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COLDEN'S LIQUID BEEF TONIC quiets irritable,
unsteady nerves; supplies a nutritive tonic-
stimulant which enriches blood and forms tissue:
imparts a staying and resisting power to the nervous
system; dispels melancholic tendencies; puts the
patient on a normal basis for regaining strength.

Often when all other medication has failed, the
patient has begun at once and continued to gain
steadily on Colden's Liquid Beef Tonic.

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THE OLDEST POST-GRADUATE SCHOOL IN AMERICA

Organized in 1881. Opened in 1882.

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NEW YORK POLYCLINIC

MEDICAL SCHOOL AND HOSPITAL

CHARTERED BY THE UNIVERSITY OF THE STATE OF NEW YORK. For information, write to

DR. W. R. TOWNSEND, Secretary, 214 East 34th Street, New York.

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In order to understand the difference between the various forms of infant feeding, it is necessary to consider the anatomy and physiology of the young digestive tract.

The infants stomach is vertical and cylindrical and the fundus is but little developed, thus whenever there is a tendency to vomit, the antiperistaltic motions press directly upward. There is therefore, rather an overflow than a vomiting of the gastric contents, which takes place easily without disturbing the baby.

The mucous membrane of the infant secretes a gastric juice which in general, is similar to that of the adult, though being far less in amount. The mucous membrane of the mouth being practically dry at birth, the secretion of saliva is very small, but increases toward the end of the second month. The sugar-forming property of saliva is trifling at the commencement, but increases with the quantity. This is true also of other secretions; thus the pancreatic juice does not have the same emulsifying properties in the infant as in the adult.

There are two functions of the pepsin and hydrochloric acid: first the power of killing bacteria; second as a solvent for albumen. While the size of the stomach prevents the function from being thoroughly developed, it is evident that

Read before the first meeting of the Southeastern Alabama Medical League,
Troy, Ala., July 30, 1903.

fluid substances, like water, a solution of salt, and a solution of sugar, are absorbed and in a less degree albumen also.

The relative length of the intestine in the infant is greater than in adults; said to be about six times as long as the body. Foster believes this is one reason why nurselings get more nourishment from milk than do adults.

Amylopsin, the ferment of the pancreatic juice, seems to have a similar action to ptyaline, though it acts much more energetically on starch; at the temperature of the body the change takes place very rapidly. The action of the fluid of the small intestine is weaker than ptyaline or amylopsin, and seems only to continue their action.

When we consider the lesser development of the muscles of the intestine, we can readily understand that peristaltic movements are more irregular and less forcible, and that the muscles possess less tone; on this account there is a larger amount of gas contained in the intestine, which constantly distends it. Thus it is apparent why the abdomen appears larger in the infant in proportion to the other parts of the body.

The liver in nurselings is relatively larger than in adults, and the quantity of bile in the gall-bladder is very small. The presence of a small quantity of bile acids is thought to be beneficial as they inhibit the digestive action of pepsin and of the pancreatic juice. The absence of bile acids also prevents the assimilation of larger quantities of fat, as it is impossible to split up fat into fatty acid and glycerine.

It is an established fact that the best possible food for an infant is breast milk. Where the mother of an infant is prevented from nursing her child, the next thing to consider is wet-nursing. It is a well known fact that nursing the infant is an advantage to the mother as it influences contractions and stimulates circulation.

During the first month feed every two hours, but never oftener. During the second month, every two and a half to three hours. Never disturb a child from its sleep to be nursed; leave the baby at rest as long as it seems satisfied. This applies only to healthy children. (In sickness special rules are required for individual cases.) If the child thrives, gains weight, then it is advisable to have an interval of from

seven to eight hours at night. When an infant is six months old, certain additions to food can safely be made, such as the white of a raw egg can be given every second day, and on the alternate days several teaspoonfuls of beef soup, in which barley has been boiled and strained. If the bowels are in good condition, then a few spoonfuls of very light wheat flour ball can be given every few days. It is made as follows: Plain wheat flour is boiled in a bag for five hours, then dried, broken open, the rinds rejected and then grated into a powder. of pure milk, mixed and scalded, one pint; of sterile water, one pint; of boiled flour, a heaping teaspoonful; of cane sugar, one spoonful, and a pinch of common salt. The milk is heated, the flour is rubbed to a fine paste with the water and then added to the milk; it is then brought to the boiling point, taken from the fire, salt added and the whole is then placed on ice. It is heated again when used.

Take

Two ounces can be given every two hours to a child two months old, increasing ounce each month, while the water is decreased one ounce each month, milk being added to keep the quantity up to two pints. Cows' milk is the only milk worth con. sidering in connection with artificial feeding of infants, yet it shows great variation in composition. The problem before the physician in bottle feeding is to prepare a food that approximates mothers' milk in composition and physical properties. To get good results good cow's milk must be used, and this can be obtained only when strict cleanliness is observed throughout the whole process, from the care of the cow until the milk is given to the infant.

To sterilize milk in a filthy bottle, or to put milk contami. nated with filth or containing pathogenic bacteria, into an absolutely clean bottle is surely repulsive.

Cleanliness should be the watchword. A food that I have had success with in infants under six months of age, is prepared as follows: Take of pure cows' milk three tea-cupfuls, sterilized water two tea-cupfuls, cane sugar one spoonful, of lime water one spoonful. Put this into a nursing bottle holding about five ounces, place this bottle in a tin bucket of water and put the bucket into a pot of boiling water for from 20 to 30 minutes; stop the bottles with clean cotton, and place them on

ice or in cool water. Give the contents of one bottle every four hours, bringing the milk to about body heat when ready for use. It is said that the use of lime water as an addition to milk is a frequent cause of constipation, and consequent fissures of the anus in children. Yet I believe that the small quantity used above would be harmless in this respect.

If constipation does exist, a small dose of glycerine may be added to each bottle ( to 1 teaspoonful.) Glycerine has a pronounced antifermentative effect and also nutritive properties. Pasteurizing and asterilizing are, I believe, necessary evils. They are more useful in keeping milk from spoiling than for any other purpose. Bacterial growth is what is to be feared in milk, and this can be prevented by keeping it at low temperature. While the bacteria are killed by heat, the toxins they produce are not destroyed.

Heating produces many changes in milk, some of which are not well understood. Boiled milk does not curdle with rennet as easily as raw milk, the cream is about one-third denser, and the albumen is almost if not wholly insoluble, thus making it less nutritious.

Yet if the infant's food cannot

be kept below 50°F., it should be sterilized at once.

INFANT FOODS PLACED UPON THE MARKET AND EXPLOITED AS SUITABLE FOR INFANTS.

These foods may be classified under two heads: first, infant foods in which cows' milk dessicated is a constituent; second, infant food to be used with and as adjuncts to fresh cows' milk. The foods of which dried milk is a constituent are made from cereals and cows' milk, and are commonly known as dried milk foods. If the starch is untransformed they are termed farinaceous dried milk foods.

The second class or foods used as adjuncts to cow's milk, are either farinaceous foods made from cereals and consisting largely of unconverted starch, or malted foods also made from cereals, but having the starch transformed into soluble maltose and dextrine.

As fresh cow's milk is the best material for the artificial feeding of infants, it seems that the foods of the latter class used

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