for the nurses' own children led in 1762 in France to a law that a woman could not become a wet nurse until her own infant was nine months old.

The countess Elizabeth Clinton gave out her 18 children to wet nurses. Women in this profession commonly did not care enough for their charges to keep them alive in spite of breastfeeding them and only one of her sons survived. Her daughter in law breast fed her own children, showing the countess the error of her ways and prompting her to print a book in 1662 entreating women to breast feed. She lists (and rejects) the objections to breastfeeding current at that time: "it spoilt the figure," was "noisome to one's clothes," and "interfered with gadding about" (20).

Another solution for women who wanted to be away from their infants temporarily is the breast pump. The first picture of one appeared in Italy in 1577. Breast milk banking first started in Boston in 1910 (13).

References

1. Wickes IG. A history of infant feeding. Part I. Primitive peoples: ancient works: renaissance writers. Archives of Disease in Childhood 1953;28:151-158.
2. Ploss HH, Bartels M, Bartels P. Woman 1935;3:184-216.
3. Ford CS. A Comparative Study of Human Reproduction. New Haven: Yale University Press, 1945. Publications in Anthropology; vol 32).
4. Mercurialis H. De Morbis Puerorum. Venice: 1583.
5. Ettmuller M. Etmullerus Abridg'd. (Second Edition ed.) London: 1703.
6. Smith H. Letters to a married woman. (6th Edition ed.) London: 1792.
7. Jelliffe DB, Jelliffe EFP. Human Milk in the Modern World. Oxford: Oxford University Press, 1978.
8. Guillemeau J. Nursing the Child. London: 1612.
9. Pernell R. Treatise of the Diseases of Children. London: 1653.
10. Pechey J. Diseases of Infants and Children. London: 1697.
11. Wickes IG. A history of infant feeding. Part III: eighteenth and nineteenth century writers. Archives of Disease in Childhood 1953;28:332-340.
12. Cadogan W. Essay upon nursing, and the management of children. London: 1748.
13. Wickes IG. A history of infant feeding. Part IV: Nineteenth century continued. Archives of Disease in Childhood 1953;28:416-422.
14. de Sainte-Marthe S. Paedotrophia. London: 1584.
15. Brennemann J. Arificial feeding of infants. In: Abt IA, ed. Pediatrics. Philadelphia: W.B. Saunders Co., 1923. Page 622. 16. Laubengayer BW. The evolution of the art of infant feeding in relation to the development of the science of nutrition. Thesis, Ithaca, NY: Cornell, 1935.
17. Hymanson A. A short review of the history of infant feeding. Archives of Pediatrics 1934;51:1.
18. Anonymous. Journal of the American Medical 1973;81:97.
19. Drake TGH. Annals of Medical History 1935;ns 7:49.
20. Wickes IG. A history of infant feeding. Part II. Seventeenth and eighteenth centuries. Archives of Disease in Childhood 1953;28:232-240.


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