W. Grant Hague

Elementary Principles of Milk Modification—The Secret of the Efficiency of Mother's Milk—Two Important Factors in Successful Artificial Feeding—Every Child is a Problem in Itself—Proprietary Foods of Little Value as Infant Foods—Their Value is in the Milk Added to Them—The Credit Belongs to the Cow—Difference Between Human and Cow's Milk—What "Top-milk Feeding" Means—Utensils Necessary for Home Modification of Milk—Artificial Feeding from Birth to the Twelfth Month—How to Measure Top-milk—Easy Bottle-feeding Method—Condensed Milk Feeding—Objections to Condensed Milk Feeding.

Elementary Principles of Milk Modification.—Mothers who have to raise their children on artificial food should understand the elementary principles of milk modification. They should know, for example, that the one object of milk modification is to render it as nearly an exact substitute for mother's milk, according to the age of the child, as is possible. If we could do this with scientific exactness, artificial feeding would be a simple process. We cannot, however; nor has there ever been devised a method by which we may hope successfully to duplicate mother's milk. It is a comparatively simple matter for the efficient chemist to analyze the breast milk of any nursing mother; and it is quite possible to duplicate the milk according to the analysis, with chemical exactness, but the two fluids will not be the same. There is present in the mother's milk something which synthetic chemistry cannot discover. This something is nature's secret,—it is akin to the life-giving principle which is contained in the germinal fluid, and in the hen's egg. We cannot therefore hope to build up an artificial food that contains this mysterious life-giving principle which is the secret of the efficiency of maternal milk,—we can only hope to approximate it. It is possible that we might be successful so far as its nursing efficiency is concerned, if all children were alike, if all children were of a uniform standard of health. As a matter of fact, no two babies are exactly alike. And while the mother of each child undoubtedly secretes a milk suitable to the degree of healthfulness of her own child, the same milk might not be equally suitable to another child. The milk, therefore, that is manufactured to agree with an average mother's milk is dependent for its success upon the vitality of the child to which it is fed. If that child is not a well child, according to an accepted standard, the milk will not agree with it, even though it is the best possible substitute for an average breast milk.

We have consequently two factors to consider in successful or efficient artificial feeding:

It is the lack of a uniform health standard in children that gives to artificial feeding all its difficulties. It renders the successful artificial feeding of children a personal or individual problem. Some children,—those who approximate a standard of health for their age; in other words, "well" children,—thrive on a milk modification that experience has taught us is suitable for well children of their age. Others, and they are in the majority, have to be fed on a modification which actual test proves to agree with their digestive capabilities. Every artificially fed child therefore must be studied from its own individual standpoint. A certain modification of milk may not agree with a child fed every two and one-half hours, which will be found to agree if fed in the same quantity, to the same child, every three hours. The slightest change, a change which would seem to be so insignificant in itself as not to justify serious consideration, may mean the difference between normal healthfulness and constant ill health. A food that is too strong for a child's digestive ability, and which causes vomiting, colic, and diarrhea, may be rendered exactly right by the slightest modification one of its constituents. To effect such a change quickly and successfully, one must be trained to interpret the symptoms correctly and to know how to make the change in the modification of the milk. Mothers cannot be expected to possess this degree of skill: they should therefore refrain from experimenting, because an experiment on a baby is not only dangerous, but ethically it is criminal. Call the family physician; put the burden on his shoulder.

It is this element of uncertainty in our ability to effect a standard modification of milk that has afforded manufacturers the rich opportunity of putting on the market various baby foods for which much is claimed. These foods are really substitutes for the inefficiency of the average mother. There is no real justification for their use. If all mothers were clean, faithful, and efficient, there is no reason why each one could not be taught to modify cow's milk to suit her child, just as satisfactorily, or more so, than a manufacturer who never saw her child. The manufacturers, however, do the work, and the naturally ignorant or lazy and inefficient mother, is willing to pay for the extra cost of labor, to save herself the trouble on the one hand, and to subject her child to a series of experiments in order to discover the manufactured food that is particularly adapted to her particular baby on the other hand. We believe that most mothers have never considered the question from this standpoint; that most mothers adopt this method of artificial feeding at the direct suggestion of their family physician, and are not, therefore, responsible. These foods do not contain the nutritional elements necessary to healthy growth; or as they exist in normal breast milk; or as they can be approximated in ordinary milk modification at home. Proprietary foods are of decidedly poor value in infant nutrition, and should not be used. They have a value, however, in certain diseased conditions, but within a very small range. As a food for a healthy growing infant, they should not be used, and when the average physician appreciates this fact, and so instructs the mothers of the country, it will be to the distinct advantage of the race in every respect. Proprietary foods to which fresh cow's milk is added, are not foods at all,—they depend upon the milk so far as any nutritional value is concerned; and it would be far safer to modify at home a good milk than to buy a proprietary food, the analysis of which cannot be depended upon. The credit for the fat, healthy babies we see advertised does not belong to the manufacturers, but to the cow whose milk you add to the manufacturer's sugar.

The proprietary beef foods are also valueless as infant foods. In certain illnesses, when we want a mild stimulant, a teaspoonful or two in hot water may have a certain value, but that is all. The beef juice of home manufacture is much more valuable.

Difference Between Human and Cow's Milk.—The composition of cow's milk is as follows:

The composition of an average human breast milk is as follows:

It will be observed from a comparison of the above tables that cow's milk is much richer in proteids (the substances which form with water the curd of sour milk) than is human milk. If one remembers that cow's milk is manufactured by nature primarily for the feeding of calves, not for babies, and that the stomach of a calf is intended to exist exclusively on vegetable products, and that nature is preparing it for this purpose, and feeds it a food when young that will enable it to grow so as to be adapted for that purpose, one can understand that the problem of the modification of cow's milk to suit the stomach of a baby is not by any means a simple matter. Since the proteids are so much in excess in cow's milk, we must dilute cow's milk with twice its bulk or more of water to render it fit food for a new born baby. If we dilute cow's milk to this extent to get the proteid percentage right, we immediately disarrange the percentage of the cream or fat. We overcome this difficulty by taking the cream from the top of the bottle and diluting it because it is richer in fat and does not need so much dilution. This is the explanation of the so-called "top-milk feeding." The percentage of sugar represents another problem. The percentage of sugar in cow's milk compared with the sugar in human milk is deficient, so we add milk-sugar to the cow's milk to make up the deficient percentage.

There is yet another feature which we must rectify; cow's milk is acid, while human milk is alkaline. To overcome this difference we add lime-water. We must also take into consideration that cow's milk is ordinarily full of germs, while human milk is free from them; to overcome this danger we resort to heating the milk to a degree which experience has taught us will kill all germs. Cooked milk is not as wholesome as uncooked milk, and it has a tendency to cause constipation. We have to a certain extent overcome the need for cooking all milk for babies, as will be noted later, but in summer time, unless the milk is known to be pure and free from germs, it is advisable to sterilize it.

UTENSILS NECESSARY FOR HOME MODIFICATION OF MILK

A detailed description of the proper kinds of bottles and nipples will be found elsewhere. The measuring glass or graduate should be wide-mouthed. It is not safe to spoon the top-milk off, nor is it safe to pour it out. Absorbent cotton should be provided to close the nursing bottles when filled and left standing in the ice box.

ARTIFICIAL FEEDING FROM BIRTH TO THE TWELFTH MONTH

The following formulas for the different ages may be found useful for well babies:

From the third to the tenth day:

Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.

From the tenth to the twenty-first day:

Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.

From third to the sixth week:

Eight to nine feedings in twenty-four hours; 2 or 3 ounces at each feeding.

From sixth week to the third month:

Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces at each feeding.

From third to fifth month:

After this age two bottles of milk are required, 16 ounces being taken from the top of each bottle and mixed.

Six feedings in twenty-four hours; 4 to 5 ounces at each feeding.

From the fifth to the seventh month:

Six feedings in twenty-four hours; 5 to 7 ounces at each feeding.

From the seventh to the ninth month:

Five to seven feedings in twenty-four hours; 6 to 8 ounces at each feeding.

From the ninth to the twelfth month:

Five to six feedings in twenty-four hours; 7 to 9 ounces at each feeding.

It will be observed that 16 ounces of top-milk is used to make the various formulas from. This means that the mother will dip off, with a Chapin dipper, 16 ounces from the top of a bottle of milk which has stood for four or five hours to allow the cream to rise; she will then mix this and take from the mixture the number of ounces called for in the formula she is using according to the age of the child. The ordinary milk that is delivered in New York City may be assumed to have stood the four or five hours necessary. This may not be so, however, in the country, as it is frequently delivered there as soon as it is milked. In such cases the mother will permit it to stand in the ice box until the cream has risen.

When the mother is about to make the mixture called for in feeding from the third to the fifth month she will observe that 18 ounces of milk is called for. Now since she only uses 16 ounces of the top-milk from one bottle this will not be enough. She must therefore use 16 ounces from two bottles of milk; this she will mix together and from this mixture she will take the 18 ounces wanted. Whatever milk is left over may be used for ordinary table purposes.

EASY BOTTLE-FEEDING METHOD

The following formulas and instructions for bottle-feeding are taken from the Rules for the Care of Infants and Young Children which are used by Dr. Kerley at the out-patient department of the Babies' Hospital and give the simplest and easiest means of bottle-feeding:

Barley-Water.—The barley-water used in the above formulas may be made in the following way: To two teaspoonfuls of pearl barley, add one quart of water, and boil continuously for six hours, keeping the quantity up to a quart by the addition of water; strain through coarse muslin. The barley will be better if it is soaked for a number of hours, or over night, before cooking. The water in which it is soaked is not used.

An equally good barley-water may be made in an easier way by using Robinson's prepared barley. This may be procured in the drug stores. It is only necessary to take one even tablespoonful of this barley to twelve ounces of water and cook for twenty minutes.

Condensed Milk.—When the mother cannot afford to buy bottled milk from the wagon, when she has no ice-chest and cannot afford to buy ice, she should not attempt cow's-milk feeding, but may use canned condensed milk as a substitute during the hot months only. The can, when opened, should be kept in the coolest place in the apartment, carefully wrapped in clean white paper or in a clean towel. The feeding hours are the same as for fresh cow's milk:

"Under three months of age: Condensed milk one-half to one teaspoonful; barley-water, two to four ounces.

"Third to sixth month: Condensed milk, one to two teaspoonfuls; barley-water, four to six ounces.

"Sixth to ninth month: Condensed milk, two to three teaspoonfuls; barley-water, six to eight ounces.

"Ninth to twelfth month: Condensed milk, three teaspoonfuls; barley-water, eight to nine ounces."

Objections to Condensed Milk Feeding.—Condensed milk is not to be recommended as a permanent food where good cow's milk can be obtained. In most cases it should be used as the sole food for a few weeks only. It may be used when the digestion is impaired for some reason. If the symptoms are intestinal it will be more apt to agree than if they are caused by stomach ailments. The symptoms of intestinal disturbances are,—colic, flatulence (gas), curds or specks in the stools, constipation or diarrhea. It will not be found suitable if the child is simply vomiting.

The objections to condensed milk are: It is very rich in sugar and very deficient in proteids and fat. Children fed on condensed milk often gain very rapidly in weight but have little strength or resistance. They do not fight disease well for this reason; they are apt to develop rickets and scurvy.