PREPARATION OF THE DAILY SUPPLY. —The full quantity of food for twenty four hours should be made at one time; then clean bottles for the required num ber of feedings are filled, stoppered with on-abE,orbent cotton, and sterilized, pasteurized, or, if the food is to be used raw, placed immediately on ice.
Of the many hundred marasmie and raehitic infants observed, it is believed that fully tr15 per cent. had been fed on the meal-foods or on condensed milk, chiefly the latter. In order to make up the deficiency of fats and proteids in condensed milk, cream may be added in proportion to make up the deficient fat. Among di.spensary patients codliver-oil supplies the deficiency, the dose varying with the age of the baby, the ability to dige.st it, and the season of the year. Ten drops to a dessertspoonful, three or four times daily after feeding. During very hot weather the dose must be re duced or suspended if there are eddences of gastro-intestinal disturbance.
The low proportion of proteids may be increased by adding a meat-broth. One pound of lean beef is boiled in one quart of water till the liquid is reduced to one pint. Such a broth contains OS per cent. proteids; so that if 1 part of con densed milk is added to 12 of broth the mixture will contain 0.5 per cent. of fat, 1.4 per cent. of proteids, and 4 per cent. of sugar. This will answer for a child three months old, fat being supplied by eodliver-oil. When the sixth month is reached 1 part of condensed milk may be added to 9 of broth. The percentages then will be, approximately, 0.75 per cent. of fat, 1.7 per cent. of proteids, and 5 per cent. of sugar. This, with codliver oil, will answer until the eighth or ninth month, when barley- and oatmeal- gruel, with other meal mixtures, may be al lowed. Kerley (Med. News, vol. lxx, No. 23, '97).
The number of children over four months of age who are fed exclusively on condensed milk are "an ill-conditioned class of children with their starved mus cular and nervous systems and catarrhal tendencies, who fall an easy prey to broncho-pneumonia in the winter, to the gastro-intestinal diseases in the summer, and to the infections diseases during the entire year." The chief objection to con
densed milk as an infant-food is the fact that it contains a slight deficiency of proteids and an excessive and almost fatal deficiency of fat. Condensed milk cannot be changed or fortified so as to render it a desirable food; it may be made permissible; nevertheless, its use is not to be advised when a better food can be procured. Sometimes the practi tioner is obliged to use it among the ex treme poor.
One of the most frequent and serious errors in infant-feeding is overfeeding. Crandall (Archives of Ped., Aug., '97).
For home-modification of milk, Soxh let, of Munich, has devised a formula which has proved of value in most cases. This can be made by diluting the niilk coming from a. very good dairy 7, with water, for a, child below nine months, and adding to each 8 ounces a teaspoon ful of sugar of milk, dissolving the sugar of milk first in the 4 ounces of water, and then adding the 4 ounces of milk. Below three months the children should be given 3 ounces in each bottle, and 8 bottles in 24 hours. Henry Koplik (N. Y. Med. Jour., Apr. 23, '98).
Following requirements given for a perfect modified milk: (1) alkalinity and body-temperature, (2) sufficient quantity, (3) proper proportion of con stituents, (4) dig,estibility, (5) freshness, sterility, and cleanliness, (6) absence of adulteration. Edward Hamilton (Amer. Jour. of Obst., ete., Aug., '98).
It is sometimes more difficult to digest laboratory-milk which has been centrif ugated and then mixed than milk which has been modified at home. The labora tory-milk often shows large oil-globules floating on the top. If milk can be obtained pure it should be neither steril ized nor pasteurized. If one is not sure of his milk it should be pasteurized for 20 minutes at 156° F. Use of top-milk is recommended; this is obtained by letting the milk stand for 6 to 8 hours and taking the top quarter.