158 MILK AND ITS HYGIENIC RELATIONS 



from any one centre. Where, however, although each centre is 

 individually small, the experience runs along identical lines, 

 some reliance may be placed upon the general results obtained. 

 It is the opinion of the officers who supervise the work at 

 these centres that the provision of an adequate food-supply for 

 the mother almost invariably enables breast-feeding to be main- 

 tained, mothers who have previously been unable to feed their 

 children being able to do so without difficulty when provided with 

 sufficient food of a suitable nature. Moreover, in many instances, 

 where the milk-supply was becoming apparently short, it has been 

 completely regained, and lactation continued up to the ninth month. 



No special foods or substances are either indicated or contra- 

 indicated. The health of the mother must be maintained. Where 

 this is affected owing to the idiosyncrasy of the individual for any 

 particular food-stuff, that food-stuff should be avoided that is all. 



Birk considers the question of an increased output, obtained 

 as a result of increasing the number of children fed, in relation to the 

 health of the mother. He found that where several infants were 

 fed by one mother, the amount of energy taken in, in the food of 

 the mother, might not be sufficient. In several cases investigated 

 by him he found that the residual energy available for the mother, 

 after deducting the energy given off in the milk, was below that 

 usually considered sufficient for health. He thinks the question 

 probably does not arise when only one child is fed, but in other 

 cases he suggests that attention should be paid to the energy require- 

 ments of the mother, especially to the inorganic salts in the food. 



Bamberg, however, does not take quite the same view, and 

 regards the output of milk as to some degree controlled by a self- 

 regulating mechanism. He estimated the heat value of the food 

 taken and of the milk given out by several women who were suckling 

 more than one child. In several cases he found that there was 

 not enough difference between the two values to provide the 

 theoretical amount of calories per kilogram of body-weight for the 

 mother. These women, however, appeared to be quite well, did 

 a fair amount of work, and did not lose weight. These practical 

 points appear to outweigh the theoretical question of calories 

 needed, and led him to the conclusion that the total output of 

 milk was regulated so as not unduly to deplete the maternal 

 organism. 



Budin's tables 1 show that a considerable supply of milk 

 may be given for sixty-four weeks, and this has already been 

 referred to as occurring in this country. General experience, 

 and considerations arising out of the composition of milk after 

 about the eighth month of lactation, fixes the length of lactation 

 at from six to nine months, the longer period being a very usual 

 one. 



1 Cp. Appendix A. 



