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 Eqprinii'd from the MorUrcai Medical Journal, August, 1891. 
 
 ON INFANTS' FOOD.* 
 
 By A. D. Blackader, B.A., M.D., 
 
 Lecturer on Discuiicu of Children, McGill University ; Assistant Physician, Montre a 
 
 Goncrul Hospital. 
 
 One of the subjects which must give us no little thought 
 and trouble at all times, but especially during the summer 
 weather, is how to feed the infant deprived of its maternal 
 supply. Its food must be sufficiently nourishing — i.e., should 
 contain albuminous, fatty, saccharine, and saline ingredients in 
 proper proportions, neither too little nor too much, or nutrition 
 will suffer ; it must be eLiily digestible, else will colic, vomiting 
 or diarrhoea supervene ; and it must be practically a sterilized 
 food, free from bacteria or other micro-organisms, else will the 
 infant run the chance of being poisoned by some product of their 
 activity. Many investigators are endeavouring to solve the 
 difficulties which surround the subject. Practically, all unite 
 in regarding cow's milk, or some preparation of it, as the only 
 serviceable substitute for human milk. He would be a rash 
 physician who would dare to order a permanent diet for an infant 
 in which milk did not enter ; and every patent food in the 
 market is dependent on it for much of its nutritive material. 
 
 The use of cow's milk, however, is attended with some diffi- 
 culties, which must be clearly appreciated, and overcome, if we 
 would succeed in attaining our three requisite conditions. These 
 difficulties may be briefly stated as follows : 
 
 1. Cow's milk contains about double the amount of the 
 
 * Read before the Medioo-Cbirurgiool Society of Montreal. 
 
 MEDICAL FACI;LTY, 
 
 Ir 
 
 ''■^"Vii^iRS^t 
 
albuminoids that human milk dues, and these albuminoids appear 
 to contain the curd-forming elements in much larger proportion 
 than do the albuminoids of human milk. This large amount of 
 curd is apt to prove a source of indigestion to the infant. The 
 fats and sugars are found in slightly larger amount in human 
 milk than in pure cow's milk, and human milk is always distinctly 
 alkaline, while cow's milk, even when fresh, gives generally a 
 slightly acid reaction. 
 
 2. Cow's milk as ordinarily obtained, especially during the 
 hot season, swarms with many varieties of microbes, for which 
 it forms an excellent culture fluid, and during summer weather 
 infant foods prepared with it are generally contaminated with 
 multitudes of these organisms, and with their frequently poisonous 
 products. 
 
 3. As cow's milk can be obtained in almost unlimited quanti- 
 ties, and can be supplied to the infant without any regard to 
 regularity, or interval between times of feeding, we have not the 
 same check on the amount, as we have when the infant is depen- 
 dent on the breast, and with careless or ignorant nurses, we are 
 apt to have complicating the other two difficulties, that of over- 
 feeding. 
 
 Each one of these difficulties alone could defeat an attempt 
 to nourish an infant with cow's milk, but operating, as is usually 
 the case, together, it is little wonder that artificial infant feeding 
 often means infant atrophy, and that such a large percentage of 
 such cases, especially in our province, and in our city, perish 
 during the summer months from diarrhoeal diseases. 
 
 Recent investigation, however, has done a great deal, and, 
 theoretically, all the above difficulties have been solved, yet, 
 cUnically, we still find ourselves in trouble. 
 
 During the early part of the winter I was confident that we 
 had at last obtained sufficient data on which to construct an 
 ideal infant's food. Our knowledge of the composition of the 
 two milks was sufficiently accurate to enable us to alter the one 
 to make it closely resemble the other in chemical composition. 
 By careful sterilization, with Soxhlet's apparatus, or in an 
 Arnold sterilizer, in bottles holding just sufficient for the one 
 feeding, the milk thus prepared can be administered to the infant 
 
H 
 
 in a practically sterile condition ; while— thanks to the work of 
 Snitken, Holt, and others — we have definite and correct ideas 
 of how much should be given at each time of feeding, and the 
 interval that should elapse between the feedings. 
 
 In some of my cases, these means carefully carried out yielded 
 gratifying results, but in others my hopes were disappointed. 
 The infants, though apparently free from digestive troubles, 
 did not thrive, continued to look puny, and only very slowly 
 increased in weight, clearly indicating that my food was faulty. 
 Since then several communications have from time to time 
 appeared in our medical magazines, where others have related 
 a similar experience ; and corroborating this clinical experience. 
 Dr. Hiesland of Philadelphia and Dr. Leeds of New York have 
 published the results of their individual investigations on the 
 eifect that prolonged heat has on the milk. They both speak 
 very similarly of the changes which milk undergoes in the 
 sterilizing process. Their observations may be briefly epitomized 
 
 as follows : — ' : 
 
 I. — The starch liquifying ferment, galactozymase, which exists 
 in normal cow's milk in minute quantities, is destroyed when the 
 heat rises much above IGS^'F. (75°C.). 
 
 II. — A portion of the lactalbumin is coagulated. 
 
 III. — The casein, after the action of prolonged heat, is less 
 readily coagulated by rennet, and yields slowly and imperfectly 
 to the action of pepsin and pancreatin. 
 
 IV. — The fat globules are injuriously affected by the heat. 
 The fat is freed to some extent, and after standing, small lumps 
 of butter fat are sometimes observed on the surface of the milk, 
 while the portion not freed has a decidedly lessened tendency 
 to coalesce. When sterilized and unsterilized portions of milk 
 were churned, and a note made of the time required to form 
 appreciable amounts of butter, the unsterilized was found to 
 yield a larger amount in considerably less time than the steri- 
 lized. 
 
 V. — Milk-sugar, by long-contin\ied heating, is completely 
 destroyed ; that it undergoes some change in the process of 
 sterilization is shown by a lessened dextro rotatory power. 
 
It would appear, therefore, that milk, sterilized as wc have 
 been doing it, must be regarded as distinctly less readily and less 
 perfectly digestible than raw milk. The destruction of the 
 galactozymase, the coagulation of the lactalbumin, and the altera- 
 tion of the casein, so that it is more slowly acted on by rennet, 
 all presumably diminish its digestibility by the gastric juice of 
 the infant ; while the changes in the fat globules, noted after 
 prolonged sterilization, whatever be their nature, must interfere 
 considerably with their digestion and assimilation. 
 
 Yet even with these disadvantages, the testimony of most of 
 the physicians connected with the large foundling hospitals and 
 dispensaries of New York is that it is decidedly to be preferred, 
 as the lesser of two evils, to milk swarming with bacteria. Under 
 its use, the percentage of lives saved has been largely increased, 
 and the number of cases of summer diarrhoea much diminished. 
 But is it not possible to avoid these disadvantages ? We all know 
 the benefit that ensues in most cases, when we are able to order 
 the infant to the fresh ailk and pure air of the country. Some- 
 times, for those living in the suburbs, it may be practicable for 
 the family to keep their own cow and attend carefully to its 
 feeding and milking. But for the great majority of the infants 
 in our city, neither of these plans are available ; and the question 
 arises, Is all this sterilization necessary to obtain a practically 
 sterile food ? Dr. Leeds answers in the negative. He finds 
 that cow's milk rendered feebly alkaline, and heated, as soon as 
 received in the morning, to a temperature of about 155°R (68°C.) 
 (somewhat short of the degree of heat necessary to coagulate the 
 galactozymase), is rendered practically sterile. His remarks on 
 this point may be quoted : 
 
 " It is evident, in the first place, that no milk having an acid 
 reaction, is in a proper condition to be heated, because of the 
 effect of acidity upon coagulation. And inasmuch as cow's milk, 
 as delivered to consumers, has usually developed a notable acidity, 
 the addition of the requisite amount of a suitable alkali is the 
 first point to be considered." By experiments he found that it 
 required, to neutralize this acidity, about 2| grains of sodium 
 carbonate or 9J grains of ordinary liquor calcis to the pint of 
 
milk. " On making gelatine-peptone cultures, one drop of the 
 original milk yielded 400 colonies of bacteria after five days' 
 culture at common temperatures, while the same milk rendered 
 very feebly alkaline with lime yielded 250 colonies. Another 
 sample yielded, per drop, 43 colonies after four days and 3,r)00 
 colonies after six days. This milk alkalinized by lime gave 14 
 colonies in the four days and 211 colonies in the six days. After 
 heating for ten minutes in sterilizing flasks at 100°C., both the 
 original and the alkaline milk were practically sterile, developing 
 from 1 to 4 colonies per drop after four days culture. Raw 
 milk, after heating to 68®C. for an hour, proving to be practi- 
 cally sterile (1 to 2 colonies per drop), the experiment was tried 
 at keeping the temperature at 6S^C for six minutes, when the 
 same result was obtained. On cooling and diffusing the cream 
 which the heating had brought to the surface, the appearance 
 and properties of the milk heated to this temperature in no wise 
 noticeably differed from raw milk." 
 
 A difficulty arises in securing the proper amount of heat, if 
 we are to have this degree of sterilization carried on in the 
 household. At my suggestion, Mr. Dyer has made a series of 
 experiments with milk contained in glass flasks and heated in 
 an Arnold sterilizer. Having, at the outset, the water in the 
 sterilizer and the milk in the flasks at ordinary temperatures, 
 placing the sterilizer over a brisk Bunsen gas-burner, it took 
 about twelve minul'-s for the milk in the flask to reach the tem- 
 perature of 155°. 11, now, the gas be turned out, and the cover 
 of the sterilizer be placed slightly ajar, and the milk left in for 
 another Ave minutes and then removed to a cool place, all the 
 sterilization necessary will have been effected, and none of the 
 deleterious changes will have taken place. 
 
 In feeble infants, when the digestive powers are very weak. 
 Dr. Leeds recommends the combination of peptonization with 
 sterilization, the temperature never being allowed to exceed 
 68°C. Once the temperature rises over 75°C. changes occur 
 which interfere with the digestibility of even the peptonized milk. 
 
 In some families even sterilization as directed above, cannot be 
 obtained, either from ignorance or poverty, and in such cases 
 

 
 the u^o during the summer months of a good brand of condensed 
 milk may perhaps fulfil the conditions. As the condensation of 
 the milk is conducted in vacuo^ a temperature above 15r)^F. is, 
 I understand, never reached. Condensed milk has the disad- 
 vantage of being very deficient in the amount of the fats it 
 should contain — the cream being to a great extent removed in 
 the process, to secure an absence of rancidity in the prepared 
 article. If condensed milk is used permanently, this element 
 must be replaced by cream, or, perhaps, cod-liver oil, in the 
 cooler months. In preparing this condensed milk for the infant, 
 water that has been boiled, but that has been allowed to cool to 
 about 155''F., should be used. 
 
 In the preparation of cow's milk for the infant, the largo 
 excess of the albuminoids which it contains must always be borne 
 in mind ; bnt in simply diluting it, wo must remember we increase 
 the already existing deficiency of the fats and sugars. In a city, 
 and especially during hot weather, cream is always a doubtful 
 quantity and generally contains many bacteria, and for these 
 reasons, I think, should rarely be used in infant feeding. The 
 deficiency of the carbo-hydrates may, however, be often advan- 
 tageously supplied in children, over two or three months of age, 
 by the addition of a prepared flour of one of the cereals. This 
 method has been long a favorite one with Dr. Jacobi and Dr. 
 Lewis Smith. The cereals used have been principally barley, 
 wheat, and oatmeal, and of these my preference is for the barley. 
 It is the blandest and most nutritious, contains the largest amount 
 of the phosphates, and has neither a constipating nor relaxing 
 action on the intestinal canal. 
 
 Mr. Dyer has, at my suggestion, prepared a food of pure barley 
 flour, in which the starch granules have been altered by the 
 action of a heat of 212" maintained for five or six days. At the 
 end of this time the flour has assumed a somewhat yellow colour, 
 a slightly sweeter taste, and a not unpleasant cooked odour. He 
 has had the changes in it carefully examined by Dr. Ruttan, 
 who has found that the starch has been partly converted into 
 dextrose and is thus rendered decidedly more soluble in the 
 juices of the infant stomach. 
 
The additiun of 8uch a Huur as this tu cow's milk, uitliur pure 
 ov coiuluiistid, (Iocs to some extent prevent the formation of lur^c 
 curds, and must supply some of the deficiencies produced when 
 we simply dilute the milk. In the youn;; infants, we should 
 advise its use more as a diluent ol* the milk, hut in infants over 
 six months of ugc, it may form a fair proportion of the lood. 
 
 . 
 
 Dii. RuTTAN stated that he had been consulted regarding tho 
 length of time required to convert barley flour into a more 
 digestible form of i'ood, and also regarding the nature of the 
 change that had occurred, lie made a number of oxporiucnts, 
 the results of which may be briefly summarized as follows : 
 Barley flour heated to 212°F. for 96 hours was much more easily 
 converted into dextrose by boiling with dilute acids than was the 
 original flour. This change was still more marked when tho flour 
 was heated for 144 hours ; but if the heating be continued for 
 24 hours longer, the product became much darker and contained 
 considerable maltose and a caramel-like body, giving it a bitter 
 flavour. Experiments in the artificial digestion of the various 
 jyioducts showed that the flour, after 144 hours heating, was 
 very (quickly converted into dextrose by an amyloly tic ferment ; 
 27 per cent, of the flour so treated was converted into dextrose 
 in fifteen minutes, while but a trace of sugar was formed from 
 the original flour in a parallel experiment. The analysis of the 
 product at the end of 144 hours was made ; the starch was 
 nearly all changed into a form of dextrin — part, however, was 
 in the form of amylin and a small part was apparently unchanged. 
 Dr. Ruttan, in the course of his remarks, said he was unable to 
 make out exactly what form of dextrin was produced ; it was 
 not ordinary British gum alone, but probably a mixture of sol- 
 uble starch and some of the intermediate products formed as 
 dextrin passes into maltose and dextrose. Ordinary British gum, 
 such as is used on postage stamps, etc., had never been thought 
 of as an article of food, yet it clearly resembled the chief con- 
 stituent of flour prepared in this way. This method of preparing 
 flour for infant's food has long been followed in a crude way by 
 
iiiuthci'H und timtroiiM uf infuntH* as^rluiiis. Tliey Hiiii|ily tied thu 
 fl'jur ill a bag and kopt it in boiliti;^ water lor Hcvcral days, the 
 roBuIt being a similar product to tliat analysed, but, of course, 
 the conditions necessary to the [troduction of a similar result 
 could not be controlled. One of the great advantages connected 
 with this mode of preparing flour was the coagulation of the 
 albuminoid constituents in a finely granular state. 
 
 This reprint is prcsontcd witli the coniiilimcnts of 
 
 W. A. DYER & CO., 
 
 Mnnulacturcrs of Djicr's Improved Food for Infanh,. 
 
 A pi'c|)aration of pure ruuil lUirley niiiimrnctiu'i'd in accordance 
 with suggestions found in this lectiiru ''On Infants' Kood." 
 
 Tills Improved Food we pro[)are with the aid of machinery 
 specially designe'l hy us for this jmrposc, and at all times the 
 Profession can rely upon its being uniform in composition. 
 
 \Sv claim for this Food : 
 1st — That only the best l*eari iJariey is used for j)reparing the 
 
 Hour. 
 ■Jnd — Uniformity of composition. 
 
 ;')ril — Our process is so regulated ih.it the starch is not converted 
 
 into any form of sugar. 
 1th — Reasonableness of price. Notwithstanding the time and 
 expense incurred in its manufacture, we have decided to 
 
 otFer it to the jiublic at such a price that it can be within 
 
 the means of all.