MODIFICATION OF COWS' cause of the differences noted above be tween breast-milk and cows' milk, cer tain modifications must be made to adapt cows' milk to the digestion of the aver acre infant.
Proleids.—Most important is a reduc tion. in the proportion of the proteids. This can be effected by simply diluting the milk.
Sugar. — Sufficient sugar must be added to bring the proportion in the food up to between 5 and 7 per cent. Good milk-sugar is preferable in the great majority of cases, but where it is not obtainable, or where it causes indi gestion, grannlated suglir may be used, and with many infants answers quite as well. The quantity of cane-sugar used, however, should be only about half the amount of milk-sugar required, because, if added in full quantity, it makes the food too sweet.
A thorough examination of the sources of all milk for general use is imperative, and the laboratories supplying this milk should be under the most careful super vision. Cows' milk should be reduced to the proportions of woman's milk, and a slightly acid milk should be trans formed to one of slightly alkaline reac tion in preserving it from a contamina tion and making it as nearly as possible like a mother's milk. Cows' milk is ap proximately 4 per cent. of fat, 4 per cent. of sugar, and 4 per cent. of proteids. In consequence, then, it is necessary to re member three formulas: Feeding for the newborn, adapted to the majority, should comprise 2 per cent. of fat, 5 per cent. of sugar, 0.75 per cent. of proteids. Low average breast-milk should contain 3 per cent. of fat, 6 per cent. of sugar, and I per cent. of proteids. High-average breast-milk, 4 per cent. of fat, 7 per cent. of sugar, and 2 per cent. of proteids. These modifications should be regulated gradually and frequently by small fra.e tions from one to another. From eight to ten months it is time to make the proportions approximate that of the whole cows' milk. IV. P. Northrup (N. Y. Med. Jour.. Alan 16, 1901).
Fat.—Diluting the milk to reduce the proteids diminishes the proportion of fat also; so that cream must be added, or specially rich milk used, in order to have the fat in proper amount.
Inorga-nic Salls.—The excess of salts in cows' milk is about the same as that of the proteids; so that the dilution required for the proteids will reduce the salts to about the proper proportion.
Reachion.—The acidity of cows' milk may be overcome by adding 1 ounce of lime-water for each 20 ounces of the food, or by adding about 1 grain of bi carbonate of soda for each ounce of the food. The soda is preferable where there is constipation.
water. The gruel is stirred and kept warm until it becomes thin and watery. The top-milk taken from the original bottle with the digested gruel is then diluted and sugar is added. The food for a young infant should contain from one-eighth to one-third of the 9 ounces of top-milk. The food for an older in fant should contain one-sixth to two thirds of the 16 ounces of top-milk.
Sugar is added to make up for the amount lost in the dilution. When the milk cannot be kept below 60° F., it will have to be pasteurized. When there is vomiting of food, the digested gruel may be fed temporarily, and a top-milk poorer in fat used for making up the A simple, accurate method of substi tute infant-feeding. In preparing, the in fant-food it is necessary to have the milk bottled at the dairy and kept at low temperature. From 9 to 16 ounces are dipped from the top of the bottle (avoiding the siphon), and then the milk-bottle is set aside. Dextrinized gruel is then prepared in the following manner: Beat into a smooth, thin paste with a little cold water two heaping, tablespoonfuls of wheat or barley flour and a quart of boiling water, and boil the gruel for about fifteen minutes. It is then cooled and it preparation of diastase is added. The aqueous solution of diastase should be prepared at home by soaking malted barley-grains in cold next feeding. II. D. Chapin (New York Med. Jour., Feb. 23, 1901).
Centrifugal cream is probably Fess de sirable for infant-feeding than gravity cream. As obtained from dealers it is often far from accurate in percentage. Siphonage for 'obtaining gravity cream is an accurate method, but one requiring considerable skill to perform accurately and safely. Dipping oft' the top-milk is an accurate and safe method if reason able care is used. The method for ob taining gravity cream by pouring off the top is very accurate and extremely simple. There is no instrument to be bought and kept clean. By this method it is possible to obtain cream of any de sired percentage up to 26 per cent. To t .t? Iretfllellt eX• le- NN it 11 ile Babcock.
!, atm. d bin for practical purposes t prON Wed the mixed !. rs from a \Nell rogttla ted dairy is ob 1, I. t . Townsend Boston Med. -.tit: Jour.. April 10. 1903).
Sterilization and Pasteurization of 3Iilk.
l'•.e purposes of "sterilizing" milk 1. destruction of pathogenic .
i.acttria which may have gained 'ranee. These are the germs of typhoid, ,1•1 iitheria, cholera, tuberculosis, and t 1—se which produce diarrhceal diseases.
The milk may receive this contamination frem disease in the cow, from the tr.4 hands, or from the water in which the pails, cans, and jars are washed. The close connection which exists be tween the diarrhceal diseases of summer and a contaminated milk-supply must never be lost sight of. The fact that these pathogenic germs are so frequently present, together with the fact that milk in cities is twenty-four to forty-eight hours old, and must often be kept r ut ice, makes some means of destroying the germs desirable or imperative.
2. The destruction of the ordinary ;Terms of lactic-acid fermentation is de --sirable in order that the milk may be ker t safely for a longer time.