THOMAS S. SOUTHWORTH, M. D. 251 



for the bottle feeding of infants, and granting that the best 

 results are obtained only when there is a high degree of intelli- 

 gence on the part of the mother and close observation and direc- 

 tion by a skillful physician, the fact remains that no perfect 

 substitute for breast milk has been, or in the nature of things 

 can be, devised by art. Of any two considerable groups of 

 infants the one group nursed at the breast and the other fed 

 upon the bottle there will always be better development, less 

 illness and fewer deaths among the nursed infants. If these 

 facts were placed clearly before every mother in the land, so 

 that she could not escape the knowledge that in putting her in- 

 fant upon the bottle she was electing to make much greater 

 chances of illness and death, there would seem to be little doubt 

 that the number of mothers who would endeavor to nurse their 

 infants would be considerably increased. 



Salutary as such a movement might be, it would not wholly 

 solve our problem. Seen from the standpoint of the thought- 

 ful medical investigator, more important questions lie beneath 

 the surface. The people of our country may for our present 

 purposes be divided roughly into several groups: 



1. The ultra-social group. 



2. The educated classes of means, large or small. 



3. The great middle classes, including well paid artisans. 



4. The very poor and the ignorant, including the foreign 



immigrants. 



Conditions for successful nursing vary widely in these groups. 

 Good food, comfortable homes, and a reasonable freedom from 

 worry, though not always essential, have a desirable influence. 

 Unfortunately, however, education and successful nursing do not 

 always go hand in hand. We sometimes find that it is the 

 stolid ignorant mother who is best able to nurse her baby, and 

 the educated and intelligent one who has the most difficulty. 



Among both laymen and physicians the opinion has until 

 recently prevailed that many mothers refused to nurse their 

 children because they were unwilling to give up social pleasures 

 and devote themselves to their offspring. This may have been 

 true some years ago, but obstetric physicians agree that such 

 instances are less numerous today possibly because of a larger 

 knowledge of matters pertaining to children among the intelli- 

 gent classes. In any event, such women are in very small 

 minority among the women of this country and would be neg- 

 ligible as a factor in this discussion were it not for their promi- 

 nence in the public eye and the possible effect of their example. 

 Moreover, in consequence of ample means, skillful nurses, and 

 expert medical attention, the limited number of such bottle-fed 

 children shows less mortality than in other ranks of life. 



