Sam Curry is a fourth year Anthropology major from South Kingstown, Rhode Island. His main academic interests involve humans’ relationships with the nature and environmental health, and he hopes to work in environmental policy after graduation. His other main interest is racquetball.
In 1912, pediatrician Henry L. Coit, mourning his son’s death from typhoid fever, led the Certified Milk movement’s efforts to provide standardized raw human milk to infants. [1] Coit devised a novel plan to prove that cows’ milk was a poor substitute for mothers’ milk: he fed human milk to puppies. Coit reported that the puppies “remained alive…but in a very miserable condition”, thus showing that newborns fed milk of another species “were inferior to the breast-fed animals, both at the time of the experiment and afterward”. [2]
This strange episode, though unusual in its design and its cruelty, reveals a few realities about breastfeeding at the time. In the early 20th century United States, breastfeeding, often a very close, intimate interaction between mother and child, was subject to wider social and economic factors, including the relative role of business, science, and government. These contestations made breast milk, and the female bodies of both humans and non-humans that produce it, a commodity to be bought, sold, and rationally distributed. They also led to the substitution of wet nurses, cows’ milk, and artificial formula for a mother’s own breast milk. Going hand in hand with these changes was a massive drop in the percentage of women who breastfed their children throughout the 20th century. From 1926 to 1930, only 50% of women breastfed their children, and only 22% in 1972, in comparison to the 70% of women who initiated breast feeding with their children from 1911 to 1914. Not until 1984, in which 60% of women breastfeed their children, did an upswing truly begin. [3] These immense shifts show that political and economic structures influence even the most seemingly personal elements of health, and that these influences are the most acute in the case of women’s health and female bodies.
In the 1880s women of all social classes began supplementing their breast milk to their children with milk from cows, leading to an increase in infant mortality rates. Infants fed from their mothers’ breast died at much lower rates than children fed from cows. [4] The rise in infant mortality led to a variety of public health campaigns with a variety of different methods, but all aiming to lower infant mortality rates. The differences in these public health responses reveal the oftentimes competing forces acting upon the American medical system in the early 20th century.
The first method sought to ensure the distribution of sanitary cows’ milk. This movement articulated a difference between clean and dirty cows’ milk, while labeling cows’ milk as “one of the essentials of daily living”. [5] Clean milk, and infant health, would be ensured by pasteurizing milk from healthy cows, processing this milk under sanitary conditions, and sealing and shipping these bottles. These standards could be ensured through “close cooperation between medical commissions and dairy farmers”. Medical commissions would “establish the…procedures by which the milk producer would collect and handle the product [and] the dairy farmer would agree to abide by all such regulations.” [6] This vision would combine medicine and business into a united industry that would ensure high quality medical products to be sold in the marketplace, and cut mothers out of the child nourishment process entirely.
Cow milk regulation began in Chicago in the year 1892, and continued for about 30 years, with slow progress in regulating different parts of the cows’ milk supply chain. In 1916, the city required to dairy farmers to pasteurize milk. By 1920, they had to keep milk cold during shipping, and, in 1926, they were legally obliged to test milk cows for bovine tuberculosis. [7] This regulatory plan’s incremental advances reveals both the burgeoning role of government in the Progressive Era in the early 20th century, and the enduring and growing importance of business. The ideology of the Progressive Era placed great faith in the ability of government to improve the lives of its citizens by offering a wider range of services and protections, such as regulating businesses. However, the decision to regulate cows milk shows an underlying faith in business by advocating milk as a commodity, rather than a substance to be passed directly from mother to child.
The second major public health effort of the time aimed to increase rates of breastfeeding from mothers to children. These campaigns efforts were based on the fact that breastfed children rarely died in the hot summer months that killed large numbers of children fed with cows’ milk. These campaigns, when properly executed, were quite effective at reducing infant mortality rates. Similarly to campaigns improve the quality of cows’ milk, these efforts put faith in the ability of government and public health officials to intervene in the public sphere and improve citizens’ lives, but, unlike cows’ milk centered campaigns, these efforts did not involve mandatory, standardized regulation of large business. Rather, public health workers worked at the level of the individual citizen and actively engaged them in ensuring positive health outcomes.
The case of the Breast Feeding Investigation Bureau, an initiative of the Department of Pediatrics at the University of Minnesota, is particularly instructive. In 1919, public health workers, acting under the director of the Bureau, visited the home of nearly every new mother, sometimes daily, and ensured that they were continuously breastfeeding their children. This intensive support resulted in 96% of children being breastfeed through 2 months, and 72% into their 9th month. Infant mortality declined by 20%. [8] These campaigns worked effectively, public health workers attested, because they reaffirmed the benefits of breastfeeding, and comforted mothers that they were caring for their child the right way. A worker with the Minneapolis Infant Welfare Society stated when mothers was “most liable to discouragement [and] anxiety…convinced her that milk was not the right food”, a public health worker was there to ease her fears. [9] Unfortunately, programs such as this were few and far between. The American medical field and the public, fully provided with fresh, clean cows’ milk, saw mothers’ milk as largely unnecessary, and the declining rates of breastfeeding continued.
However, the American medical system was never completely able supplant the human foundations of breastfeeding, and wet nurses served as both a reason for the transition away from human sources of milk, and the last line of defense against the complete implementation of this change. Both mothers and doctors in the early 20th century deeply mistrusted wet nurses because of both their predominantly lower class economic status and minority racial status, and this distrust was a major factor in moving away from wet nurses. Upper-class mothers who could afford wet nurses look upon them with apprehension and disgust, and doctors sympathized with their fears. At the same time, doctors and mothers were forced to rely upon wet nurses because, oddly enough, “their bodies were ideal storage containers for breast milk.” [10] This inherent tension produced some wonderfully twisted advice from doctors such as Frank Churchill, a leading Chicago pediatrician who warned “a wet nurse is one-quarters cow and three-quarters devil”, but added if a good wet nurse can be found, she would be a much better substitute than cows’ milk. [11]
Doctors dealt with this tension by transforming wet nurses’ milk into a commodity to be distributed by knowledgeable professionals. Medical institutions tried to build a system to perfectly distribute milk, since mothers were incapable of doing so themselves. For example, in 1922 two researchers at the Massachusetts Institute of Technology attempted to create a powdered form of human milk from wet nurse donors, while another doctor in Boston, Fritz Talbot created the Directory for Wet Nurses, an agency that referred pre-screened wet nurses to doctors and their patients. [12] Whereas families had typically hired wet nurses directly, this directory inserted doctors and their medical knowledge into the hiring of a “suitable” wet nurse. Additionally, the directory provided a home for prospective wet nurses, where doctors and nurses “monitored the diet, dress, and behavior of the women”, in a similar regulatory mechanism that ensured cows’ milk was suitable for human consumption. [13]
Public health campaigns advocating for cows’ milk and those advocating for maternal breastfeeding represented two competing views about the relationship between gender, science, and society, while wet nurses situationally represented both the commodification of breast milk and its maternal, uncommodified nature. Efforts to clean, regulate, and commodify breast milk, cows’ milk, and formula, usually researched and expressed by men, inserted scientific, capitalist knowledge into the feminine, maternal process of breastfeeding. Male professionals conceived of breastfeeding largely as an economic issue of supply and demand. One physician from Detroit asserted that if mothers with abundant milk donated to mothers without enough milk “it would be a great factor in reducing infant mortality, as well as preventing a great economic waste.” [14]
Even public health movements advocating for mothers breastfeeding their children, such as the Minneapolis campaign, used economic discourse to advocate breastfeeding. One doctor urged the medical community to follow Minneapolis’ efforts as a guide and see breastfeeding from a “business-like standpoint” and encouraged them to “rank the promulgation of breastfeeding education as one of [its] greatest investments.” [15] On the other hand, health campaigns such as those in Minneapolis attempted to the support the connection between mother and child, and wet nurses found themselves both maintaining the connection between lactating women and children and being treated as any other commodity.
Of course, breastfeeding does include a sort of supply and demand, in that mothers who do not breastfeed their children consistently have problems producing milk later on. The movement away from mothers breastfeeding their babies themselves was therefore a positive feedback loop. If a mother did not routinely breastfeed her child, she would have problems producing enough breast milk later, and would be forced to rely upon wet nurses, artificial formula, or cows’ milk. The forces of capitalism, supported by the medical industry and the interventionist spirit of American governance in the beginning of the 20th century, did provoke a stark change in the bodies of mothers across the United States. The decline in breastfeeding rates shows the considerable ability of the American medical system to inscribe its values upon the bodies of the people that it serves, sometimes even to their own detriment.
Notes
[1] Frank R Greer “One Hundred Years Later-Milk Safety Revisited,” Pediatric Research 45 (1999), 1.
[2] Jacqueline Wolf “Low Breastfeeding Rates and Public Health in the United States,” American Journal of Public Health 93 no. 12 (December 2003), 2002.
[3] Richard J. Schanler and Anne L. Wright, “The Resurgence of Breastfeeding at the End of the Second Millennium,” The Journal of Nutrition 131, no. 2 (February 2001), 421S.
[4] Wolf “Low Breastfeeding Rates and Public Health in the United States,” 2001.
[5] Ibid., 2002.
[6] Rima D. Apple, Mothers and Medicine (Madison: University of Wisconsin Press, 1987), 59.
[7] Wolf, “Low Breastfeeding Rates and Public Health in the United States”, 2009.
[8] Ibid., 2003.
[9] Ibid., 2004.
[10] Kara W. Swanson “Human Milk as Technology and Technologies of Human Milk: Medical Imaginings in the Early Twentieth Century United States,” Women’s Studies Quarterly 37 no. 1 and 2 (Spring/Summer 2009), 25.
[11] Jacqueline Wolf ““Mercenary Hirelings” or “A Great Blessing”?: Doctors’ and Mothers’ Conflicted Perceptions of Wet Nurses and the Ramifications for Infant Feeding in Chicago, 1871-1961,” Journal Of Social History 33, no. 1 (Autumn 1999), 100.
[12] Swanson, “Human Milk as Technology”, 21-22.
[13] Swanson, “Human Milk as Technology”, 24.
[14] Wolf ,“Mercenary Hirelings or A Great Blessing”, 104.
[15] Wolf, “Low Breastfeeding Rates and Public Health in the United States”, 2004.
Further Reading
