TECHNIQUE OF ARTIFICIAL FEEDING After considering the different methods of artificial infant feeding, its technique and practical application will he discussed. The age, weight, and state of health of the infant serve as guides in the formation of the plans for feeding. These factors determine the quality and number of meals. Weight and age furnish us information as to the amount of energy to be supplied. During the first four months, as previously explained, about 110 calories have to be introduced per kilo, during the second 100, and during the third 90. In order to simplify the calcula tions, the calorimetric values of the most important infants' foods are given, according to Salge, in the table on the following page.
These figures cannot be regarded as absolutely correct; as, for in stance, the calorimetric value of cow's milk varies between 500 and 700 calories, according to its lower or higher content of fat, etc. If under normal conditions the energy quotient deviates for a long time from the figures stated above, disturbances are to be expected. Furthermore, the weight and age of the infant determine the and relative proteid content of the food or the milk concentration, and also the amount at each feeding and for the day. Finally, the economic condi bons of the family are of importance, since the more expensive prepa rations and selected mill: properly delivered cannot be used; moreover, the degree of intelligence is to he considered, as well as the interest of the persons who are intrusted with the carrying- out of the feeding.
Sometimes we may adhere with advantage to a certain fixed scheme of feeding, but a. procedure does not enable the individual case to be carefully considered. Iliedert elaborated such a scheme and used the percentage method, and Escherich advanced another based on the volumetric method. Such schemes may he very different, depending on the social condition, intelligence, customs and habits of the region, and the material at one's disposal (for instance, the milk of mountainous regions being rich in fat, and that of the plains poor in fat). The follow ing scheme proved successful as a rule in the middle classes of Southern Germany: The transition is to he accomplished very gradually, so that one bottle of the more diluted food is replaced by one of the more concen trated. If the infants are very robust, we proceed more rapidly than is indicated in the table.
Since the food for the infant is frequently prepared in a faulty man ner in spite of all directions, and since people not accustomed to it find great difficulties in measuring out required quantities of milk, the author constructed a model for mixing, which obviates these difficulties. It is
a stand made of sheet iron, and several cards are provided which can be displayed on the vertical part of the stand. Bach card shows the picture of a bottle with marks fixed at different heights (according to the different ages of the infants) which indicate the amount of milk, etc., to be put in the actual bottle standing opposite the picture.
The following may be added to what has been said with regard to the handling of the milk at home: The milk should he mixed and strained immediately after its delivery and then diluted as desired, and the required addi tions he made. Then either the total amount is boiled (in so-called milk boilers (Fig. 5S) over the free flame or in the water-bath), or, better, the milk is first distributed into the bottles, each con taining the amount for one meal (according to Soxhlet). The cooling must take place as rapidly as possible after the boiling, in summer time if possi ble in the refrigerator (it must be remembered that the temperature remains relatively high in many refrigerators), or in running water.
The bottles are closed with the contrivances introduced by Soxhlet, ()llendorf, and Stut zer. These are expensive and do not last, long. The stoppers of Raupert (Fig. 59) are cheap and easily cleaned, and are therefore to be recommended. The bottles should he smooth on the inside and the corners of the bottom should he rounded. If possible the bottles should be made of hard glass. [In the United States, cylindrical bottles with rounded interior are readily obtained; non-absorbent cotton makes the best stoper.] Simple nipples are used or those which resemble the natural nipple. [" llygeia " nipples.] Both kinds are cheap and easily cleaned. By changing the size of the hole in the nipple, the outflow and consequently the work of surlding may be regulated to a certain extent. Nipples provided with a long tube should be absolutely forbidden, as they can not lie thoroughly cleaned.
Alateritils composed of rubber or hard rubber must be cleaned imme diately after use. `1'hey :ire rinsed out with warm water, and the inside and outside are rubbed with salt and again rinsed with water, and occa sionally they tire boiled: they are kept in clean well covered vessels. The bottles should be cleaned with water immediately after use. Hach bottle must be cleaned daily with a hot solution of sodium carbonate and a brush, and then be rinsed with water. They should be kept dry, standing bottom up. If held against the light, the bottles should not show' ally CI 01A(111leSi.