CHAPTER XIV. FOOD. (Part 1)

CHAPTER XIV. FOOD. A whole book might be written on this subject, but I shall endeavor to give only a few of the principal points of interest. From birth until six months old, the diet consists of milk, either mother's or modified cow's milk. The best food for an infant, under nor- mal conditions, is mother's milk, which is composed of thirteen parts of solids and eighty-seven parts of water. By normal conditions, we mean that the moth- er is in perfect health. A woman suffering from an infectious disease, such as tuberculosis, syphilis or puerperal sepis, should never nurse her child because of the danger of infection for the child, and it is too great a drain on the mother's strength and vitality. That the milk is perfect in quality, and sufficient in quantity. Should a mother be unable to nurse her child, a wet nurse should be recommended. Mother's milk is the food nature has provided for the child, and the mother should always nurse her child if pos- sible, as man can never exactly reproduce the work of nature. If it is impossible for the mother to nurse her child or to procure the services of a wet nurse, or if the aversion of the patient to wet nurses as a class, and this is the rule rather than the exception, cannot be over-come, then we must resort to artificial food, and this is of the greatest importance. More infants 192 die from improper food and the manner in which they are fed, then from any other cause. Two-thirds of all the children born die before reaching the age of three years, and the greater part of sickness and deaths among children are due to improper food and the man- ner in which they are fed than all causes conbined. Think of the little lives that might be saved if parents only gave this subject a little more thought and con- sideration ! When baby must be fed artificially, cow's milk is best. The milk of the ass is more like mother's milk than cow's, but it is hard to get. All milk contains the same constituents, no matter from what animal it is obtained ; the difference lies in the proportions of these ingredients. Here is a table giv- ing the constitution of each : Mother's Milk. Fats, Sugar, Proteids, Salts, Water, Reaction 4.0 7.0 1.5 2.0 Cow's Milk. 87 Alkaline Fats, Sugar, Proteids, Salts, Water, Reaction 3-5 4-5 4.0 7.0 87 Acid By comparison we see that the main difference be- tween cows milk and mother's milk is that mother's milk contains more sugar and less proteids. So we see that cow's millk in its natural state is inadequate to replace mother's milk, and is unfit for food for an in- fant. We must change the constituents of the cow's milk to resemble mother's milk and to make it digesti- able for the infant. This process is called "modifying." The protieds of cow's milk differ from human milk in quantity and quality. This is the element that is the tissue builder and strength producer of milk. It is more than an infant can digest, and if given in its ii3i 193 natural state will form irritating, hard, tough curds in the baby's stomach. We see then that cow's milk cannot be fed to an infant without changing or modi- fying it. Although it contains the same element as mother's milk it is not in the same proportions. But it is easy and simple to change or modify it to re- semble mother's milk. This is done by adding cream. sugar and water. Sometimes whey is used as a dilu- tent instead of water, and lime water overcomes the acidity of cow's milk, making the reaction alkaline. The first step is to obtain the primary formula, the ten per cent milk. This is milk containing ten per cent fat ; which is obtained by taking equal parts of plain milk and ordinary cream, or the upper third of a quart bottle of milk after standing at least four hours. It is more convenient to use the plain milk and ordinarv cream in making: the formulas. 194 FORMULA I. Third to the fourteenth dav Third to the fifth day, Number of ounces. Ten. One ounce at a feeding. i/ 1/ Milk Cream Lime water Milk sugar Boiled water Oz. Oz. Oz. Oz. Oz. sy2 Fifth to the seventh day, Number of ounces. Twenty-one. Two ounces at a feeding. Milk Cream Lime water Milk sugar Boiled water Oz. Oz. Oz. Oz. Oz. i i Diluted nine times. Diluted six time; Seventh to the tenth day. Number of ounces. Twenty. Two ounces at a feeding; Diluted four times Tenth to the fourteenth day. Number of ounces. Twenty. Two ounces at a feeding, ilk Oz. -earn Oz. ime water Oz. ilk sugar Oz. 3iled water Oz. Diluted four times. Milk Oz. 2 Milk- Oz. 2 Cream Oz. 2 Cream Oz. 2 Lime water Oz. I Lime water Oz. 1 Milk sugar Oz. i/4 Milk sugar Oz. i> Boiled water Oz. 15 Boiled water Oz. 15 The above formulas are to be divided into ten feed- ings each, in twenty-four hours. Every two hours by day and two feedings at night, if the baby is awake. Never wake a child at night for food. If fed at night, the hours are usually one and four o'clock. If top milk is used, use the ten per cent milk, and take as much as milk and cream combined. 195 FORMULA II. Second to the sixth week. Using ten per cent milk as primary formula. Third w eek Fourth week. Number of ounces. Number of ounces. Twent y. Twenty-five. Two ounces at a feeding. Two and a half ounces at a feed: ing. Milk Oz. 2 Milk Oz. 2y2 Cream Oz. 2 Cream Oz. zy2 Lime water Oz. i Lime water Oz. iy2 Milk sugar Oz. iy2 Milk sugar Oz. \y2 Boiled water Oz. 15 Boiled water Oz. i%y2 Diluted four times. Diluted four times. Fifth week. Number of ounces. Thirty. Three ounces at a feeding- Milk Cream Lime water Milk sugar Boiled water Oz. Oz. Oz. Oz. Oz. 3 3 2 22 T/ Diluted four times. Sixth week. Number of ounces. Thirty. Three ounces at a feeding. Milk Cream Lime water Milk sugar Boiled water Oz. Oz. Oz. Oz. Oz. 3 3 2 22 T/ Diluted four times. The above formulas are for ten feedings each, in twenty-four hours. Every two hours by day and four hours at night, if baby is awake, usually at one and four o'clock. If the ten per cent top milk is used, use as much as milk and cream combined. 196 FORMULA III. Sixth to the twelfth week. Using ten per cent milk as primary formula Seventh week. Eighth week. Xmnber of ounces. Twenty-four. Twenty-eight. Three ounces at a feeding. Three and a half ounce a feeding. :s at Milk ( )z. 3 Milk ()z. Cream Oz. Cream Oz. 3^ Lime water Oz. iy2 Lime water Oz. tt_; Milk sugar Oz. 154 Milk sugar Oz. i- , Boiled water ( )z. i6V2 Boiled water Oz. r r; - i Diluted three time: Diluted three time: Ninth and tenth weekr Number of ounces Thirty-two. Four ounces at a feeding Eleventh and Twelfth weeks. X umber of ounce-. Thirty-six. Four and a half ounces at a feed in st. ii'. Milk- Oz. 4 Milk Oz. Cream Oz. 4 Cream Oz. Lime water Oz. TT2 Lime water Oz. Milk sugar Oz. 2 Milk sugar Oz. Boiled water Oz. 22T/2 Boiled water Oz. Diluted three times. Diluted three times. The above formulas are to be divided into eight feed- ings each, in twenty-four hours, every three hours dur- ing the day, and one feeding- at night if the baby is awake. Usually about two o'clock. These formulas may be continued until the baby is four months old. It is often better to increase the 197 quantity first, and then if baby is not satisfied, the quality. But I have found babies thrive much better on a weak formula ; the gain is not so rapid, but they do not seem to have the stomach complications that rich, over-fed babies are victims of. The next series of formulae for the middle months, a change is made in the milk. At this period the seven per cent milk is used as a dilutent instead of the ten per cent milk. The seven per cent milk is obtained as top milk, by tak- ing the upper half of a quart bottle, after it has stood at least four hours, or by using one-fourth ordinary cream, containing sixteen per cent fat, and three- fourths plain milk. At this age, also, the number of feedings are seven in the twenty-four hours, every three hours by day and none at night. Usually at the age of six months the infant needs a more mixed diet. Farnaceous food in some form, usually as strained gruel, may be added to its mid-day feeding, and strained broths may be given to some children at this age. But, as we are dealing only with the new born infant of four days to three months (this includes the length of time the nurse is with the little stranger)' we will not go into details of foods required later. A nurse should be very careful, and never prescribe any form of food. This is the physician's duty, and he should prescribe the food as he does the medicine, giv- ing the nurse a written prescription for its prepara- tion. The above or foregoing tables are only used in an emergency, or in the absence of the physician. The same proportions are not suited for every case, and must be often modified, by experience, to suit the in- dividual child. According to the health of the child, these conditions should be changed to meet its de- mands. As infants have no stomach at birth, only 198 an enlargement of the alimentary canal, which forms a kind of a pouch, holding about one ounce, two table- spoons, how important, then, that the specified amount be given, and at regular intervals. How important for the nurse, that she understands this all-important duty, and is equal to her responsibilities. That she knows what is best for each child in order that it may thrive and grow. Cow's milk, modified according to the needs of each individual child, is the most perfect food for an infant deprived of mother's milk. How to Feed the Baby. — Never feed a baby lying in bed, except at night. The infant should be taken up and held in the same position as a mother holds her rfte Fig-. 51 — The proper manner of holding- a babv when giving it the bottle. child when nursing it. The infant should nurse con- tinuously. Never allow it to go to sleep and then wake up and continue to nurse. Never allow it to nurse more than fifteen or twenty minutes. If it seems sleepy, try and keep it awake by gently shaking or moving it so as to rouse it until it empties its bottle. If this does not succeed, try washing its face with cold 199 water. Should this fail, take its bottle away and let it wait until next feeding. Do not feed it between feed- ings. Give it water if fretful. All water given an in- fant should be boiled, and given at a temperature of one hundred F. Always use a dairy thermometer in testing the heat of the milk, and it should be given to a child at one hundred degrees F. The bottle should have a piece of flannel wrapped around it so it will keep warm until baby takes it all. A child that is fed from a bottle should be nursed as regularly as an infant that is fed from the breast. A young baby should be fed every two hours during the day and twice during the night, if awake. Or ten feedings during the twenty-four hours. A baby should be awakened during the day for its food at the proper time, and it will soon learn to awake of its own accord. Its health depends upon regularity. Never wake a baby at night ; it may sleep the whole night through, if it will, without feeding. At live weeks it is usually fed every two and a half hours dur- ing the day and once at night ; if awake, until three months old, at which time it is fed every three hours during the day and no feeding at night. Bottle-fed babies are usually pale, but thrive fairly well. The success depends on scrupulous cleanliness in regard to the bottles, nipples and the preparation of the food and regularity in feeding*. As soon as baby finishes tak- ing its bottle, it should be laid gently in its little bed. HOW TO PREPARE THE FOOD. Material and Appliances Used in its Preparation. Material Needed.- — The material needed is milk, cream for top milk), lime water, milk sugar and boiled water. 200 Appliances Needed. — A Nelson's siphon. This may be obtained at any surgical supply house, or by tak- Fig. 52— Nelsons Siphon. Fig-. 53— Langerfeld's sterilizer. ing a long, straight glass tube, heating it and then bending it the shape desired. It should be V shape with one arm twice as long as the other. This is used Fig. 54 — Gran- ite pitcher. Fig " Glass funnel. Fig. 57 — B rush with wire handle for cleaning the bottles. Fig 56 — Graduate measuring glass. 8 oz.. used in preparation of baby's food. to siphon off the top milk, if top milk is used. Feed- ing bottles, sterile cotton to cork them with, rubber 201 nipples, a vessel for mixing, usually a large granite pitcher, this must be used for nothing else but baby's milk, a glass funnel, and an eight ounce graduate measuring glass, a stiff bottle brush with a wired handle, a granite cup to boil the nip- ples in, to be used for this purpose and no other, and a deep granite cup for warming the bottles of Fig. 58 — Food warmer milk. A nice little alcohol warmer can now be had at most drug stores costing less than a dollar. These articles with a dairy thermometer complete our ap- pliances. To prepare the bottles. — Prepare the number re- quired for the number of feedings in the twenty-four hours by boiling twenty minutes in a solution of bi- carbonate of soda, then rinse them with plain boiled water and alloAv them to remain in same until needed. 202 It is best and safest to allow for accidents by prepar- ing two extra feedings. After each feeding the bottle should be rinsed with cold water and rill with same until they are prepared for the reception of the milk. The Preparation of the Formula.— The nurse pre- pares the formula given her by the attending phy- sician. The physician should give a written prescrip- tion for the preparation of the infant's food, as he does for the prescribing of medicine, and the nurse should carefully and conscientiously fill same. Prepare the entire twenty-four hours' feeding- at a time. The cream, or top milk, is first siphoned off. To accom- plish this, the Nelson's siphon is used, or the glass V- shape tube. If the tube is used, a piece of rubber tub- ing is fastened to the long arm and the tube is then filled with water and the rubber tube held compressed with the fingers. The short arm is placed in the bot- tle and the top milk will flow in the vessel held be- neath. With the siphon is full directions for use. The sugar is dissolved in the water, the cream, milk, or top milk and lime water is added. Use the pitcher for mixing- it in and the graduate glass for measuring the ingredients. After mixing it well, put it in the sterile bottles and set them in a pan of water and place the pan on the stove. The water should reach two-thirds the height of the bottles. Let it remain on the fire until the milk in the bottles reaches 167 de- grees F. Always test the heat with the dairy thermom- eter. The bottles are then corked with sterile cotton, removed from the fire and as soon as cooled place them in the refrigerator or ice box, and it should be kept at a temperature of forty-two degrees. Open only when needed. AYhen a bottle is once opened, if baby does 203 not take it. or only a part, it must not be given the baby again, but thrown away. Pasteurizing Milk. — Pasteurizing milk means heat- ing it to one hundred and fifty to one hundred and sev- enty degrees F. Sterilizing milk. — Sterilizing milk means heating it to two hundred and twelve degrees. Both these processes are to destroy bacteria. Some authorities tell us that, unless there is good reason for so doing it. it is best not to either pasteurize or sterilize the milk, as heating interferes with the digestibility of the milk. Of course, if the nurse has reasons to believe the milk is not pure or clean, then pasteurize it. AYe seldom sterilize milk, unless we want to preserve it. as for example, an ocean voyage, so as to keep it sweet. Pasteurizing milk renders it harder for an infant to digest. To Heat the Milk. — Place the bottle in cold water. Do not put it directly in hot water, but in cold water. If put directly in hot water, when taking it from the ice box. it is apt to crack the bottle. After the chill is oil. the bottle is then placed in warm water. When the water is cool