Our Own Devices: How Technology Remakes Humanity (7 page)

Before the twentieth century, hand-blown, narrow-mouthed bottles and long tubes were hygienic nightmares. The flattened Turtle was also called the Murder Bottle. Courtesy of Corning Museum of Glass, Corning, N.Y., left to right: nursing bottle, “Cerity & Morrel Feeder,” after 1880 (58.4.16. United States. Colorless glass with an aquamarine tint; mold-blown), gift of Mrs. Thomas Wilmot; nursing
bottle, “Tyrian Nurser,” 1890–1910 (62.4.43. United States, Andover, Mass., Tyler Rubber Company. Colorless glass, cork, wood, brush, metal; mold-blown, assembled), gift of Mr. and Mrs. Paul Perrot; nursing bottle, 1870–1910 (66.4.53. United States. Colorless glass; mold-blown), gift of Arthur A. Houghton, Jr.; nursing bottle, patented 1890 (57.4.19. United States, New York, N.Y., McKinnon & Co.
Colorless glass, metal, paper; mold-blown), gift of Hugh L. Kline
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And a tradition of kitchen-table innovation endures. Advances in molding have recently permitted at least one variant recognized by a major cultural institution: in 1988, the Museum of Modern Art design collection added a plastic nursing bottle called the änsa, produced by an Oklahoma couple with no professional child development
or design experience, shaped like a long doughnut for better infant gripping. Admiring as he was, the inventors’ own pediatrician still had a concern: that babies would like the änsa so much their parents would let them go to bed with it. While there has apparently been no independent health evaluation of this design, the doctor was wary because bottles in general have an unfortunate effect on
infants’ feeding, for taking nourishment is also a technique. When a child sucks its mother’s breast, it “latches on,” taking the nipple into the mouth, clamping down with its jaws on the areola, and obtaining milk by inducing peristalsis with its tongue. In this process, the nipple can stretch to twice or three times its usual length, and the milk shoots from fifteen to thirty pores throughout the
infant’s mouth.
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Rubber, plastic, and silicone nipples function differently, with consequences
for the infant’s technique. When presented with a bottle, the jaws need not engage the nipple. Negative pressure alone transports the milk. The artificial nipple is more efficient; the baby has less work to do. For this very reason, unfortunately, once an infant begins to feed from a bottle, even soon
after birth or as a supplement to breast-feeding, the new style of feeding is not easily abandoned. The infant has lost its innate tendency to open wide when feeding, expects to have a nipple solidly in its mouth, is used to a free flow of milk, and pushes its tongue forward: all behaviors that will frustrate its experience of breast-feeding. With reduced sucking, the mother’s breasts will become
engorged, reducing her milk production and making it more likely that the infant will continue to be bottle-fed. Infant feeding specialists call this effect nipple confusion or triple nipple syndrome. Breast-feeding and child welfare advocates are thus especially alarmed by hospital programs promoting formula-feeding for newborns and presenting mothers with free starter kits. An American hospital
innovation of the 1970s, disposable sterile plastic bottles of formula for newborns, saved preparation time and improved quality but did nothing to overcome criticism. And advocates are concerned about “mixed feeding,” the alternation of breast milk and formula.
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(Paradoxically, lactation consultants recommend a technological solution for nipple confusion and other feeding problems that combines
ideas from earlier feeding vessels: placement on the mother’s body and use of a long tube. The Supplemental Nursing System [SNS] is a plastic bottle filled with the mother’s own expressed milk or formula, channeled through a tube that runs along the breast and is held in place with nonirritating tape. The tube is so narrow and flexible that the infant maintains or develops a normal breast-feeding
technique and the mother’s nipple receives the stimulation that assists lactation. A valve in the bottle releases the milk only when the infant begins to suck. For bottle-feeding infants, manufacturers also offer “physiologic” nipples that encourage natural tongue technique.)
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Besides the initial mechanical problems of bottle-feeding, there are consequences for the baby’s mouth. Inexperienced
parents may put children to bed with nursing bottles and let milk or juice build up around the teeth, causing decay. Bottle-fed children also have a higher rate of malocclusions. According to one study from 1981, 36.4 percent of children breast-fed not at all or for less than three months had occlusal anomalies, while 24.2 percent of children breast-fed for more than six months did— an increase
of risk by 50 percent. A 1987 paper reported an 84 percent
higher risk of malocclusion among children breast-fed three months or less or not at all, and the authors estimated that 44 percent of malocclusions among the children in the study were due to brief or nonexistent breast-feeding. One medical writer on breast-feeding believes that the pistonlike motion of the tongue in bottle-feeding—it
has a rolling action in breast-feeding—may be responsible.
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The mechanical risks of the bottle are still small compared to its possible nutritional consequences. Pediatric researchers and nutritionists are fond of repeating that infant formula as a substitute for human breast milk is “the largest
in vivo
experiment without a control series.”
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While artificial feeding
methods had been folk practice for centuries, even millennia, scientific replacements for mother’s milk were a nineteenth-century innovation. Early modern urban elites used some expedients we would find bizarre: only two of Mozart’s six children, all fed mainly sugar water, survived beyond their third year. The cow and goat milk sometimes previously used as a substitute or supplement was too thick
and alkaline. In 1741, the London physician Sir Hans Sloane established that at the Foundling Hospital, 53 percent of infants receiving animal milk or cereal mixtures died, as opposed to 19 percent of those with wet nurses. American nineteenth-century doctors documented that the milk of sick cows could transmit not only throat infections but life-threatening diseases like typhoid and tuberculosis.
They warned about the deficiences of “swill milk” from cows consuming brewery slops. In late-nineteenth-century London, milk still might be adulterated with as much as 25 percent water. As railroad supply lines and chemical knowledge grew, preservatives—including truly dangerous ones like hydrogen peroxide—were marketed openly; by one estimate, they were used by half the dairy trade.
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Even as
some manufacturers were producing dubious additives, more idealistic chemists were finding new ways to detect them. And still others had an even more ambitious and, it seemed, noble goal: developing scientifically optimal foods for infants. The problems of artificial feeding, like other technological dilemmas, began with the best of motives. In England’s industrial cities, malnutrition of mothers
and the feeding practices of untrained women who cared for infants during the working day had raised the mortality rate of young children as high as 55.4 percent in 1858. In the
1860s, chemists began to develop foods with patented or secret formulas that “humanized” cow’s milk to make it suitable for human infants. Baron Justus von Liebig (1803–1873), a founder of nineteenth-century chemical research,
education, and industry, and one of Europe’s most influential scientists, tried to help his nanny’s granddaughter, who was unable to nurse her own children. Earlier in the century, the family would have brought a wet nurse to live in, but the middle class was beginning to avoid what it perceived as a potential source of malnutrition and, linked with malnutrition in their minds, bad moral
influence. Liebig developed an infant feed consisting of ten parts of cow’s milk with one part each of wheat flour and malt flour, and a supplement of potassium bicarbonate. Liebig claimed that it offered nutrients in twice the concentration available in human milk, and that infants would thus need less of it. Unfortunately, his ratios were indirectly based on the methodologically flawed studies of
a Berlin chemist named J. F. Simon. As a result the formula was too high in carbohydrates and had dangerously low levels of vitamin C, of other vitamins, and of amino acids.
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Liebig was an outstanding predecessor of today’s academic scientist-entrepreneurs, not only a preeminent chemist but an esteemed mentor and the master of a flourishing professional network. He promoted his preparation vigorously
in the popular science press, solicited testimonials, and licensed an English company that soon was producing a dried form with pea flour to be mixed with cow’s milk. Meanwhile, a self-taught Texan inventor, Gail Borden, had turned from meal biscuits to milk after observing children die, apparently of malnutrition, on an ocean voyage. (He adapted a spherical copper vacuum condenser used
by Shakers for condensing fruit juice.)
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Despite medical reports of the food’s inadequacy and mixed responses from consumers, Liebig’s prestige allowed him to maintain his claims for the superior nutritional value and digestive qualities of his product. At least one supporter wrote that because its composition had been scientifically shown to have “the very same ingredients” as human milk, “I
cannot understand why they should be unable to digest Liebig’s Food.” It went on sale in the United States in 1869, advertised with the slogan “No More Wet Nurses!” Other entrepreneurs had already realized the product’s economic potential—Liebig’s Food sold for a dollar a bottle in New York at a time when that sum represented many workers’ daily pay—and competition grew. In Switzerland, with its
large dairy industry, the American diplomat Charles Page and his brother formed the Anglo-Swiss Condensed Milk Company in 1866 to use Gail Borden’s 1856 patent for the production of
condensed milk. The following year a Swiss merchant named Henri Nestlé developed an infant preparation that allegedly had saved the life of a baby that had refused all other food. It consisted of “good Swiss milk”
and bread, “cooked after a new method of my invention” and marketed in tin packages, to be mixed with water. The market proved spectacular, and in 1873 Nestlé was selling half a million boxes annually in Europe and in North and South America. Meanwhile, an English chemist named Gustav Mellin developed a variation of Liebig’s Food to which cow’s milk as well as water were to be added. In the United
States, the Borden Company was promoting its own Eagle Brand, and the pharmaceutical industry began to take notice of the potential market when Smith Kline & French bought the rights to a product called Albumenized Food. The manufacturers appealed to doctors and lay consumers alike. Some, like Nestlé, promoted the safety of using only (preferably boiled) water; others, like the makers of Mellin’s
Food, sought medical support for mixing their product with raw milk. Doctors could not agree on the optimum treatment.
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Between 1890 and World War I, some physicians tried to place substitute infant feeding on a scientific basis free from the manufacturers’ commercialism. The leader of this movement, Thomas Morgan Rotch of Harvard Medical School, sought not merely an acceptable substitute for
breast milk, but scientifically optimal nutrition for each child that could reduce the still-high rate of infant mortality. Using analyses by the Philadelphia physician A. V. Meigs, a significant advance on Liebig’s work, he developed a series of tables instructing mothers on the preparation of a formula containing precisely correct proportions of fat, sugar, and proteins, to be compounded by the
mother from milk, milk sugar, cream, and lime-water (a solution of calcium hydroxide in water). To avoid contaminated milk products, Rotch worked with scientific dairies to produce certified milk products with newly developed hygienic procedures. Other doctors in France, Great Britain, and the United States helped establish “depots” where pure milk could be provided under medical supervision. Contamination
of commercial cow’s milk nevertheless remained widespread through the 1920s, if British and American evidence is typical. Critics of the formula industry argue that even the best-managed programs did not contribute to the decline of infant mortality that commenced around 1905, but they did establish a disturbing and continuing link between medical clinics and artificial milk distribution.
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The complexity of Rotch’s “percentage method,” which turned the household into a small-scale chemical laboratory, led to its abandonment
after 1915. (It had been influential mainly in the northeastern United States.) In its place, a new pattern of infant nutrition appeared: the marketing of infant formula to be administered under pediatricians’ supervision. For these rising specialists, and for
family practitioners, scientifically managed feeding was a medical crusade. While some authors present the medicalization of life as the imposition of professional judgment on an intimidated laity, the reality was more complex. Many doctors as well as mothers affirmed the superiority of breast milk. But older networks of support for nursing mothers encountering difficulties were declining in the
early twentieth century. On the other hand, at least before about 1875, lay men and women were enthusiastic about the authority and capabilities of scientific medicine. Medicalization may have introduced new prejudices and errors, but it was not simply imposed by legislation. Women themselves turned, whenever possible, from the craft knowledge of midwives to the care of obstetricians for safer and
less painful delivery. They believed in the movement called “scientific motherhood” as much as the physicians did. The technologies of bottle, nipple, and formula likewise appeared to mothers and physicians alike as a more modern replacement for the techniques of breast-feeding that had been transmitted informally. With hospital delivery (rising from 20 percent to 80 percent of American births between
1920 and 1950), artificial feeding was institutionalized. To prevent infection, hospitals limited the frequency and duration of contacts between mother and infant. Babies regularly received supplementary feedings, and were bottle-fed at night to let mothers sleep.
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