656 
ing her incompetent as a nurse, as these conditions may, at first, 
notably affect her supply of milk. 
Weaning . — The time at which weaning should takk place is sub- 
ject to considerable variations. With an abundant supply, nursing 
may usually be continued to adA^antage during nine or ten months of 
the first year. Some mothers are able to extend this period through 
the twelfth month. After that time breast feeding is seldom advis- 
able. As a usual thing, the ninth month marks the time when the 
breast must be supplemented by other food. 
Method of weaning. — Weaning should be gradually done, both in 
the interests of the mother and the child. Much of the difficulty at- 
tending the gradual Aveaning of infants may be eliminated by accus- 
toming the child to take a bottle from the outset. This may be ac- 
complished by feeding it boiled Avater from a bottle from the begin- 
ning. In the absence of such measures the 'experience is too frequent 
that the child refuses all other food as long as it has access to the 
breast, and nothing short of actual starvation Avill induce it to accept 
either the bottle or the spoon. 
Weaning during the hot months should be postponed if possible; 
but the harm thus done is not usually so great as the continuance of 
the child on an inadequate breast milk. 
Indications for sudden weaning. — Sudden Aveaning may be neces- 
sary at any time on account of the development in the mother of se- 
A^ere acute disease, such as typhoid fever or pneumonia ; of grave 
systemic disorders, as tuberculosis or nephritis; from the intercur- 
rence of pregnancy or of disease of the mammary gland. Minor ill- 
nesses or acute sickness of short duration are not indications for wean- 
ing. though if the attack be severe the infant may be placed tempo- 
rarily on the bottle, and the fioAV of milk maintained by the breast 
pump. Upon the establishment of convalescence, the infant is re- 
turned to the breast. 
Mixed feeding. — This is a combination of breast and artificial feed- 
ing. It is useful Avhen the mother’s milk is good but someAvhat defi- 
cient in quantity. It may also be adopted when it is evident that the 
strain of maternal nursing is making inroads on the mother’s reserA T e 
of health. She may then be relieA^ed to the extent of one or tAVO 
nursings a day, and thus considerably prolong the period of her lac- j 
tation. Mixed feeding is also useful as an expedient to bridge over 
temporary insufficiency in the mother’s supply of milk' It is not i 
expedient, however, to reduce the maternal nursings by three or more 
a day, lest the mother suffer a serious deterioration in the quality of 
her milk. 
ARTIFICIAL FEEDING. 
In considering the artificial feeding of infants, there are several 
general principles which have received universal acceptance: 
