CHAPTER XVII INFANT FEEDING (Part 2)

it to stand for ten minutes, when it is ready to be used at once. Feedings of more or less than 4 oz. must be worked on the basis of 1 oz. of peptonizing solution to 4 oz. of milk. Peptonized milk is valuable when there is feeble proteid digestion. It is not advisable to continue its use indefin- itely, as the stomach gradually becomes less and less able to do its work. At the most it should be used only for a month or two at one time; when stoppage of this method is desirable, gradually diminish the amount of powder used. Method of Peptonizing Mixtures. — First, make up mixture according to the formula. Then add the pep- tonizing fluid (made according to the formula) and allow the whole quantity of milk to stand in a bottle or pitcher in a pan of water, 1200 F., for the prescribed length of time, say ten minutes or a half hour, according to the order. Then quickly raise the water around the milk to the boiling-point and allow it to boil for three or four minutes. Remove the milk, cool, and bottle, and place on ice. The boiling of the water around the milk will stop the peptonization which, if not stopped, will cause the INFANT FEEDING 323 milk to become very bitter; it also sterilizes the milk and does away with the necessity of pasteurizing. Oatmeal Gruel. — Mix two rounding tablespoonfuls of Bethlehem oatmeal with a little cold water; add a quarter teaspoonful of salt. Pour over it one pint of boiling water and stir over the fire until it boils. Then stand it where it will bubble slowly for a half hour, add a lump of sugar and a tablespoonful of whipped cream or a tablespoonful of sherry wine, and serve. Children seldom care for foods prepared with wine. Apple Gruel. — Good in irritation of the bowels. Core and quarter a large apple. Pour over it one pint of boiling water and simmer until it is reduced to a pulp. Strain.. Mix two level tablespoonfuls of arrow-root with a little cold water and add to the hot apple water. Stir until it boils; then move back and let it cook slowly for ten minutes. Do not serve too hot and preferably without sugar. Farina Gruel. — Put a pint of milk into a double boiler. When it comes to the boiling-point sprinkle into it two level tablespoonfuls of Hecker's farina. Stir until it thickens and then let it cook for twenty minutes. Add a quarter of a teaspoonful of salt and a lump of sugar, and serve. Flour Gruel or Pap. — Put a pint of milk into a double boiler and let it come to the boiling-point. Moisten two level tablespoonfuls of flour with a little cold water and stir into the boiling milk. Add one-fourth of a teaspoonful of salt and let it cook for twenty minutes. Add a lump of sugar and a little nutmeg if desired. German Gruel made with Flour Ball. — Put one pint of Hour into a strong bag and tie tightly with twine. 324 DISEASES OE CHILDREN FOR NURSES Put into a kettle of boiling water and boil for five hours. When done take off the cloth and peel off the outside moist portion. Grate the ball and then put the flour into a baking pan and dry in a moderate oven for two hours, being careful not to brown. Moisten two tablespoonfuls of this flour with a little cold water and pour over it one pint of boiling water and simmer for three minutes. Add a small pinch of salt and a lump of sugar and 4 oz. of warm milk, and serve. Barley Gruel Liquefied or Dextrinized with Cereo or Maltine.— One heaping tablespoonful of barley flour, one pint of boiling water. Mix the flour in a small part of water and add to the rest. Boil fifteen minutes, then add enough cool water to make up the original pint. Cool to ioo° F. or 105 ° F. and liquefy with one teaspoon- ful of cereo or maltine. This predigests the gruel. Barley Gruel. — Moisten one tablespoonful of Robin- son's Patent Barley with 4 oz. of cold water; pour over it 4 oz. of boiling water and add a half teaspoonful of salt. Let it simmer for five minutes; then add 4 oz. of hot milk. Let it come to a boil. Stir in a teaspoonful of sugar and serve. Arrow-root Gruel.— Morten an even tablespoonful and a half of arrow-root in a little cold water. Pour over it a pint of boiling milk, stir over the fire until it thickens and let it boil slowly for ten minutes. Take from the fire and add a teaspoonful of sugar and one-fourth tea- spoonful of salt. When this gruel is made for a child who is on a weak milk mixture, like 3.6.1. or weaker, the gruel should be made with two-thirds water and a third milk instead 01 a pint of full strength milk. INFANT FEEDING . 325 Arrow-root Gruel with Egg. — Separate an egg, beat the white and yoke until light; then mix them carefully. Add slowly one pint of plain freshly made arrow-root gruel, and serve. Rice Flour Gruel. — Mix a tablespponful of rice flour with a little cold milk and add it to a pint of scalding milk. Cook for fifteen minutes. Add one-fourth teaspoonful of salt, a teaspoonful of sugar, one-fourth teaspoonful of ground cinnamon, and a teaspoonful of brandy. This is especially beneficial as a food in cases of diarrhea. Barley Jelly. — Put two tablespoonfuls of washed pearl barley into one and a half pints of water and slowly boil down to one pint. Strain and let the liquid settle into a jelly. Barley Jelly made with Robinson's Barley Flour. — Dissolve slowly two rounding tablespoonfuls of Robinson's barley flour with two ounces of cold water. Add one pint of boiling water and simmer gently for fifteen minutes, stirring all the time. Strain and let the liquid settle into a jelly. Beef Juice. — A piece of lean steak is slightly broiled on each side and the juice pressed out by a meat press or a lemon squeezer. Two or three ounces can ordinarily be obtained from one pound of beef. This is seasoned with salt and given cold or warm, but not heated suffi- ciently to coagulate the albumin in solution. If heated above 1600 F. it will be unfit for use. Beef Juice and Milk. — When beef juice is added to milk the milk should never be heated above ioo° F. before the addition of the beef juice. Barley Jelly, Maltine, and Milk Mixture. — Dissolve- two teaspoonfuls of barley jelly (made with Robinson's 326 DISEASES OF CHILD REX FOR NURSES flour) by adding one-fourth teaspoonful of Maltine and stirring. After the jelly has become a liquid add to the milk mixture in the proportion of the above quantity of liquid to every 4 oz. of mixture. Preparation of Gelatin in the Treatment of Infan- tile Diarrhea. — Five hundred grams (—17 oz., 3 dr. 10 grs.) of chemically pure gelatin are dissolved in a liter (~33i oz- ) °f boiled water; the solution is filtered, and after being sterilized for an hour in an autoclave at a temperature of 248 ° F., is poured into tubes having a capacity of 10 cc. (-21 \ fldr.), each tube thus con- taining 1 gm. (about 15 gr.) of gelatin. When it is desired to use this preparation, it is liquefied by plac- ing the tubes in hot water. As much as 12 gm. or 14 gm. have been given in the course of twenty-four hours. Weill commences with 3 gm. a day and increases at the rate of 1 gm. a day until a decided effect is produced. Oatmeal Jelly. — Soak two ounces of coarse oatmeal for twelve hours in one quart of cold water, then boil the mixture down to one pint, and strain while hot through a fine cloth or several thicknesses of gauze. Malt Soup Mixture. — To make a 40 oz. mixture: 20 oz. of milk, 20 oz. of water, 3 oz., by measure, of wheat flour (measured loosely and not packed), \ oz., by measure, of malt soup. Number 1. — Mix the flour with the 20 oz. of milk and suspend it so as to make a uniform mixture. After as much of the flour is dissolved or suspended as posMble strain through gauze (two thicknesses) to strain out all the lumps or excess. Number 2. — Dissolve the i^oz. of malt in 20 oz. of water. Number 3. — Take the first mixture and the second INFANT FEEDING 327 mixture, that is, the flour and the milk mixture and the malt and the water mixture, and stir them together thoroughly. Place the whole in an enamel pot (or double boiler) and put over a slow fire, allowing the mixture to come to 1600 F. and keeping it at that temperature for twenty minutes, stirring all the time. At the end of the twenty minutes bring the mixture to a boil and remove from the fire. If there is a loss in the bulk through the cooking make up the full amount (40 oz.) by adding sterile water; then place in the bottles and cool down slowly to the temperature of running water. When the mixture is finished it has a light yellow color, smells of malt, and when it cools becomes quite thick, but when again heated becomes fluid and easily taken through the ordinary nipple if the holes are large. When the malt soup mixture is ordered one-half or one-third strength, it means that instead of taking the full amount of milk (that is, the 20 oz.) half or only 10 oz. of milk is to be used and the other half is to be water, making in the whole mixture, milk 10 oz., water 30 oz., instead of 20 oz. The extra 10 oz. of water is to be added to the 10 oz. of milk, and then the flour is dissolved or suspended in the half strength milk or pro- ceed as directed above. Buttermilk. — At times the proteid in plain cows' milk is indigestible even when given in very small percentages. Large curds continually appear in the stools. In such cases buttermilk often cures the indigestion in remarkably short periods of time. It should be prepared as follows: Flour 3] dr. by weight. Sugar 15 " ' " Buttermilk 1 quart. 328 DISEASES OF CHILDREN FOR NURSES The mixture should be brought to the boiling-point, stirring continuously. Just as it is about to boil it should be removed from the stove and cooled rapidly under running water. The mixture should then be placed upon the ice. The proper amount for the age is poured into a nursing bottle at feeding time and slightly heated. This mixture contains a much higher percentage of proteid than diluted cows' milk, but some change takes place in it which renders the mixture easily digestible. It should not be given for any length of time without the addition of cream. Buttermilk Conserve.— This is a condensed form of buttermilk. One part is added to three or four parts of water. It is a very good method of serving buttermilk. It should be slightly heated before adding the water. Condensed Milk.— It is made by heating milk to 2i2° F. to destroy the bacteria and then evaporating in a vacuum at a low temperature to less than one-fourth its volume. Condensed milk contains, after diluting six times, about i per cent, of fat, 1.20 per cent, of proteid, 7.23 per cent, of sugar, and .17 per cent, of salts (Holt). As the usual dilution is from twelve to eighteen times it is evident how it lacks in fats and proteid. Knowing how necessary fats and proteids are to the infant it can be appreciated why condensed milk should not be used as a permanent food. It sometimes works well as a slight change for a short period in acute indigestion, but it should not be used permanently without the addition of cream, and never if good milk and accurate milk mixture can be obtained. Junket.— To one pint of fresh hike- warm cows' milk add two teaspoonfuls of essence of pepsin or liquid rennet. INFANT FEEDING 329 Stir for a moment and then allow to stand until firmly coagulated. It is served cold. Kumiss and Bean Flour. — These are preparations sometimes used in infant feeding. Kumiss is a fermented form of cows' milk. It is more useful for older children than for infants. Bean flour has been recommended by Edsall for feedings in cases of difficult proteid digestion. Especially prepared flour must be obtained, and prepared according to the physician's instructions. The mixture has a nauseating odor, but it has given good results in a limited number of cases. INFANT FOODS These are not in any way substitutes for mother's or properly modified cows' milk. They are capable of doing and have done much positive harm. They are the greatest exciting cause of rickets and scurvy. At times some of the preparations may be of considerable value, but chiefly for temporary use in pathologic conditions. Here they should be prescribed like drugs. The majority of the preparations are rich in sugar and lacking in fats and proteids. Children may gain weight, but they do so on the carbohydrates alone. The result of such develop- ment leads to the waxy appearance which children develop, when about a year of age, who have been fed on these foods.