The numerous preparations, some of which have been in use for many years, show that the method of adding cream with or without the addition of carbohydrates has given good practical results. The partic ular method and the preparation ‘vhich should he used in a given case depends upon circumstances. As it is the use of fresh cream would he preferable. But only with difficulty can be obtained to meet all requirements, particularly in summer time. The general objections against the use of proprietary are not so great when we take into consideration the dangers of an unsuitable cream, and furthermore the composition of the preparations is much more constant and their use simpler. A prolonged use of these preparations, however, leads to cer tain dangers. Many infants do well on the fat preparations, but a con siderable number do not tolerate an increased amount of fat, and react sooner or later with intestinal disturbances. The increased ingestion of fat may increase the acidosis, with its detrimental effect on the total metabolism. Caution should therefore be exercised in increasing the fat in the infant's food and the deficiency of the diluted milk in calories should not be corrected by the addition of fa( alone.
The second group of additional food materials is composed of carbo hydrates. Disaccharides and polysaccharides enter into consideration, while monosaccharides are hardly ever used. It was natural to use ihe milk-sugar, a disaccharide, particularly since its recommendation by Soxhlet, Heubner and Hofmann: it is employed with success in rearing numerous infants. But it soon became manifest that the more concen trated solutions of milk-sugar caused diarrlicua, and the gain in weight did not always correspond to the amounts of milk-sugar given. These two phenomena may be partially due to the fact that certain amounts of lactose are decomposed in the intestines through the action of bacteria and are thus lost to the energy metabolism. It may be best to add front about 5 to 7 per cent. milk-sugar during the first weeks of life.
The use of cane sugar is somewhat limited, as it causes fermentation and diarrhea in the higher concentrations. Its sweetness may lead to repulsion or may cause a refusal of other food. However, if the infant is older, an addition of from 2 to 5 per cent. cane sugar in combination with other nutritive substances may be regarded as suitable.
The last disaccharide to be mentioned is maltose. It is not used in a pure state, but in combination with other substances as with dex trin. Soxhlet's ''Xiihrzucker" contains both these substances, in about equal parts; improved Liebig soup containing about 60 per cent. mal tose and 20 per. cent. dextrin; Keller's malt soup contains in 1000 Gm. soup, 100 Gum. malt soup extract, and 50 Gm. wheat flour; Mellin's food contains about 50 per cent. maltose and 35 per cent. dextrin. The use of maltose seems to have been first introduced into pediatrics by Liebig, in the form of his malt soup.
The use of the polysaccharides, flour and dextrin, has fallen into discredit. The unfavorable results of feeding with gruels is responsible for this, beside the opinion that the diastatic power of the salivary glands and of the pancreas is not sufficiently developed in the young infant. Thus, many deem it a mistake to add flour before the tenth month. Re cent investigations have revealed the fact that small amounts of flour can readily he digested so early as the first weeks of life, and that it is frequently possible to obtain very good results even at this time, but particularly so later on, after cautious additions of flour or dextrin to the food. The influence on the movements of the bowels is frequently very favorable. Constipation is relieved, the fat and soap stools disap pear, and the passages become uniform and soft. Nevertheless, the young infant should be watched carefully when fed on flour, since an excess may occasionally cause sudden catastrophes. As soon as the passages give a distinct reaction for starch, or become very acid, the addition of flour has to he reduced or stopped entirely. As a rule, such preparations ma be added to the food mixture in the following amounts: during the first month about 1 per cent., during the second 2 per cent., during the third 3 per cent., and from then on -1 to 5 per cent.
The dextrinized flours are to be recommended, not so much perhaps on account of practical observations as on the basis of theoretical con siderations. They always contain more or less starch beside the dex trin. Their main representatives are the flours for infants, some of winch are prepared with an addition of sugar, and, rather irrationally, with milk (as, for instance, that of Nestle). The table on the following page informs us of their composition.
The percentage of soluble carbohydrates varies greatly. The man ufacturers like to use this fact as a basis for their statements, frequently in a very objectionable manner. Zwieback, which is cheap, is very useful for and contains much less dextrin.
Furthermore, we have at our disposal preparations of fine flour de rived from oats, rice, or corn. These are manufactured in good quality and ttt very reasonable prices. They contain about GO to per cent. insoluble and 2 to 5 per cent. soluble carbohydrates. amounts (1 to 5 pet' cent.) of insoluble starch :111(1 to a small extent of soluble starch are to be found in the cereal decoctions (from oat, rice, and barley meal), which are frequently used as diluents, particularly during the. first week. These are prepared as follows: One tablespoonful of the meal is treated with 1 pint of water and a little table salt, the mixture is boiled half or three-quarters of an hour, and is that strained: if desired, the evaporated water is replaced.