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OFFICERS AND MEMBERS

OF THE

WESTMORELAND COUNTY MEDICAL SOCIETY.

President.-Jos. L. Cook.

Vice-Presidents.-J. A. MILLER, H. L. DONNELLY.

Recording Secretary.-ROBERT Brown.

Corresponding Secretary.-W. F. OSBORN.

Treasurer.-D. W. MCCONAUGHY.

Censors.-J. M. STEVENSON, JOHN MCNEIL, J. W. ANAWALT.

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FOOD FOR INFANTS.

BY HIRAM CORSON, M. D.,

MONTGOMERY COUNTY.

Ir it be an important duty to check disease and stay the hand of death in the aged, whose genius and talents have been already exercised for the good of their country, who at furthest can live but a few years longer, and who are bound to life by few ties, how much more important to preserve the lives of children in whom are centred the hopes and affections of fond parents, and all of whose powers are ready to develop themselves for the joy of their parents, the glory of their manhood, and the benefit of human society. They are to supply the places of those worn out in the service of mankind, and yet how lightly we regard their early death! They die by thousands for want of proper nourishment. Even the best of mothers, through ignorance of the proper mode of treatment, see them pine and die, though the keenest affection watches night and day over the cradle.

In Burns' work on the Diseases of Women and Children, edited by Professor Thomas C. James, in 1823, he says: "Some mothers cannot, and others will not, suckle their children, but employ another nurse, or bring up the child on the spoon. If the latter mode be adopted, it is necessary to determine the proper diet, and the best mode of giving it. Milk consists of cream and whey; and the whey, the greatest portion of which is water, is the only part that becomes sour. The quantity of cream is greatest in ewe's milk; next in that of woman, the goat, the cow; and then the ass and the mare. The proportion of whey is greater in the milk of mares and women than in that of the cow or sheep. The caseous part is greatest in the milk of sheep, the goat, the cow, the ass, the mare in the order in which they stand; and is little in that of women. Sugar is abundant in the milk of the mare and woman; less in that of the goat, the sheep, and cow." After this statement, he concludes that asses' milk most nearly approaches the human, but as it is not easily procured, he selects cow's milk as the one to be used in rearing children by hand.

The cow's milk, he says, must be so changed as to lessen the proportion of curd and increase the sugar and cream; and he directs the cow's milk to be mixed "with an equal quantity of new made whey, a sixth part of cream, and a little sugar." Some, he says, dilute the milk with water-gruel. And Dr. James, in a foot-note, says: A good substitute may be had in equal parts of barley water and fresh cow's milk, sweetened with good loaf-sugar.

Dr. D. Francis Condie of Philadelphia, in his work on the Diseases of Children, in 1853, says: "Nature does not afford, nor can art supply, any substitute for the mother's milk; and to it, therefore, it should be entirely confined, when possible, until dentition has made some progress." And of the extreme danger of attempting to rear a child deprived of the mother's milk, he thus speaks: "In the asylums for foundlings and young infants, where feeding by the hand has been substituted for the natural nourishment, the mortality has been invariably most appalling; forty, sixty, and even as high as eighty and ninety per cent. being destroyed. Even in the domestic nursery, where the utmost care and attention are every moment bestowed, the task is a difficult one, and against the few instances in which it succeeds, we must place the very many in which it entirely fails." He then quotes from Dr. Merryman: "That the attempt to bring up children by hand proves fatal, in London, to at least seven out of eight of these miserable sufferers; and this happens whether the child has never taken the breast, or, having been suckled for three or four weeks, is then weaned." How fearful is this statement of Dr. Condie! Sixty to eighty per cent.-seven out of eight-lost! Can it be possible that such frightful mortality cannot be averted by a better mode of feeding children? Dr. Condie directs "that milk should be taken from a healthy cow, and if possible from the same one; that the quantity of milk necessary should be diluted with nearly an equal quantity of warm water, and well sweetened with the best loaf-sugar. With this mixture the infant should be fed by means of a sucking-bottle." Some directions in relation to keeping the bottle clean, and preventing acidity of milk, complete what he has to say on the subject.

Dr. Combe, in his excellent work on Infancy, edited by John Bell, M. D., in 1840, after referring to the constituents of different kinds of milk, says: "The most suitable nourishment for the newborn infant will be that which makes the nearest approach to the mother's milk. Cow's, goat's, or ass's milk largely diluted with water, deserves the preference over every other kind of food. At first two-thirds of pure fresh water should be added to one-third of cow's milk; but of goat's or ass's milk, only an equal part of water

need be added. After a week or two the water may be only onehalf, and afterwards one-third, at which proportion it should be retained for four or five months. This should be given at the same temperature as the mother's milk, 96° or 98° Fahrenheit." Of the quantity to be given at one time, he says: "As a general rule, six or eight tablespoonfuls will be quite sufficient at one time for the first two or three weeks."

Now, though Burns and Professor James in 1823 recommended that the milk be diluted "with an equal quantity of new-made whey, or an equal quantity of barley water;" and Dr. Condie, in 1853, directs that "the milk should be diluted with nearly an equal quantity of warm water ;" and Dr. John Bell and Dr. Combe in 1840 state that, "at first two-thirds of pure water should be added; after a week or two only one-half; and still later only one-third, and this should be continued for several months;" yet so far back as 1833 Professor Dewees had, in his emphatic way, declared that "the proper substitute for the mother's milk was a mixture of two-thirds milk, one-third water, and a little loaf-sugar;" and in 1865, Dr. John Bell, in his admirable "Report on Physical Education," says: "At first the milk should be slightly diluted with water, with the addition of white sugar, and after a while be given in its natural state." Dr. Bell appears to have undergone quite a great change of opinion since 1840.

Some substitutes for cow's milk have been recommended, of which Liebig's Artificial Milk is perhaps best known. At a late meeting of the Academy of Medicine, in Paris, M. Giboust, Professor of the School of Pharmacy, after having reminded the assembly of the composition of this milk and the difficulties attending the preparation of it, in many places, added, that "we have at our disposal a natural product which more nearly resembles human milk than does a mixture of cow's milk, flour, malt, lactate and butyrate of potassa. It is cow's milk itself. By taking the latter, and adding a little sugar and one-fifth by weight of water, we have an aliment at the disposal of everybody, forming a better substitute for human milk than any artificial compound." In Philadelphia " Hard's Food" is somewhat popular. I have seen but one trial of it. It was a careful trial, made in summer time, and persisted in for months with ill success. The child was poorly for some months, and was speedily restored by being placed on a diet of cow's milk.

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So much for the writers on the subject. During the last few years I have noticed that all our young men, graduates of the Medical Schools of Philadelphia, who come to practice in the country, and even those whom I have met who practice in cities, invariably

give the same advice to the mothers who consult them in relation to the proper mode of feeding children to be raised by hand. They all direct them to give one-third milk and two-thirds water. And they give the reason for adding the water, viz: "The whole milk is too strong." Now where do they get this knowledge? Has it come down from the authors already named to the present teachers, and do they so instruct their pupils? That is the rational conclusion. It appears, then, that from the time of Burns, and probably from a much more remote period, this opinion, that cow's milk is too strong to be used without free dilution, has been handed down by writers and teachers with scarcely a doubt of its correctness. If we have made any progress in all this time, it has been not to lessen the dilution, but to increase it from one-half to two-thirds water; and with this the great body of the profession is satisfied; and yet in the very face of this treatment stands the appalling fact, that from "forty to eighty per cent.," "seven out of every eight" of the little creatures perish within a few months after their birth.

During a long and busy practice I have been enabled, I hope, to arrive at a better mode of feeding infants deprived of the mother's nourishment, and for the benefit of those who are just entering upon the duties of our profession, and who will be called upon for advice in this matter, I desire briefly to record my observations and experience.

Leaving to others the task of analyzing cows', goats', and asses' milk, to discover which approaches nearest to the human milk, in the proportions of its constituents; and selecting cow's milk as the one to be used, simply because it is more easily procured than the others, and not that I know it on any other account to be preferable, my remarks will apply only to it. In the early part of my practice, I gave the ordinary directions to those who inquired of me, namely, to give milk and water sweetened. Supposing the mother or nurse knew the proper quantity to be given in a day, I said nothing about that. And this neglect to speak of the quantity is, I think, very common with physicians. Thirty-two years ago, it became necessary to have my own child reared by hand, and I then discovered how ignorant I had been in relation to the quantity of food necessary for an infant, and was also enabled to observe the effects of an insufficient amount of food. Subsequent observations through many years have convinced me that there is not more than one woman in five, and perhaps not more than one in ten, who knows what amount of milk a child should have. Nor is there one physician in very many who can tell the mother or nurse what quantity it would need in twenty-four hours. I have repeatedly

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