* The subject of peptonization is further considered in Chapter IX (Dietary).

Peptonized milk.........

Milk sugar..............

Water..................

4 tablespoonfuls (fld. oz. 2).

1/2 teaspoonful. 2 tablespoonfuls (fld. oz. 1).

To this, cream may be added when desirable, and by diminishing the quantity of water and increasing that of milk the strength of the food may be made greater at any time.

Although every precaution be taken, the last of a quantity of predigested food is very apt to grow bitter; and if the attendants will take the trouble, it is much better to peptonize every meal separately. This is readily done by obtaining a number of powders of pancreatin and bicarbonate of sodium, so proportioned that each packet shall contain the proper amount for one bottle of food. For example:

Take of-

Extractum pancreatis...............

Bicarbonate of sodium............

9 grains. 24 grains.

Mix and divide into twelve powders, and dispense in waxed papers.

Directions. - Put one powder into a nursing bottle with two fluidounces of filtered water and two fluidounces of fresh sweet milk; shake together and keep warm in a water-bath for about half an hour before feeding; sweeten with half a teaspoonful of milk sugar.

Partial predigestion is the most useful and most uniformly applicable of all the methods of modifying cows' milk for infants having feeble digestive powers. For this purpose I have, for many years, employed the material known as Fairchild's pep-togenic milk powder. This powder contains a digestive ferment, pancreatin; an alkali, bicarbonate of sodium, and a due proportion of milk sugar. It is in no sense an infant's food, and as considerable heat (115°F.) is required to insure its action, the food prepared by it is not only partially predigested, but also, to a certain extent, Pasteurized, a result greatly to be desired under certain conditions, as will be detailed later. The mode of employment is as follows:

Take of-

Gravity cream (16%).....

Milk....................

Water...................

Peptogenic milk powder...

1 tablespoonful (fld. oz. 1/2). 4 tablespoonfuls (fld. oz. 2). 4 tablespoonfuls (fld. oz. 2). 1 level teaspoonful.* and the whole is heated slowly to boiling, ten minutes being occupied, and then quickly cooled. Here the object is to stop the digestion, so that the portion to be used later in the day may not be fully peptonized and bitter. This method has the advantage of effecting more perfect Pasteurization. When properly prepared, the resultant so-called "humanized milk" presents the casein in a minutely coagu-lable and digestible form; has an alkaline reaction; contains the proper proportion of salts, milk sugar, and fat; is not bitter in taste; has the appearance of human milk, and by Leeds's analysis shows:

This mixture is heated over a brisk flame to 115°F., kept at this heat, with constant stirring, for six minutes, and then quickly cooled to the proper temperature (98°F.) for administration. The stirring is best done with a food thermometer, as this gives a constant record of the temperature, and the vessel containing the mixture must be moved away from or nearer to the source of heat as the temperature rises above or falls below the required point. In preparing each bottle separately - by far the better plan - the mixture should never be heated to the boiling point, as this checks the action of the pan-creatin, and all digestive action after ingestion is lost. On the other hand, when the whole supply for a day is prepared at once, the required bulk of powder for the quantity of milk mixture is added,

* Measure provided with jar only to be used when preparing, at once, the whole quantity of food to be given in a day.

Water...........................

Fat..............................

Milk sugar.......................

Albuminoids.....................

Ash (salts)......................

86.2 per cent. 4.5 per cent. 7.0 percent. 2 .0 per cent. 0.3 per cent.

This corresponds very closely with this observer's average analysis of human milk.

The great advantages of partial peptonization are that the necessity for lime-water, barley-water, and thickening substances to keep apart the curd is done away with, and that, when the digestive disturbance requiring a careful preparation of food is removed, an ordinary milk diet can be gradually resumed by regularly diminishing the time artificial digestion is allowed to progress. This changes the casein in a less and less degree, until finally it is taken in its natural form.

Sometimes milk, in every form and however carefully prepared, disagrees, exciting vomiting, or causing great flatulence and discomfort, while it affords little nourishment. With these cases and also when there is acute gastric indigestion with repeated vomiting and fever or acute intestinal disturbance with fever, pain, flatulence and diarrhoea, with green, liquid movements containing mucus and milk curds, the best plan is to withhold milk entirely for a time and try some other form of food. The following are good substitutes for an infant from three to six months old:

1. Albumin-water *........ 6-8 tablespoonfuls (fld. oz. 3-4).

For one portion, to be given every two hours.

Barley-water........... 6-8 tablespoonfuls (fld. oz. 3-4).

Milk sugar............ 1/2 teaspoonful.

For one portion, to be given every two hours.

2. Barley-jelly............ 1 teaspoonful.

Water................. 8 tablespoonfuls (fld. oz 4).

Mix and add half the white of a fresh egg. For one portion, to be given every two hours.

3. Veal-broth* (1/2 lb. of meat to a pint of water), Barley-water... of each, 4 tablespoonfuls (fld. oz. 2). For one portion, to be given every two hours.

4. Raw-beef juice + ........ 1-2 teaspoonfuls.

Every two hours.

* See Chapter IX (Dietary). + See Chapter IX.