156 MILK AND ITS HYGIENIC RELATIONS 



weeks when removal was only practised three times a day. This fact 

 is of considerable importance in connection with mixed feeding. 

 Mixed feeding, i.e. giving both human and cows' milk to the same 

 infant at the same period of life, is now universally accepted as 

 greatly superior to artificial feeding alone. The practical difficulty, 

 however, is that just referred to, namely, that when the gland 

 is only emptied two or three times in the day the secretion tends 

 to decrease. 



The greater equality in the amount given which results from 

 the less frequent intervals of feeding has been recently further 

 demonstrated in this country by H. K. Waller, who showed that 

 if the child is only fed three times in the twenty-four hours 

 the amounts become more equal (in one case 14, 12, and n oz. 

 respectively). 



General experience has shown that mechanical means for 

 emptying the mammary gland are much less effective than suckling 

 the infant. The last portions of the milk cannot easily be removed 

 by the usual apparatus, which will, however, remove the greater 

 portion of the supply. Hence, the gland subjected to mechanical 

 emptying only, will usually cease to produce milk. Helbich, 

 however, with care, succeeded in maintaining the function of the 

 gland in several wet-nurses for many weeks, when the breast was 

 emptied artificially only. 



Out of the numerous cases described in detail by Helbich, two 

 will provide illustrations of the main results : 



Case A . The child was ten days old when it came under observation for 

 this experiment. It then weighed 1900 grammes (rather over 4 Ibs.). The 

 child was too weak to obtain the milk from the breast, and the milk was, there- 

 fore, drawn off artificially. The child died a fortnight later. The mother was 

 then instructed to draw off the milk with the breast-pump. The daily amount 

 of milk, which at the beginning of the period of observation was about 300- 

 400 grammes, rose to about 800 grammes before the child died, and continued 

 to rise gradually until 10 weeks later it had reached a fairly constant 

 level of 1300 grammes. 



Case B. The child was fourteen days old when the observations were com- 

 menced, and was too weak to obtain sufficient nourishment by suckling. At 

 first the amount of milk which could be obtained artificially from the breast 

 amounted only to a few grammes in the day. A week later the child died, and 

 the daily amount of milk given had then reached 300-400 grammes in all, 

 including that taken by the child. Artificial removal of the milk was 

 continued, but for about five weeks did not exceed 400-500 grammes a day. 

 It then gradually rose, and in the next five or six weeks reached about 1300 

 grammes, a maximum of 1500 grammes being attained later. The amount 

 remained at about 1400 grammes until the patient left the hospital, the milk 

 having been withdrawn artificially for 21 weeks. 



So far, in considering the function of lactation, it has been 

 assumed that satisfactory conditions were provided for the maternal 

 organism, upon which the gland depends for its blood supply. It 

 is essential that the food supply for the mother should be sufficient 

 and suitable. Remarks are frequently found upon the value of 



