The Mother and Her Child
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William S. Sadler >> The Mother and Her Child
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PASTEURIZATION
When baby is to use the milk within twenty-four hours,
"pasteurization" is better than boiling as a method of destroying
microbes.
There are many pasteurizers on the market which may be depended upon,
among which are the Walker-Gordon Pasteurizer, and Freeman's
Pasteurizer; but in the absence of either of these pasteurization may
be successfully accomplished by the following method:
On the bottom of a large kettle filled with cold water, place an
ordinary flatiron stand upon which is put a folded towel. On this
place the bottle of milk as it comes from the dairyman, with the cap
of the bottle loosened. The cold water in the kettle should come up to
within an inch of the top of the bottle of milk. Heat this water
quickly up to just the boiling point--until you see the bubbles
beginning to rise to the top. The gas is then turned down or the
kettle is placed on the back of the range and held at this
near-boiling point for thirty minutes, after which it is taken to the
sink and cold water is turned into the water in the kettle, until the
bottle of milk is thoroughly cooled. It is now ready to be made up
into the modified food for baby.
Never let pasteurized milk stand in the room, nor put it near the ice
when warm. It must be cooled rapidly, as described above; that is,
within fifteen or twenty minutes.
The "spores" of the milk are not killed by pasteurization and they
hatch out rapidly unless the milk is kept very cold, and, as already
stated, it should be used within twenty-four hours after
pasteurization.
THE CARE OF BOTTLED MILK
The certified milk or the ordinary milk that has been delivered to
your home and is to be used without pasteurization or sterilization,
should receive the following care:
1. It should be placed at once in a portion of the ice box that is not
used to store such foods as radishes, cabbage, meats or any other open
dishes of food whose odors would quickly be absorbed by the milk. The
milk should never be left standing on the doorsteps in the sun, for
many reasons: the sun heats the milk, encourages the growth of
bacteria, and a passing cat or dog, whose mouth often contains the
germs of scarlet fever, tonsilitis, and diphtheria, should it be
hungry, laps the tops of the bottles, particularly in the winter when
the cream has frozen and is bulging over the edge.
2. It should never be kept in the warm kitchen, as when visiting her
sick baby we discovered one young mother doing. In answer to my
question, she explained; "Doctor, we do not take ice in the winter
time, everything is ice outdoors, so I just set the bottle outside the
window bringing it in whenever I need to give the baby some food. I
forget to put it out sometimes, but really now, does it matter?" It
really matters much, for you see, reader, the milk is first freezing
then thawing and it is rendered entirely unfit for the baby.
3. Milk should be kept covered and protected from dust and flies; it
should be kept in glass jars which have been sterilized by boiling
before being filled, and then placed in the refrigerator. If the milk
is sour, or if there is any sediment in the bottle, it is unfit for
baby's use.
CHAPTER XVIII
HOME MODIFICATION OF MILK
In a previous chapter it was found from comparing the analysis of
mother's milk with that of cow's milk, that they widely differed in
the proteins and sugar. The art of so changing cow's milk that it
conforms as nearly as is possible to mother's milk is known as
"modification." Where protein, sugar, and fat are given in proper
amounts, healthy infants get along well; but when either the fats or
proteins are given in excess, or when the digestion of the child is
deranged, there is often no end of mischief.
There are two groups of milk formulas that are useful. First, those in
which the fats and proteins are about the same, known as "whole milk,"
or "straight" milk mixtures; second, those in which the fats are used
in larger proportions than proteins, and known as "top milk"--milk
taken from the upper part of the bottle after the cream has risen. And
since the larger proportion of babies take the lower fats or "whole
milk" formulas, and seem to get along better than the babies who have
the "top milk" formulas, we will first take up the consideration of
the modification of whole milk.
PREPARATION FOR MODIFICATION
To begin with, everything that comes in contact with the preparation
of baby's food must be absolutely clean. The table on which the
articles are placed, and any towel that comes in contact with the
articles or the mother's hands, or those of the nurse, must be
thoroughly scrubbed.
There is only one way to prepare the utensils that are to be used in
making the baby's food, and that is to put them in a large kettle and
allow them to boil hard for fifteen minutes just before they are to
be used. The articles needed are (Fig. 12):
1. As many bottles as there are feedings in one day.
2. A nipple for each bottle.
3. Waxed paper for each bottle top.
4. Rubber bands for each bottle.
5. A two-quart pitcher.
6. A long-handled spoon for stirring the food.
7. A tablespoon.
8. A fork.
9. An eight-ounce, graduated measuring glass.
10. A bottle of lime water.
11. A fine-mesh, aluminum strainer.
12. A square of sterile gauze for straining the food (should be boiled
for fifteen minutes with the utensils).
13. One plate, and later a double boiler (14).
15. The sugar.
16. The milk.
17. Ready for the ice box.
18. Refrigeration.
BOTTLES AND NIPPLES
There is but one bottle which can be thoroughly washed and cleaned,
and that is the wide-mouthed bottle. It should hold eight ounces and
should have the scale in ounces blown in the side (Fig. 10). The
nipple for this bottle is a large, round breast from which projects a
short, conical nipple, which more nearly resembles the normal breast
than do the old-fashioned nipples so frequently seen on the
small-necked nursing bottles. There is a great advantage in this, in
that the baby cannot grasp the nipple full length and thus cause
gagging. These bottles and nipples are known as the "Hygeia," and have
proven to be a great source of comfort to the baby as well as to the
mother or nurse whose duty it is to keep them clean. There are a
number of other nursing bottles on the market, which, if they are
used, must be thoroughly cleansed with a special bottle brush each
day. The neck is small and the nipple is small and great care must be
taken in the cleansing of both of them.
CARE OF BOTTLES AND NIPPLES
When there is a bottle for each individual feeding in the day,
immediately after each nursing both bottle and nipple should be
rinsed in cold water and left standing, filled with water, until the
bottles for one day's feeding have all been used. The nipples should
be scrubbed, rinsed, and wiped dry and kept by themselves until their
boiling preparation for the following day's feeding.
[Illustration: Fig. 12. Articles Needed for Baby's Feeding]
If the same bottle is to be used for the successive feedings during
the day, it should be rinsed, washed with soap and water, and both
bottle and nipple placed in cold water and brought quickly to the
boiling point and allowed to boil for fifteen minutes. No bottles or
nipples must ever be used after a mere rinsing; boiling, preceded by a
thorough washing in soap and water, must take place before they are
used a second time.
New nipples are often hard and need to be softened, which is readily
done by either prolonged boiling or rubbing them in the hands.
All new bottles should be annealed by placing them on the stove in a
dishpan of cold water and allowing them to boil for twenty minutes,
and then allowing them to remain in the water until they are cold.
When bottles are treated in this manner they do not break so readily
when being filled with boiling water or hot food.
PREPARING THE FOOD
In a large preserving kettle place all the utensils needed in the
preparation of the food--pitcher, spoon, fork, measuring glass,
bottles, nipples, cheesecloth for straining, agate cup, wire strainer,
in fact everything that is to be used in the preparation of the food.
Now fill the kettle with cold water and place over the gas and allow
to boil for fifteen minutes. On a well-scrubbed worktable place a
clean dish towel, and on this put the utensils and the bottles right
side up. The nipples on being taken out of the boiling water will dry
of themselves; they should be placed in a glass-covered jar until they
are needed for each individual feeding, the nipples not being placed
on the bottles as they go to the ice box.
Having been given your formula by your physician, proceed in the
following way. Suppose we were preparing the food for a normal
two-months old baby that weighed ten pounds, with the prescription as
follows:
BABY SMITH.
R_{x}
Whole Milk ounces 11
Cane Sugar level tablespoons 2
Boiled Water ounces 121/2
Lime Water ounces 1
Amount at Each Feeding ounces 31/2
Number of Bottles 7
Interval Between Feedings hours 3
DETAILS OF PREPARATION
Two level tablespoons of cane sugar are placed in the agate cup and
dissolved in a small amount of boiling water. The solution should be
perfectly clear, and if it does not clear up put it over the heat for
a few moments.
This is now turned into the eight-ounce measuring glass which is then
filled with boiling water and emptied into the two-quart pitcher. We
need four and one-half more ounces of boiling water to complete the
prescription requirement of twelve and one-half ounces.
The bottle of milk, if properly certified, need not be pasteurized;
but if it is not, it should have been previously pasteurized while the
utensils were boiling according to the suggestions found in the
chapter on "milk sanitation." The top of the milk bottle should be
thoroughly rinsed and wiped dry, and after a thorough shaking of the
milk, the cover is removed with the sterile fork and eleven ounces are
measured out by measuring glass and poured into the pitcher. All is
now stirred together with an ounce of lime water, which should never
look murky, but should be as clear as the clearest water and should
always be kept in the ice box when not in use.
The sterile cheesecloth which has been boiled for fifteen minutes is
now put over the nose of the pitcher, the contents of which is
accurately measured into the seven clean, empty bottles, each
containing three and one-half ounces. Over the top of each of the
nursing bottles is placed a generous piece of waxed paper which is
held down by a rubber band. Each meal for the day is now contained in
a separate bottle, and all are placed in a covered pail of water
containing ice, and put in the ice box.
If the prescription for the baby's food contains gruel, it is prepared
in the following manner:
Suppose the baby is eight months old and the prescription called for
two level tablespoons of flour and eight ounces of boiled water. The
two level tablespoons of flour, whether it be wheat (ordinary bread
flour), or barley flour, are put into a cup and stirred up with cold
water, just as you would stir up a thickening for gravy; now measure
out eight ounces of water and allow it to come to a boil in the inner
pan of the double boiler, into which the thin paste is stirred until
it comes to a boil. After boiling for twenty minutes, remeasure in the
measuring glass and what water has been lost by evaporation must be
added to complete accurately the prescription requirement of eight
ounces; this is now added to the other ingredients of the
prescription.
TABLE FOR INFANT FEEDING
We now offer a monthly schedule--a table which is the result of our
experience in feeding hundreds of babies in various sections of
Chicago. It is not a schedule for the sick baby, but it is a carefully
tabulated outline for the normal, healthy, average child ranging from
one week to one year in age. In offering this table we remind the
mother, if the baby is six months old and not doing well on the food
it is getting and a change is desired by both mother and physician,
that it is far better to begin with the second or third month's
prescription and quickly work up to the sixth month's. This change may
often be accomplished in two or three days.
In all large cities there are to be found milk laboratories which make
it their business to fill prescriptions for the modification of milk
under the direction of baby specialists. This milk can be absolutely
relied upon. In specialized diet kitchens in many large hospitals,
these feeding prescriptions also may be filled.
ARTIFICIAL FEEDING SCHEDULE
==========+========+=======+=======+=======+========+=======+========+
Age | | | | | | | Amount |
| Baby's | Whole | Cane | Wheat | Boiled | Lime | at |
| Weight | Milk | Sugar | Flour | Water | Water | Feeding|
----------|--------|-------|-------|-------|--------|-------|--------|
| | | Level | Level | | | |
| Pounds |Ounces | Table-| Table-| Ounces | Ounces| Ounces |
| | | spoon | spoon | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
1 week | 71/2 | 21/2 | 1 | | 5 | 1/2 | 1 |
----------|--------|-------|-------|-------|--------|-------|--------|
2 weeks | 71/2 | 41/2 | 11/2 | | 9 | 1/2 | 2 |
----------|--------|-------|-------|-------|--------|-------|--------|
3 weeks | 73/4 | 7 | 2 | | 10 | 1/2 | 21/2 |
----------|--------|-------|-------|-------|--------|-------|--------|
4 weeks | 8 | 9 | 2 | | 11 | 1 | 3 |
----------|--------|-------|-------|-------|--------|-------|--------|
2 months | 10 | 11 | 2 | | 121/2 | 1 | 31/2 |
----------|--------|-------|-------|-------|--------|-------|--------|
3 months | 12 | 15 | 2 | 1/2 | 15 | 1 | 41/2 |
----------|--------|-------|-------|-------|--------|-------|--------|
4 months | 13 | 18 | 21/2 | 1 | 131/2 | 11/2 | 51/2 |
----------|--------|-------|-------|-------|--------|-------|--------|
5 months | 14 | 21 | 21/2 | 11/2 | 131/2 | 11/2 | 6 |
----------|--------|-------|-------|-------|--------|-------|--------|
6 months | 15 | 23 | 21/2 | 11/2 | 101/2 | 11/2 | 7 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
7 months | 16 | 25 | 2 | 11/2 | 81/2 | 11/2 | 7 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
8 months | 17 | 27 | 11/2 | 2 | 8 | 11/2 | 71/4 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
9 months | 18 | 29 | 1 | 2 | 8 | 2 | 73/4 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
10 months | 19 | 30 | 3/4 | 2 | 8 | 2 | 8 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
11 months | 20 | 31 | 1/2 | 2 | 8 | 2 | 9 |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
12 months | 21 | 32 | | | 7 | 2 | 9 |
| | | | | | | |
| | | | | | | |
----------|--------|-------|-------|-------|--------|-------|--------|
18 months | 24 | 36 | | | | | 12 |
| | | | | | | |
----------+--------+-------+-------+-------+--------+-------+--------+
==========+=========+==========+=========+==========+========
Age | Number | Interval | | Soups | Total
| of | Between | Fruit | and | Daily
|Feedings | Feedings | Juices | Broths |Calories
----------|---------|----------|---------|----------|--------
| | | | |
| in 24 | Hours | | |
| Hours | | | |
----------|---------|----------|---------|----------|--------
1 week | 8 | 3 | | | 112
----------|---------|----------|---------|----------|--------
2 weeks | 7 | 3 | | | 184
----------|---------|----------|---------|----------|--------
3 weeks | 7 | 3 | | | 267
----------|---------|----------|---------|----------|--------
4 weeks | 7 | 3 | | | 309
----------|---------|----------|---------|----------|--------
2 months | 7 | 3 | | | 351
----------|---------|----------|---------|----------|--------
3 months | 7 | 3 | | | 447
----------|---------|----------|---------|----------|--------
4 months | 6 | 3 | | | 553
----------|---------|----------|---------|----------|--------
5 months | 6 | 31/2 | | | 628
----------|---------|----------|---------|----------|--------
6 months | 5 | 4 | one | one | 680
| | |teaspoon |tablespoon|
----------|---------|----------|---------|----------|--------
7 months | 5 | 4 | two | 1/4 | 732
| | |teaspoons| cup |
----------|---------|----------|---------|----------|--------
8 months | 5 | 4 |one-half | 1/4 | 767
| | | orange | cup |
----------|---------|----------|---------|----------|--------
9 months | 5 | 4 | one | 1/2 | 854
| | | orange | cup |
----------|---------|----------|---------|----------|--------
10 months | 5 | 41/2 | one | 3/4 | 875
| | | orange | cup |
----------|---------|----------|---------|----------|--------
11 months | 5 | 5 | one | 1 | 906
| | | orange | cup |
----------|---------|----------|---------|----------|--------
12 months | 5 | 5 | one | 1 cup |
| | | orange | arrowroot| 950
| | | | cracker |
----------|---------|----------|---------|----------|--------
18 months | 3 | 6 | toast, gravies, baked
| | | potato and apple, etc.
----------+---------+----------+---------+----------+--------
Note 1 ounce of whole milk equals 21 calories
1 level tablespoon of cane sugar equals 60 calories
1 level tablespoon of milk sugar equals 45 calories
1 level tablespoon of flour equals 25 calories
The juice of 1 average orange equals 75 calories
1 cup of average bouillon equals about 100 calories
(This table is calculated on the basis of about 45 calories for each
pound of baby weight)
TOP-MILK FORMULA
Top milk is the upper layer of milk which has been removed after
standing a certain number of hours in a milk bottle or any other tall
vessel with straight sides. It contains most of the cream and varying
amounts of milk. It may be removed by a small cream dipper which holds
one ounce, or it may be taken off with a siphon, but it should never
be poured off. To obtain seven per cent top milk which is the one most
ordinarily used in the preparation of top milk formulas, we take off
varying amounts--according to the quality of the milk--which Doctor
Holt describes as follows:
From a rather poor milk, by removing the upper eleven ounces from
a quart, or about one-third the bottle.
From a good average milk, by removing the upper sixteen ounces,
or one-half the bottle.
From a rich Jersey milk, by removing the upper twenty-two ounces,
or about two-thirds the bottle.
Cream is often spoken of as if it were the fat in milk. It is really
the part of the milk which contains most of the fat and is obtained by
skimming, after the milk has stood usually for twenty-four hours; this
is known as "gravity cream." It is also obtained by an apparatus
called a separator; this is known as "centrifugal cream," most of the
cream now sold in cities being of this kind. The richness of any cream
is indicated by the amount of fat it contains.
The usual gravity cream sold has from sixteen to twenty per cent fat.
The cream removed from the upper part (one-fifth) of a bottle of milk
has about sixteen per cent fat. The usual centrifugal cream has
eighteen to twenty per cent fat. The heavy centrifugal cream has
thirty-five to forty per cent fat.
The digestibility of cream depends much upon circumstances. Many
serious disturbances of digestion are caused by cream.
It is convenient in calculation to make up twenty ounces of food at a
time. The first step is to obtain the seven per cent milk, then to
take the number of ounces that are called for in the formula desired.
One should not make the mistake of taking from the top of the bottle
only the number of ounces needed in the formula, as this may be quite
a different per cent of cream and give quite a different result.
There will be required in addition, one ounce of milk sugar and one
ounce of lime water in each twenty ounces. The rest of the food will
be made up of boiled water.
These formulas written out would be as follows:
FORMULA FROM SEVEN PER CENT MILK
I II III IV V VI VII VIII IX
Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz.
7 per cent milk 2 3 4 5 6 7 8 9 10
Milk sugar 1 1 1 1 1 3/4 3/4 3/4 3/4
Lime water 1 1 1 1 1 1 1 1 1
Boiled water 17 16 15 14 13 12 11 10 9
--- --- --- --- --- --- --- --- ---
20 20 20 20 20 20 20 20 20
The approximate composition of these formulas expressed in percentages
are as follows:
Formula Fat Sugar Proteins
I 0.70 5.00 0.35
II 1.00 6.00 0.50
III 1.40 6.00 0.70
IV 1.75 6.00 0.87
V 2.00 6.00 1.00
VI 2.40 6.00 1.20
VII 2.80 6.00 1.40
VIII 3.10 6.00 1.55
IX 3.50 6.00 1.75
It is necessary to make the food weak at first because the
infant's stomach is intended to digest breast milk, not cow's
milk; but if we begin with a very weak cow's milk the stomach can
be gradually trained to digest it. If we began with a strong milk
the digestion might be seriously upset.
Usually we begin with number one on the second day; number two on the
fourth day; number three at seven to ten days; but after that make the
increase more slowly. A large infant with a strong digestion will bear
a rather rapid increase and may be able to take number five by the
time it is three or four weeks old. A child with a feeble digestion
must go much slower and may not reach number five before it is three
or four months old.
It is important with all children that the increase in the food
be made very gradually. It may be best with many infants to
increase the milk by only half an ounce in twenty ounces of food,
instead of one ounce at a time, as indicated in the tables. Thus,
from three ounces the increase would be to three and one-half
ounces; from four ounces to four and one-half ounces, etc. At
least two or three days should be allowed between each increase
in the strength of the food.
PEPTONIZED MILK
Another modification which at times may be ordered by your physician
is peptonized milk. Since it is infrequent for the proteins of milk to
be the cause of indigestion, peptonized milk has only a limited use,
chiefly in cases of acute illness. The milk is peptonized in the
following manner:
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