I. FLATULENCE A:NM HABITUAL COLIC. —These symptoms are ahnost invaria bly due to difficulty in the digestion of the proteids. The cause of this diffi culty may be either that the proteids are too high or that the child has a feeble digestion as regards proteids. There are three methods of overcoming the difficulty: first, by reducing the pro portien of proteids; second, by partly predigesting the proteids; and, third, by the addition to the milk of fari naceous substances which theoretically aid proteicl digestion.
By 1?educing the Proportion of Pro leids.—Suppose, for example, a child of one month, taking the proper formula for that age, has colic. The proteids may he reduced without changing the percentage of sugar and fat by using a 16-per-cent. (gravity) cream instead of the 12-per-cent. cream, and making a higher dilution with the sugar solution. Or, again, a child of six months may be taking 4-7-2, and suffer from flatu lence and colic. The proper treatment is to return to one of the earlier for mul,—as 3-6-1.
It must be kept in mind, however, that, after each change of formula to a higher proteid, there may be a slight amount of colic and flatulence for a day or so; one should not, therefore, be dis couraged and go back to a lower per centage until a fair trial of the higher proportion has been made.
By Partly PepIonizing the ood.—At first the food may be peptonized for an hour, preferably just before the feeding time; later the process. may he short ened to fifteen or even ten minutes. The use of the peptonizing tubes is most satisfactory; but a somewhat similar re sult is produced by using the peptogenic milk-powder. Peptonized milk should not be given for a longer period than absolutely necessary,—never, if possible, longer than three months,—lest the child gradually lose its ability to digest proteids. It must be remembered that,
even with peptonizing as an adjunct, a proper formula is essential.
By Adding Farinaceous Substances to the Food. — Experience indicates very clearly that many children can manage the proteids of cows' milk more easily when some farinaceous substance in the form of gruel is added to the food; and that many of the signs of proteid indi gestion—flatulence, colic, etc.—are re lieved by this addition.
Personal experiments showing that it is possible to cause a marked decrease in nitrogen elimination, or an increase in nitrogen retention, by adding carbohy drates to the food. Arthur Keller (Centralb. f. Inn. Med., Jan. 14, '99).
In practice the simplest way to add carbohydrates to the nourishment is to use a gruel made of barley, oatmeal, or wheat to replace part or all of the water of the formula. Barley-gruel is the one most employed, and is easily made by boiling one tablespoonful of barley-flour in a pint of water for twenty minutes.
This may be used to replace half the water in any of the foregoing formul2e, and it usually influences not only the in testinal colic, but also has a marked effect on flatulence in the stomach. The gruel made from oatmeal is preferable if there is constipation; that made from barley or wheat- flour if there is diarrhcea.
The milk is manipulated too much in the laboratories. One obtains by this method 3 or 4 per cent. of fat, but the fat is not in a fine emulsion, and clin ically the fat, in order to be thoroughly assimilated, must be in a fine emulsion. Alany babies, not assimilating the casein, will improve by using a thin barley water that has been malted. Henry Dwight Chapin (N. Y. Med. Jour., Apr. 23, '98).