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An excellent substitute for breast milk
96
THE AMERICAN
JOURNAL
OF OBSTETRICS AND oYNECOI,(!(:Y
Hospital duration of others 24 days Duration of symptoms before treatment 10 days to 6 weeks Blood sugar lowered in 3 eases: 78 (2), 86.2 (12), 82.4 (14) mg. per 100 C.C. blood. I am indebted to Dr. S. A. Cosgrove for his interest and guidance in caring fol the majority of these patients on the Obstetrical Service at the Jersey City Hospital. REE’ERENCES Thalhimer, William: Surg., Gynec. and Obst., August, 1924, xxxix, 237. Thalhimer, William : AM. JOUR. 0~6~. AND GYNEC., May, 1925, ix, 673. Titus, I?., Hoffman, G. D., and Givens, M. H.: Jour. Am. Med. Assn., March 20, 1920, Ixxiv, 777. Titus, Paul, and Givens, M. H.: Ibid., Jan. 14, 1922, lxxviii, 92. Titus, Paul: Ibid., Aug. 15, 1925, lxxxv, 488. Wilder? R. M., and Sansum, W. D.: Arch. Int. Med., 1917, xix, 311. Editorial, Jour. Am. Med. Assn., February, 1926, Ixxxvi, 557. Starr, F., and Fletcher, A. cf.: Burg., Gynee. and Obst., February, 1926, slii, 194. 644 WEST SIDE AVENUE.
AN EXCELLENT
SUBSTITUTE
BY D. A. CALHOUN,
FOR BREAST
MILK
M.D., TROY, N. Y.
PON the obstetrician of today rests the responsibility of providing the means whereby the baby obtains the proper start in life and continues to remain in health while under his care. In undertaking this responsibility he is beset with many difficulties, and paramount among these is the all-important+ question of weight. The infant who is sufficiently nourished will be contented, healthy, and gain weight; but given an infant which is not gaining, consequently not contented, a multitude of difficulties make their appearance. The question of infant mortality is directly.‘$oncerned with gain in weight. Infants gaining properly are healthy. Maternal nursing, of course, is the aim of our endeavor, but when there is an absence, or an insufficient amount of breast milk, the infant can be made to gain by artificial means. Artificial feeding, therefore, becomes necessary under the following conditions :
U
Babies both full term and premature when the breast milk is absent. Complementary feedings when the mother’s milk is inadequate, either in quantity or quality. Artificial feeding when the baby is weaned. The first needs no comment. A maternal supply, foreign to the baby, is at best difficult to obtain and artificial milk becomes necessary. Secondly, supplemental feeding is becoming more and more prevalent. The food which will halt a faltering weight curve and guar-
(‘ALHOUN
:
SN
EXCELLENT
STJBSTITUTE
FOR
BREAST
MIIiK
!,7
antee a prompt and efficient return of the baby’s weight to normal is the one of choice, whether it be only a temporary or a permanent, feeding. How often one sees the infant under the quiet regime of t.he hospital thrive and surpass its birth weight, only to falter a,nd of insufficient nourishlose ground after reaching home. Symptoms ment make their appearance in spite of all attempt,s to regulate th? mot,her’s diet or the use of galactogogues. It then becomes necessar.v to supplement the deficiency with artificial food. Lastly, babies weaned during the first year require artificial food. Under these various conditions, what artificial food shall be used 1 It must, be one to which the baby will immediately adapt itself without difficulties or ill effect, and at the same time one on which there is immediate gain of weight without vomiting, restlessness, or intestinal upset. In fact, the formula chosen must be one which will replace the normal breast milk with all of its advantages, as near as is humanly possible. After experience with many infants, under the three previously mentioned conditions, I have ,found the lactic acid milk of Mariott and Davison to fulfill all of the above condihions, and now use it to the exclusion of all other formulae, with very successful results. 1 have not yet. seen it fail in a single instance, and the old adage of four ounces gain a week seems to be passing into oblivion. Infants on this form of nourishment surpass that figure regularly, and it is not at all uncommon to see them gain as much as a pound a week. This weight is equally distributed to all the elements of the body, thereby promoting proper growth and good health. After a few days on this formula, the weight begins to increase and continues steadily; the baby is soon content and only awakens at feeding time. The babies are all placed on a three-h’our schedule and the last feeding is given at ten o’clock after which sleep is enjoyed until the following morning. The so-called colic, so troublesome wil;h many babies on other forms of nourishment, is almost unknown. The digestion is thorough and complete as is shown by the perfectly normal stools and the absence of either constipation or diarrhea. Without going into detail, the theory upon which this type of milk is based is briefly as follows: All milk contains a certain so-called buffer substance, that is, a substance capable of uniting with considerable amounts of acid, or a.lkali, without undergoing any great change in its chemical reaction. Breast milk contains a very small amount of this substance; it therefore neutralizes the normal hydrochloric acidity of the stomach to a minimal degree, thereby making breast milk readily, quickly, and completely digested in quantities adequate for the needs of the growing infant. Cow’s milk, on the other hand, contains large amounts of the substancse and consequently neutralizes considerable amounts of the hydrochloric acidity in the
98
THE
AMERICAN
JOURNAL
OF
ORSTETRICS
AND
GYNECOLOGY
stomach, thereby decreasing the digestibility and making it difficult or sometimes impossible to feed the infant sufficient quantities to maintain a proper nutritive balance. Cow’s milk should, therefore, in some way be acidified in order to compensate for the acid neutralization referred to above. Carbohydrate deficiency should be supplied by the addition of proper quantities of some form of sugar easily digestible and assimilable. Corn syrup not only contributes the lacking calorie and nutritional value, but also furnishes the needed carbohydrate in the form of dextrose, the fully converted form into which every sugar or carbohydrate substance must be changed before absorption and assimilation occurs. This promptly absorbable and assimilable form of sugar produces no irritation of the gastrointestinal mucosa and throws no strain on the digestive function. Lactic acid milk is easily prepared as follows: 1. Use only a good grade of cow’s milk, which need not necessarily be pasteurized. 2. To each pint of milk add two tablespoonsfuls of Karo Corn Syrup and mix thoroughly. 3. Boil the milk for five minutes. If the mixture is brought to a boil and allowed to simmer rather than boil vigorously the evaporation is less and the results just as good. 4. Allow the milk to stand in a cool place until thoroughly chilled; overnight in the ice box is preferable. 5. With a medicine dropper, add drop by drop with gentle stirring, one teaspoonful of lactic acid, C. P., 85 per cent, to each pint. 6. Store in a cool place until used. TABLEI BIRTH
7 6 8 6 8 3 8 7 8 9 6 8 7 7 7 9 7 7 3 8 7
Lb. “ “ I‘ “ “ “ “ “ ‘( “ “ “ “ “ “ “ “ “ “ “
3 4 2 10 8 3 3 6 4 4 8 0 5 0 5 0
oz. “ “ (( “ “ ‘( “ “ “ “ “ “ ‘( “ “
2 5 6 3
‘( “ “ “
a 1~
18 14 14 18 19 12 18 21 17 21 17 23 15 23 18 21 23 17 15 18 17
6 MONTHS Lb. 0 Oz. ‘( 0 “ “ 3 “ “ 0 “ “ 0 “ “ 3 " “ 2 “ “ 0 “ “ 0 “ “ 0 “ “ 0 (' “ 0 “ “ 2 (' “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 2 (‘
CALHOUN
:
AN
EXCELLENT
SUBSTITUTE
FOR
BREAST
MILK
99
In order better to appreciate the value and advantages of this food, I have tabulated the weights of some of the infants fed exclusively on this milk (Table I). The weights at birth varied from three pounds in premature infants to nine pounds in full-term babies; the average weight is seven pounds and three ounces. At the end of six months, several of the babies weighed as much as twenty-three pounds. The average weight at the end of this time is seventeen pounds and two ounces. This is better than double the birth weight by three pounds. It is pertinent to mention that the state of health of these babies was perfect throughout the entire period of six months; not in a single instance had there been a single day of illness of any character. The advantages of this form of infant feeding are that it permits feeding whole milk in practically the same quantities as the normal breast-fed infant obtains, with an almost completely converted sugar content, which is in a condition for ready absorption, without appreciable digestive effort or irritative effect on the intestinal mucosa. It furnishes the mother with a very easily prepared food of normally unchanged formula, which is simply increased in quantity as the infant grows older. Due to the inhibiting effect of the acid on the bacterial growth, the food is substantially free from pathogenic baoteria, and keeps perfectly when ordinary precautions are used. The acidification of the milk promotes coagulation of the curd, thus rendering the protein element more readily digestible and absorbable. 108 SECOND
STREET.
THE AMERICAN
JOURNAL
OF OBSTETRICS AND oYNECOI,(!(:Y
Hospital duration of others 24 days Duration of symptoms before treatment 10 days to 6 weeks Blood sugar lowered in 3 eases: 78 (2), 86.2 (12), 82.4 (14) mg. per 100 C.C. blood. I am indebted to Dr. S. A. Cosgrove for his interest and guidance in caring fol the majority of these patients on the Obstetrical Service at the Jersey City Hospital. REE’ERENCES Thalhimer, William: Surg., Gynec. and Obst., August, 1924, xxxix, 237. Thalhimer, William : AM. JOUR. 0~6~. AND GYNEC., May, 1925, ix, 673. Titus, I?., Hoffman, G. D., and Givens, M. H.: Jour. Am. Med. Assn., March 20, 1920, Ixxiv, 777. Titus, Paul, and Givens, M. H.: Ibid., Jan. 14, 1922, lxxviii, 92. Titus, Paul: Ibid., Aug. 15, 1925, lxxxv, 488. Wilder? R. M., and Sansum, W. D.: Arch. Int. Med., 1917, xix, 311. Editorial, Jour. Am. Med. Assn., February, 1926, Ixxxvi, 557. Starr, F., and Fletcher, A. cf.: Burg., Gynee. and Obst., February, 1926, slii, 194. 644 WEST SIDE AVENUE.
AN EXCELLENT
SUBSTITUTE
BY D. A. CALHOUN,
FOR BREAST
MILK
M.D., TROY, N. Y.
PON the obstetrician of today rests the responsibility of providing the means whereby the baby obtains the proper start in life and continues to remain in health while under his care. In undertaking this responsibility he is beset with many difficulties, and paramount among these is the all-important+ question of weight. The infant who is sufficiently nourished will be contented, healthy, and gain weight; but given an infant which is not gaining, consequently not contented, a multitude of difficulties make their appearance. The question of infant mortality is directly.‘$oncerned with gain in weight. Infants gaining properly are healthy. Maternal nursing, of course, is the aim of our endeavor, but when there is an absence, or an insufficient amount of breast milk, the infant can be made to gain by artificial means. Artificial feeding, therefore, becomes necessary under the following conditions :
U
Babies both full term and premature when the breast milk is absent. Complementary feedings when the mother’s milk is inadequate, either in quantity or quality. Artificial feeding when the baby is weaned. The first needs no comment. A maternal supply, foreign to the baby, is at best difficult to obtain and artificial milk becomes necessary. Secondly, supplemental feeding is becoming more and more prevalent. The food which will halt a faltering weight curve and guar-
(‘ALHOUN
:
SN
EXCELLENT
STJBSTITUTE
FOR
BREAST
MIIiK
!,7
antee a prompt and efficient return of the baby’s weight to normal is the one of choice, whether it be only a temporary or a permanent, feeding. How often one sees the infant under the quiet regime of t.he hospital thrive and surpass its birth weight, only to falter a,nd of insufficient nourishlose ground after reaching home. Symptoms ment make their appearance in spite of all attempt,s to regulate th? mot,her’s diet or the use of galactogogues. It then becomes necessar.v to supplement the deficiency with artificial food. Lastly, babies weaned during the first year require artificial food. Under these various conditions, what artificial food shall be used 1 It must, be one to which the baby will immediately adapt itself without difficulties or ill effect, and at the same time one on which there is immediate gain of weight without vomiting, restlessness, or intestinal upset. In fact, the formula chosen must be one which will replace the normal breast milk with all of its advantages, as near as is humanly possible. After experience with many infants, under the three previously mentioned conditions, I have ,found the lactic acid milk of Mariott and Davison to fulfill all of the above condihions, and now use it to the exclusion of all other formulae, with very successful results. 1 have not yet. seen it fail in a single instance, and the old adage of four ounces gain a week seems to be passing into oblivion. Infants on this form of nourishment surpass that figure regularly, and it is not at all uncommon to see them gain as much as a pound a week. This weight is equally distributed to all the elements of the body, thereby promoting proper growth and good health. After a few days on this formula, the weight begins to increase and continues steadily; the baby is soon content and only awakens at feeding time. The babies are all placed on a three-h’our schedule and the last feeding is given at ten o’clock after which sleep is enjoyed until the following morning. The so-called colic, so troublesome wil;h many babies on other forms of nourishment, is almost unknown. The digestion is thorough and complete as is shown by the perfectly normal stools and the absence of either constipation or diarrhea. Without going into detail, the theory upon which this type of milk is based is briefly as follows: All milk contains a certain so-called buffer substance, that is, a substance capable of uniting with considerable amounts of acid, or a.lkali, without undergoing any great change in its chemical reaction. Breast milk contains a very small amount of this substance; it therefore neutralizes the normal hydrochloric acidity of the stomach to a minimal degree, thereby making breast milk readily, quickly, and completely digested in quantities adequate for the needs of the growing infant. Cow’s milk, on the other hand, contains large amounts of the substancse and consequently neutralizes considerable amounts of the hydrochloric acidity in the
98
THE
AMERICAN
JOURNAL
OF
ORSTETRICS
AND
GYNECOLOGY
stomach, thereby decreasing the digestibility and making it difficult or sometimes impossible to feed the infant sufficient quantities to maintain a proper nutritive balance. Cow’s milk should, therefore, in some way be acidified in order to compensate for the acid neutralization referred to above. Carbohydrate deficiency should be supplied by the addition of proper quantities of some form of sugar easily digestible and assimilable. Corn syrup not only contributes the lacking calorie and nutritional value, but also furnishes the needed carbohydrate in the form of dextrose, the fully converted form into which every sugar or carbohydrate substance must be changed before absorption and assimilation occurs. This promptly absorbable and assimilable form of sugar produces no irritation of the gastrointestinal mucosa and throws no strain on the digestive function. Lactic acid milk is easily prepared as follows: 1. Use only a good grade of cow’s milk, which need not necessarily be pasteurized. 2. To each pint of milk add two tablespoonsfuls of Karo Corn Syrup and mix thoroughly. 3. Boil the milk for five minutes. If the mixture is brought to a boil and allowed to simmer rather than boil vigorously the evaporation is less and the results just as good. 4. Allow the milk to stand in a cool place until thoroughly chilled; overnight in the ice box is preferable. 5. With a medicine dropper, add drop by drop with gentle stirring, one teaspoonful of lactic acid, C. P., 85 per cent, to each pint. 6. Store in a cool place until used. TABLEI BIRTH
7 6 8 6 8 3 8 7 8 9 6 8 7 7 7 9 7 7 3 8 7
Lb. “ “ I‘ “ “ “ “ “ ‘( “ “ “ “ “ “ “ “ “ “ “
3 4 2 10 8 3 3 6 4 4 8 0 5 0 5 0
oz. “ “ (( “ “ ‘( “ “ “ “ “ “ ‘( “ “
2 5 6 3
‘( “ “ “
a 1~
18 14 14 18 19 12 18 21 17 21 17 23 15 23 18 21 23 17 15 18 17
6 MONTHS Lb. 0 Oz. ‘( 0 “ “ 3 “ “ 0 “ “ 0 “ “ 3 " “ 2 “ “ 0 “ “ 0 “ “ 0 “ “ 0 (' “ 0 “ “ 2 (' “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 0 “ “ 2 (‘
CALHOUN
:
AN
EXCELLENT
SUBSTITUTE
FOR
BREAST
MILK
99
In order better to appreciate the value and advantages of this food, I have tabulated the weights of some of the infants fed exclusively on this milk (Table I). The weights at birth varied from three pounds in premature infants to nine pounds in full-term babies; the average weight is seven pounds and three ounces. At the end of six months, several of the babies weighed as much as twenty-three pounds. The average weight at the end of this time is seventeen pounds and two ounces. This is better than double the birth weight by three pounds. It is pertinent to mention that the state of health of these babies was perfect throughout the entire period of six months; not in a single instance had there been a single day of illness of any character. The advantages of this form of infant feeding are that it permits feeding whole milk in practically the same quantities as the normal breast-fed infant obtains, with an almost completely converted sugar content, which is in a condition for ready absorption, without appreciable digestive effort or irritative effect on the intestinal mucosa. It furnishes the mother with a very easily prepared food of normally unchanged formula, which is simply increased in quantity as the infant grows older. Due to the inhibiting effect of the acid on the bacterial growth, the food is substantially free from pathogenic baoteria, and keeps perfectly when ordinary precautions are used. The acidification of the milk promotes coagulation of the curd, thus rendering the protein element more readily digestible and absorbable. 108 SECOND
STREET.