INFANT FEEDING IN HEALTH AND DISEASE.

BY FRANK A. HODGDON, M.D., MALDEN.

(Continued from page 337.)

Another method of home modification of milk, by Dr. J. L. Morse, is in the Journal of Gynecology and Pediatrics. It may be more accurate and is more intricate.

If we wish to increase the proteids and not the fat, use the upper half of the milk instead of the upper one fourth. If the percentage of fat, sugar, and proteids must be kept low in some intestinal disorders, the nutritive value of the mixture can be increased by the white of one or two fresh eggs.

The amount of proteid in proportion to the fat can also be used by mixing the lower one fourth of the milk, but we are unable to obtain a low proteid with a high amount of fat except by using the 16 per cent cream and then there is 4 per cent fat and at least 1.60 of proteid, that is, a one to three dilution. As a matter of fact, an excess of 4 per cent fat is scarcely ever desirable.

Weekly weighing of the baby is important. In a general way, if the increase in weight is too little or absent, increase a little all the proportions of the food if the baby is otherwise healthy; if colicky, increase the proteids. If sour masses of food are spit up, diminish the fat, and less often the proteids; if constipation is obstinate, increase the fat and if not better increase the proteids; if diarrhoea and the stools contain undigested curds, reduce to a low percentage all the constituents, especially the proteids, and add fresh egg albumen. Avoid overfeeding, as shown by frequent vomiting soon after feeding.

Obtain milk as fresh as possible from the cow. Modify it, ice it thoroughly from the beginning, but do not heat it, that is, sterilize or pasteurize it, except in very hot weather or unless the milk cannot be obtained in a fresh condition.

DISCUSSION.

DR. PERKINS. In regard to the paper read I will simply say that I have enjoyed listening to it very much.

Every physician who has been in practice for any length of time has found this question of infant feeding one of the most obstinate and difficult questions with which he has to deal. If there is anything obstinate in this world it is babies whose parents are trying to feed them artificially. We all know that babies who have been unable to nurse have broken every good rule. I remember two babies in my own early experience. I tried everything I could get to feed those babies, but they did not seem to thrive on anything but plain bread and milk. These babies did well on starch food, not doing well at all on milk food.

DR. SPAULDING. On the sterilized milk question I have been on the unpopular side. I have even been called an old pettifogger because I did not "catch on" to the new and different things that have been going on in the world. However, the flail of practical experience is swinging and swinging, and finally will thresh out some good grains of wheat. I did try sterilized milk when it first came out, but it did not take me long to find out that it was not the kind of food I wanted my babies to be fed on. I was unwise enough to speak out in a meeting about it once and some of my people thought I was a little wild, but I feel that it is not the food for many babies.

I have been very much pleased to hear these papers tonight. I have been much interested in reading the circulars regarding the modified milk of Boston, and interested to see how they sterilize the milk. At first it was 220 degrees that the milk was to be boiled before giving to babies. Then it was thought best to boil it to 264 degrees. The one fourth lime water has been dropped out. Many of our best physicians have come to the conclusion that what we want is pure milk, and that it is not necessary to ever go beyond 165 degrees to sterilize it properly, and many of them feel that it is only through the hottest weeks of summer that we should sterilize it to 165 degrees. The rest of the year pure cow's milk carefully modified is the best food for children. It seems that sterilized milk is getting to be a thing of the past. It has been demonstrated by practical experience, not only in

hospitals, but by chemists who have examined the feces of children who have been fed on sterilized milk, that it is not a proper food for children. The sugar is destroyed; that of course can be replaced. The fat globules are in emulsion, but long boiling produces changes in the milk which makes it less readily acted upon by the digestive organs, and certain elements are found in the digestive tract of the child, having done the child no good.

Now, there are other objections to the sterilizing of milk. Milk that has been boiled is devitalized. Hence it is that we get some of our cases of rheumatism purpura. There are other names, but it is nothing more or less than scurvy. As to the germicidal properties, fresh drawn milk has been proved to destroy germs in one hour. Fresh drawn milk will destroy the germs of typhoid in 24 hours. Of course, if the milk has been standing for any length of time, the typhoid fever germs will live. So if we get fresh milk for the children, we need not sterilize it. Our mothers and grandmothers simply sterilized their milk by boiling. The new methods do it a great deal better. But our mothers and grandmothers knew that after the sickness was over, it was better to go back to the fresh milk.

Now, I have never seen a healthy child brought up on condensed milk, but I have used it as a temporary expedient and found it act well.

This last summer I was called to see a child that showed all the pitiable symptoms of malnutrition, with which you are all familiar. The child was pale and sickly looking and emaciated, and under the eyelids were little purple spots. The child was naturally a healthy, vivacious child, but now, when a smile could be forced from her, it was a poor, wretched, ghastly smile. It was a pitiful object. She was taking what was supposed to be sterilized milk. Some of the bottles would not have any cream whatever. Still, it was put up by rule, by prescription. The child was starving on that modified milk of Boston. Change in the diet, giving child beef juice, a little orange juice, and a modified milk of cream and water, with a good deal of careful watching, brought the

child out all right, and now it is healthy once more. These parents will never use sterilized milk again. That case is quite a fair sample of experience I have had with sterilized milk.

As to cholera infantum, I don't know as I would question the advisability of washing out the stomach or the rectum with a little sterile water; but what was it — a gallon of soapsuds? I don't believe that is called for, and I believe we have some real good homoeopathic remedies that will strike right home and cure a large majority of these cases. Of course the diet must be regulated very carefully, but I don't believe that we want to douche these cases with a large amount of water. I once had a case of dysentery that troubled me a great deal. I thought I would try the old-school physician's method, douches, etc., and my patient did just what he should have done, he discharged me. wanted and expected to get homoeopathic treatment.

He

DR. POWERS. Mr. Chairman, I wish the Doctor had said something that I could not agree with. Most of what has been said this evening corresponds to my own belief, but I do believe there is one point which has not been emphasized sufficiently in the papers, and that is of individualizing your case before giving any formula. You cannot give the same formula to all babies and have them do well on it. Still, I imagine several babies have had sterilized milk and have not had any trouble. They did not come to Dr. Spaulding because they did not need his care. We are so apt to judge simply from the babies we see.

In regard to the fresh milk, I believe that is the best if we can give it, but here in the city many of the people, the poorer classes, at least, cannot get it. I believe that the pasteurized method is of great benefit. I think the experience of the internes at the dispensary for the past half dozen years will prove that pasteurized milk has, in a great many instances, been of great use in the feeding of the poor children of the district. Now here are two or three children that were brought up entirely on Mellin's Food. One did beautifully, the other was as different as white from

black. So, I believe, we cannot give any one food to all children, but must carefully individualize each case. Before the idea of pasteurizing milk was brought to the attention of scientific men, the farmers' wives and housewives in the city had the idea. They not only were very careful about getting it fresh, but they very frequently did pasteurize it and let it stand until there was a little scum rested on the top. They did not allow it to come to a boil, but they let it get hot enough to make it sterile. Those tables will do very well at certain temperatures, but if you have had any experience in raising temperature you are aware that it is not always easy to do it. So there is another factor that comes in.

As I said before, we must individualize. Children not doing well on one food must have something else. My own boy, from the time he was nine months until something over two years old, was practically fed on pasteurized milk with gradual increase of cereals.

[The following from Dr. Guernsey shows the foolishness of publishing in college announcements statements which are in the least liable to be misconstrued. — - ED.]

A STATEMENT FROM THE HOMCEOPATHIC MEMBERS OF THE BOARD OF MEDICAL EXAMINERS OF PENNSYLVANIA, TO THE HOMCEOPATHIC MEDICAL PROFESSION.

The announcement of the Southwestern Homœopathic Medical College, Louisville, Ky., for 1900-1901 contains on page 10 the following sentence: "As an evidence of the thorough work done in our college, referring to State Board examinations, we are proud of the fact that one of our graduates, in a State Board examination in Pennsylvania last year, passed with the highest average, in a class of one hundred and sixteen applicants, nearly one half of whom were rejected."

The above statement is so utterly at variance with the truth that the Board of Medical Examiners representing the Homœopathic Medical Society of Pennsylvania, who con