Volume 4

A reference handbook of the medical sciences : embracing the entire range of scientific and practical medicine and allied science / by various writers ; edited by Albert H. Buck.

Date:
1888-1895
Catalogue details

Licence: Public Domain Mark

Credit: A reference handbook of the medical sciences : embracing the entire range of scientific and practical medicine and allied science / by various writers ; edited by Albert H. Buck. Source: Wellcome Collection.

    28/838 (page 16)
    Infectious Tumors. REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. same substances in both, not so much difference but that one might be substituted for the other without great harm resulting. But just there our knowledge is at fault, and our difficulty comes in, for, practically, we find that the two milks present entirely different results on the addi- tion of coagulating acids—cow's milk, when so treated, yielding up four-fifths of its albuminoids as a rapidly forming and firm coagulum, very slowly dissolved by the gastric juice; while human milk yields hardly one- fourth of its albuminoids, in the form of a slowly form- ing and flaky coagulum, easily acted on by the ferments of the stomach, the other three-fourths remaining unco- agulated. In what does this difference in these albumi- noids consist ? Lehmann thinks there is little but what may be caused by the more or less alkaline state of the fluid. He says: I have found woman's milk when acid yield a much thicker coagulum than when alkaline ; and cow's milk when alkaline a much looser coagulum than when acid—facts which are of the greatest interest and value in relation to dietetics. But Biedert goes far- ther, and insists on a more radical difference. Besides this difference in the albuminoids, which must rank as the most important, we note also that cow's milk contains considerably less sugar of milk and a little less fat, so that, when diluted, this deficiency becomes very notable. With these facts before us, we must endeavor to make the necessary modifications. Two ways have been pro- posed : The first is the chemical or digestive method ; the second may be called the mechanical. By the first, rec- ognizing that the important difference between cow's milk and human milk lies in the different reactions of the albumen, this ingredient is partially or entirely digested, and thus prevented from forming hard and indigestible coagula. One of the preparations of pancreatin, with the addition of an alkali, is probably the best method of accomplishing this. The following are Leeds' direc- tions, as given by Lewis Smith : 1 gill of cow's milk, 1 gill of water, 2 tablespoonfuls of rich cream, 200 grains of milk-sugar, 1£ grain of extractum pancreatis, and 4 grains of sodium bicarbonate. Put the above into a nurs- ing-bottle, and place the bottle in water of a temperature of 115° to 125° F., and allow it to stand just twenty min- utes, when it is ready to be given to the child. It should be prepared just before using. If allowed to remain too long it becomes bitter, and may on that account be refused. The mechanical method of altering the albu- men is to dilute the milk with some bland and easily digested fluid, generally farinaceous, which, by mechani- cally separating the caseous particles, prevents the forma- tion of large masses and enables the digestive fluids to act more readily upon them. This method was given to us many years ago by the late Dr. Meigs, with his em- phatic recommendation, in the well-known formula of a weak solution of gelatine and arrow-root added to the milk, with the further addition of a little sugar and cream. This was altered by Jacobi, who substituted bar- ley- or oatmeal-water for the gelatine and arrow-root, and with him it still remains a favorite formula. Though the albuminoid constituents in cow's milk form the chief dif- ficulty in its assimilation by the child, the amount of the other constituents in the milk should not be overlooked, or the infant's nutrition will surely suffer. And as nat- ure insists on keeping the sugar-supply a constant quan- tity, it will be inadvisable on our part to let it fail. In our directions cane-sugar is generally ordered, but it may well be doubted whether it is wise that it should be so, and, where practicable, sugar of milk should be used. To increase the quantity of the fats, which are also deficient, cream may be used in place of a portion of the milk. The whole fluid should be kept strictly alkaline by the addition of either lime-water or soda. Very recently Dr. Keating has been urging that a certain amount of a solu- ble salt of lime should always be added to an infant's food, to counteract the great tendency to rickets which exists in bottle-fed children ; the lime-water frequently added is not, in his opinion, sufficient. He has therefore had some compressed tablets {milk-food tablets) made, each containing : Sugar of milk, 26 grains ; calcis lacto- grain; calcis carb., -fa grain ; sodii bicarb., & grain ; potass, bicarb., y-2- grain ; sodii chloridi, £ grain. These are to be used as follows: To prepare the bottle for a child of a few weeks, take three ounces of boiling water and stir in one ounce of milk. To this add three tablets and dissolve thoroughly. Place the mixture iu a nursing-bottle, and add two teaspoonfuls of cream Shake well, and feed to the infant at about the tempera- ture of the body. For an infant of a few months, two ounces of milk and four tablets are used in the above formula. Condensed milk is used largely in the feeding of infants, and has sometimes appeared to be of service in cool weather during the early months of infancy. One part of condensed milk must be reduced by fifteen of water at first, and gradually increased to one in ten. Jacobi recommends barley- or oatmeal-water for the pur- pose. The large amount of cane-sugar it contains is, however, very apt to disagree; producing acid fermenta- tion and diarrhoea (Smith). The question here arises. Can we not obtain the same results without trouble bv ordering some of the many proprietary preparations, es- pecially such as are termed milk-foods V The fact that they are proprietary, and, therefore, secret preparations ; that analyses by many able chemists have given very va- riable and not altogether flattering results ; that they are liable to be old and musty, and that they are very expen- sive for the poorer classes, should, I think, make us re- sort to them with hesitation. The amount of nourishment required by a healthy in- fant is a subject of interest, but cannot be made a matter of rule ; some infants require much more than others to satisfy them. The danger in most cases is of overfeed- ing. To avoid that the infant should be fed regularly ; allowed to satisfy itself at the time, and then allowed no more until the next feeding-time comes round. With care in this way overfeeding at any one time is avoided. Dr. Lewis Smith had some observations made at the New York Infant Asylum in reference to the amount of nour- ishment taken by healthy infants. It was found that the average daily amount for infants under four weeks was 13 ounces, with a maximum of 22.2 ounces for a child of five days and a minimum of 5.4 ounces for another of similar age. In another series, where the infants were from one to ten months' old, the daily average was nearly 24 ounces for each child, with a maximum of 36.8 ounces for an infant of four months and a min- imum of 12.2 ounces for one of six months. Biedert, also, has published some very interesting facts in a long article entitled Weight Studies. In this he gives the conclusions arrived at from the S3'stematic weighing of infants, as to how much food a child should have to thrive on. He asserts that a bottle-fed infant thrives besc when the minimum amount of food necessary for devel- opment is given to it; and his studies were principally directed as to how much such required. His weighing showed that an infant of one month, 6 to 7i pounds weight, requires only 5-J to 6£ ounces of cow's milk dur- ing the twenty-four hours; second month, 8 pounds weight, 10 to 22 ounces ; in the third month, 3 ounces for every kilogramme the child weighs. The principal conclusions Biedert has arrived at are as follows : 1. Re- markably small amounts of nourishment, especially in the first few weeks, are sufficient for the good develop- ment of infants. 2. An increase in the amount of fat, considerably above what is contained in dilute cow's milk, spares albumen, makes digestion easier, and in- creases growth of child. 3. Sickly children must be fed with weaker preparations of milk, such as are suitable for infants of younger weeks. 4. Careful regulation is necessary, as the child has no instinct which guards against indigestible food or overfeeding. In the first months this regulation is of importance. Even breast- fed children are apt to drink too much then. As the infant grows older, and its digestive glands be- come developed, a larger amount of farinaceous food may be allowed. A pap may be made of stale bread or biscuit boiled in water sufficient to cover it, and after- ward mixed with fresh milk and sweetened. Better still is the food prepared from flour partially converted into glucose. This can be accomplished by boiling a few