Part 57

THE FEEDING OF CHILDREN

There are three ways in which a child may be supplied with food during its infancy: by its mother; by a substitute for its mother--a wet nurse; and by artificial feeding. This chapter will treat only of the latter method.

The child is fortunate whose mother can supply it with a sufficient quantity of wholesome milk. There is nothing more to be desired for it during the first ten or twelve months of its life. But often a mother, for one reason or another, is not able to nurse her child, and other means of feeding must be sought. In such cases, among the wealthier classes, a wet nurse is sometimes employed; but with the majority of people there is no alternative except artificial feeding. When this has been decided upon, the question naturally arises as to what shall be the best substitute for the natural nourishment of the child--mother's milk, which must always be taken as the perfect type of infants' food. To this subject doctors and hygienists have given much attention for a long time. Many kinds of food preparations have been made and tested. The result has been that, almost without exception, authorities agree that milk from healthy, well-fed cows, properly prepared, is the most valuable substitute for human milk that is at present known.

The following analyses give the comparison between cow's milk and human milk:

Human Milk. Cow's Milk. Nitrogenous substances 2.35% 4.30% Fat 3.40% 3.80% Sugar 4.85% 3.70% Salts .20% .60% Water 89.20% 87.60%

Cow's milk varies considerably in nutritive properties, and for the growing infant who receives no other food it is extremely important that it be of the first quality. It should be tested in every possible way to enable one to form a correct estimate of its value, and unless unquestionably good should be rejected. When fresh from the cow, not more than two hours old, and of superior quality, it need not be sterilized, but should be put into perfectly cleansed and sterile vessels, and kept in an ice-box, or refrigerator, at a temperature of 50° to 60° Fahr.

When obliged to buy the ordinary milk of commerce, select if possible that which is put up in glass jars. There are farmers who do this. Each jar is sealed, marked with the owner's name and address, and the date of sending. Such milk does not become contaminated with bad air in transit, cannot be tampered with by middlemen, and must be free from dirt, as it would show through the glass; each customer gets exactly a quart, with all the cream that belongs to it; moreover, the owner, having attached his name, has thus put his reputation at stake, and is not likely to sell inferior milk. When this is not practicable, search for the best and cleanest dairy, and see that the milk is delivered as soon as possible after being received at the dairy. Milk should not be bought from small stores.

The best milk comes from cows that have good pasturage, with clean running water, and that are fed in winter on dry fodder and grain, and not on ensilage and brewery waste.

According to the reports of the American Public Health Association, one fifth of all the deaths among infants may be traced to the milk supply, and there is no doubt that most of the sickness of bottle-fed children, during the summer months, is directly due to the unhealthy condition of their food.

It then becomes the imperative duty of every mother, nurse, or other person who has the care of children, to learn, if she does not already know, the simpler tests for milk, and something of the philosophy of the feeding of her charge. When such knowledge is more general, and women are able to determine intelligently the quality of the milk which is offered them, then will milk-dealers be forced to cease mixing, adulterating, and otherwise tampering with the milk, which, as a general thing, is sold at the farms in excellent condition.

The first object is to secure a good quality of milk; then comes the consideration of how it shall be prepared: this must be in such manner as shall render it as nearly like human milk, in composition and digestibility, as possible.

Comparison of the tables just given shows that cow's milk contains more nitrogenous matter and salts, and less sugar, than human milk. By diluting with water to reduce the protein and salts, and adding sugar and a little cream, the proportions of these different substances may be made to approximate those in mother's milk. In both the sugar is the same--lactose, or milk-sugar; the fats are also much alike in each; but the albuminous matter of cow's milk differs somewhat from that of human milk, particularly in the way in which it coagulates in the presence of acids. Human milk forms into small, light, feathery curds; cow's milk into large, compact, not so easily digested masses. It is necessary, therefore, to seek the means for preventing the coagulation of milk in large curds in the stomach of the child--in other words, to so treat cow's milk that it shall coagulate more like human milk. This may be done in two ways:

(1) By mixing into the milk some substance which shall separate the particles of albumen from each other, and so cause it to form into smaller masses.

(2) By partial predigestion.

To accomplish the first, it is necessary to use some diluting substance of a harmless nature; if it be nutritious, so much the better. For this, Mellin's food, barley-water, veal broth, lime-water, and gelatin are recommended.

Mellin's food is a partially predigested grain, in such a condition that it can be assimilated by the infant; barley-water is valuable for its potash salts, in which cow's milk is deficient, and which the growing babe needs; veal broth is rich in lime; and lime-water neutralizes the acid of the gastric juice, so that milk is not acted upon so strongly, and consequently forms into a lighter curd.

The second method is that of partial predigestion, and is accomplished by the use of peptonizing agents, among which Fairchild's peptogenic milk-powder is good (directions for its use will be given later). On account of the expense of these preparations it is not probable that they will come into general use, except in cases of sickness.

It is therefore evident that dependence must be placed almost entirely upon attenuants to render the casein of cow's milk more easily digestible. Probably for this Mellin's food is as good, if not better, than any other of the recommended preparations. It is not injurious, is nutritious in itself, and is a good diluting agent, causing milk to form into looser curds than it would otherwise do, and it contains sufficient sugar to require no further addition of this substance.

Now arises the question whether milk shall be sterilized for infants' feeding. The weight of evidence seems to be as follows: if it is possible to see the conditions under which the cows live, and to know that they are unquestionably good, that the animals are in perfect health, that the milk is drawn from cleansed udders into cleansed vessels by clean hands, kept in a cool place, and used fresh, then it is probably wise not to sterilize it. All milk otherwise obtained should be made sterile before using, and as soon as possible after milking. Looking to the standard--human milk--there are no organisms in it. That alone is sufficient reason why cow's milk should be freed from them.

Again, most bottle-fed children do well during the cold weather of autumn and winter; in summer the mortality is very great among them, especially in the poorer districts of large cities. It is well known that the chances for life with children nourished by mother's milk are greater than with those artificially fed. Why should this be? There is no doubt that it is owing to the presence in cow's milk of extraneous substances, the products of bacterial growth--products which are often absolute poisons; and it is highly probable that cholera infantum, in a vast majority of cases, may be traced to the action of such poisons.

Under favorable conditions of temperature, such as prevail in the warm months of summer and early autumn, micro-organisms grow with almost incomprehensible rapidity in any substance which is suitable food for them. Milk is such a substance; and, as bacteria multiply with wonderful rapidity, millions forming in a few hours in every thimbleful, it is perfectly evident that they must produce something. This something may or may not be of a harmful nature, depending upon what species of organism produces it. I have no evidence at hand to show what is the nature of the product of any one organism which finds a home in milk; but there are instances on record where the nature of the product of certain bacteria is known: for example, the diphtheria bacillus. This little rod, growing upon the outside of the tonsils in the human throat, produces a most virulent poison, which, taken up by the circulation, pervades the whole body, and often so enfeebles its functions as to destroy it.

Reasoning from analogy, it is not impossible to suppose that other organisms may produce substances of a similar character, poisonous in their effects, and which, when taken into the alimentary canal, may produce very grave digestive disorders.

Further, bacteria, by their multiplication, use some of the constituents of milk for their food, thus changing its composition. It is very important to prevent this growth, or, in case it has begun, to check it before it has rendered the milk unwholesome food. Hence the necessity of sterilizing immediately all milk which is not received directly from the cow. Besides, cows are often infected with tuberculosis, foot-and-mouth disease, splenic fever, pneumonia, and other dangerous disorders. Their milk may be a direct cause of infection. When it is sterilized there is less danger from it; but even then it is not, of course, a wholesome food, because of the poisons which may be produced in the animal during the progress of the disease, and because a sick and weakened cow cannot give wholesome milk.

In many cities, through the influence of children's hospitals and sanitariums, the knowledge and methods of sterilizing milk for infants' food are gradually spreading.

Circular wire frames, made something like casters, and fitted with eight bottles, each holding enough milk for one feeding, may be bought for the purpose of sterilizing at almost any pharmacy. The frame is to be set in a kettle with water in the bottom, which on boiling produces steam, the heat of which does the sterilizing. This is an easy method. Another good way is to sterilize at a lower temperature for a longer time, as less change is produced in the constituents of the milk by the lower degree of heat. This may be easily done by immersing the bottles in water at 190° Fahr., and maintaining that temperature for an hour.

=Care of Feeding-bottles.= Great care must be taken in cleansing feeding-bottles. When they can be washed immediately after using, it is easy to make them perfectly clean; but when this is impracticable they should be put to soak in cold water, then washed with hot soap-suds, and last boiled for ten minutes in clear water. If flecks dry on the inside, put a teaspoon of rice, or coarse salt, into the bottle with a little water, and shake well until all is removed. Never use shot: it might cause lead poisoning.

Plain rubber nipples alone should be used, never the tube attachment. The nipples should be washed clean and dried after each nursing. Before again using the nipple it should be put into boiling water for ten minutes, and only the rim of it should be touched in handling. The nipple should never be put into the mouth of another person to test the milk.

=Condensed Milk.= When a large percentage of the water of milk is evaporated, and sugar added, a thick syrup is formed, known as condensed milk.