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present generation, for we are not yet conversant with the character of those changes which take place in milk as a result of pasteurization, and we have still to learn to what extent these changes vary according to the length of time pasteurized milk is kept. As bearing upon the latter point, we have the gravest suspicions that some of the nutritional diseases of infancy, more especially scurvy and rickets, are attributable to the "time changes" rather than the changes caused directly by the pasteurization.
In pasteurizing milk for general use, the method in vogue in this country appears to be that known as the "flash" or "continuous" process. By this process the milk, as it flows through the pasteurizer, is heated and held exposed for from 30 to 60 seconds to a temperature of about 160° F. It should, however, be immediately cooled thereafter to 40° F., and at or about this temperature it should be kept until it is handed over to the consumer. The object of retaining it at such a low temperature is to retard as much as possible those time changes to which we have already referred, and which are far from salutary. If, therefore, pasteurization is to fulfil its primary object-that of lowering the bacterial content of the milk. -then, needless to say, the milk should be run into sterile vessels and sealed forthwith, and in this state it should be delivered. I regret to say, however, that pasteurization as at present carried out is of more value to the trader than the consumer, for the adoption of the practice undoubtedly lessens greatly the risk of annoyance and financial loss by souring. Not that "pasteurization" prevents the ultimate souring of milk, but it very markedly delays this untoward event. Quite incidentally, let me here observe, however, that pasteurized milk should never be boiled, neither should it be even pasteurized a second time.
Because of the slowly but steadily increasing evidence, chemical as well as clinical, against the feeding of pasteurized milk to babies, there has been introduced a process known as "buddeizing." This process consists in adding a small amount of peroxide of hydrogen to raw milk, and heating the mixture thereafter to a temperature of 122° F. At this temperature, it is alleged, all the hydrogen peroxide is driven out of the milk, and that by the action of the peroxide, the germs are more completely destroyed than they possibly can be by pasteurization. Now peroxide of hydrogen is a powerful oxidizing and bleaching agent, and the oxidizing powers are greatly increased in
lactose being a powerful believe that peroxide of
milk on account of the lactose in milk, reducing agent, and it is impossible to hydrogen can destroy the various germs in the milk without producing at the same time very decided chemical changes in the milk itself, and I have no hesitation in asserting that adding this agent to milk which is to be fed to infants is a dangerous procedure which cannot be too strongly condemned.
On account, therefore, of the many objections and drawbacks to the use of "pasteurized" or "buddeized" milk for the artificial feeding of infants, it is incumbent upon our Government to make due provision for an adequate and easily procurable supply of healthy, clean, raw milk for infant feeding. The milk, moreover, should be supplied from tuberculin-tested herds, as tuberculosis is to every mother a very real dread.
At this stage of our deliberation I would forcibly impress upon mothers the fact that they should neither readily nor too easily be prevailed upon to forgo the duty of nursing their infants, for the mother who resorts to artificial feeding not only exposes her child unduly to risks and dangers, but is likely thereby to treasure up for herself, and more especially during the summer months, times of worry and anxiety.
If, however, artificial feeding must be resorted to, then the milk of the cow as fed to an infant until it is nine months old should, because of the nature of the curd which it forms, be always diluted with water, and have milk sugar added as well; for, as I have already stated, the curd which forms under such circumstances is then like that of human milk, easy of digestion. It is not a matter of indifference which sugar is used, for lactose or milk sugar, which is the sugar peculiar to milk, possesses special virtues. Chemically it is totally different to cane or grape sugar. With the exception of lactic fermentation, which it undergoes with great readiness, it otherwise ferments with great difficulty, and is disdained by those yeasts that set up fermentation in other sugars. To the infant the readiness with which this form of sugar undergoes lactic fermentation is most probably very advantageous. From a biochemical point of view it is the ideal sugar for the infant, and as no other should be fed, it devolves upon our Government to ensure that it shall be easily and cheaply procurable, in a pure state, at a price as much below two shillings a pound as possible.
The milk used for the artificial feeding of infants should be of the highest grade. As obtained from the cow, and with as little handling
and delay as possible it should forthwith be filtered into 5 and 10 oz. regulation bottles fitted with a glass outside screw cap, and should be sealed immediately it is bottled. Moulded on the outside of each bottle should be the words, "Shake the bottle before measuring out the milk."
The feeding-bottle should be capable of holding 5 oz. only, and should be of a regulation pattern. It should be graduated on the outside in half ounces.
The rubber nipple should also be of a regulation pattern. It should not permit of the infant obtaining its food too easily, for the milk, as drawn from the feeding-bottle by a well determined effort, as in the case of that drawn from the breast, is not long retained in the stomach, but passes almost immediately into the bowel, for it is in the bowel that digestion in the infant is entirely effected. Overfeeding is a danger inseparable from artificial feeding, as a rule, because the infant usually obtains its food too easily and too quickly, and it is because of this that the hand-fed infant is so prone to suffer from disturbances of the stomach and bowel.
To aid in reducing the risks attendant upon artificial feeding, the greatest care and attention to cleanliness as regards feeding-bottles and nipples is necessary. These immediately they have been used should be thoroughly well washed, and thereafter be placed and kept submerged in a vessel containing cold boiled water.
TABLE VI.-SHOWING THE RELATIONSHIP OF PROTEID AND ASH IN
TABLE VII.-INDICATING PROPORTIONS IN Cow's MILK DILUTED: EQUAL PARTS MILK AND WATER.
As Nature, both in the case of civilized and primitive peoples, does not usually provide mother's milk much before thirty-six hours after birth, we are justified in inferring that a preliminary fast of thirty-six hours is the best and safest for the baby, whether the mother nurses or not. During this preliminary fast there is no objection, of course, to giving the infant a teaspoonful or two of warm water occasionally. In reducing and modifying cow's milk so as to make it as fit a
substitute as possible for mother's milk, we are guided by the amount of the total proteins and mineral substances in these two milks (see again Tables VI and VII), for we know that these two foodstuffs bear always a definite relationship to each other, and we know, furthermore, that milk sugar is to a certain extent capable of replacing and fulfilling the functions of fat. A glance at Tables VI, VII and VIII
TABLE VIII. INDICATING CONSTITUENTS OF MILK.
will reveal the fact that by diluting the milk with an equal quantity of boiling water our object can be most easily accomplished, for by so doing we bring the protein and mineral content of the cow's milk to all intents and purposes to the level of human milk. I have advisedly referred to the use of boiling water as the diluent, for it is only necessary to hold back this mixture for a few minutes before feeding it to the infant, in order to secure that temperature at which the mixture is most advantageously fed. As mother's milk becomes much poorer in protein as lactation proceeds, it is inadvisable to lessen the extent of the dilution of the cow's milk until the infant is nine months old. The amount of milk sugar added varies necessarily according to the quantity of diluted milk fed, and, roughly, it should be half a teaspoonful for each feed from the second day after birth until the end of the third month, and thereafter a teaspoonful until the child is nine months old.
A few years ago there was in this country what one can only characterize as a sour-milk craze, a craze which owed its origin to the belief that milk which contained and had been rendered sour by the lactic acid bacillus would if ingested arrest the activity of alien ferments in the digestive tract, and would thereby reduce to a minimum the risk of poisonous materials being produced in and being absorbed from the stomach and bowel. For a time the virtues of this sour milk were in fact so extolled that it seemed as though the true elixir of life had at last been discovered. This bubble has not yet burst, and it may be news to many that there are in America mothers who are rearing their infants on buttermilk. Buttermilk, besides being acid,
contains very little fat, but what the result of feeding infants on this form of milk will be time alone will reveal. I am quite certain, however, that the results will be disastrous, for it is very evident that Nature never intended the infant to be reared on sour milk, otherwise she would never have exercised that amount of care and attention in providing for it a milk the reaction of which is so nearly akin to that of the blood. (See Table IX.)
TABLE IX.-GIVING COMPOSITION OF BUTTERMILK.
The sweet cream buttermilk differs but little in its characteristics
from skimmed milk.
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