Modified milk for Children

 - Benson.A.R,

Modified milk 

In order to so change cow's milk that it will correspond with mother's milk, we must add 2.25 per cent, sugar and we must take away 2 per cent. of proteid. When we have done this we have so "modified" the cow's milk that it corresponds in percentage to the mother's milk. We may accomplish this by various methods, but whatever the method, the process is termed modification. The process of modification which is generally used in the household depends upon the use of a certain number of ounces of milk taken from the upper part of a quart bottle. The upper part of the bottle contains more cream or fat than the lower layers, while the percentage of proteid matter is practically the same throughout the bottle. Thus suppose we take a certain number of ounces of the richer milk from the top of the bottle, and find that it contains 8 per cent. of fat or cream instead of 4 per cent. which fresh milk contains. The proteids would remain practically unchanged at 3.50 per cent. If we now add an equal amount of water to this 8 per cent. top milk the fats are reduced one-half, so that we have the original 4 per cent., and the proteids are likewise reduced one-half so they are at 1.75 per cent. We have now rearranged the quantities of the constituents of the milk, and although this diluted milk contains exactly the same elements that fresh cow's milk contains, we have succeeded in diminishing the amount of proteid matter and leaving the fat unchanged. The percentage of sugar is easily adjusted by adding milk sugar to the mixture.
 This is the simplest illustration of modified milk and it is easy to understand that there can be as many different modifications as there are percentages. It is only necessary that we know the percentage composition of the milk which we use, and that we dilute it in a definite way. Assuming that we understand the principle of modifying milk, that is, changing the percentage composition of it, let us proceed to the practical application.
 The Selection of Milk : The problem of selecting milk in the country is much simpler than in the city, because we can eliminate the danger of contamination in the interval which elapses between the time of milking and reaching the home. This period is sometimes as long as twelve hours in the city. The best safeguard at present in large cities is to use certified milk, which is procured and transported under the direct supervision of the Board of Health. This milk is clean and free from disease germs, and contains a minimum number of other germs. The dairies charge more for it than other milk, but their price is not unreasonable. *
 Milk for infant feeding should be mixed milk from a herd of cows rather than the milk of one cow. When there is any choice, milk from Holstein or Durham cows should be selected.
 Preparation : As soon as it is milked, the milk should be strained through several layers of gauze, which has previously been boiled, directly into quart bottles which have also been thoroughly washed and boiled. These glass bottles should then be placed in a receptacle containing ice and water. The top of the bottle is left open for fifteen or twenty minutes until the animal heat has escaped, after which it is closed tightly like a preserve jar and allowed to remain for two to four hours. The bottle may then be removed carefully without shaking, the neck of the bottle wiped with clean cotton, and it is ready for use.
 In order to remove the upper part of the bottle (top milk), it is necessary to procure a round bottom Chapin dipper. This dipper holds exactly one ounce. It has a long upright handle, so attached that it can be passed down into the bottle. These dippers are made of either tin or aluminium, costing ten or twenty cents each, and may be procured at almost any of the larger drug stores or directly from the Cereo Company, Tappan, New York.
 In order to remove the top milk, the dipper and a teaspoon, both of which have been boiled and are taken directly from the water without coming in contact with anything else, are needed. The top ounce is carefully dipped out with the teaspoon and measured in the dipper, and from the dipper it is turned into a clean agate or earthenware vessel which has also been boiled. Now that the top ounce has been dipped out with the teaspoon, the dipper can be lowered into the bottle, using great care not to stir the milk, and the upper layers removed ounce by ounce, until the number of ounces of top milk required by the formula have been removed from the bottle and deposited in the basin. It may be necessary to use one or more quart bottles of milk according to the amount required by the formula, but after the required number of ounces of top milk have been removed from the bottle, we have no further use for the milk remaining, except when the formula calls for "fat free" milk which is the bottom eight ounces of the bottle. The top milk in the basin is now thoroughly stirred with the spoon which was first used, and this milk forms the basis of the mixture. It may be set aside and covered with a clean cloth for the few minutes that the other parts of the formula are being prepared.
 Let us suppose, for example, that we are preparing formula number one for a baby a week old. This formula calls for sixteen ounces of top milk as a basis of the food. This means that the top sixteen ounces of a quart bottle are to be removed in the manner described. In order to make sufficient food to last the baby twenty-four hours, we must prepare thirty-two ounces. To make this quantity, we use four ounces of the mixed sixteen ounce top milk, twenty-eight ounces of water, and four even tablespoonfuls of milk sugar. The water is carefully measured, the milk sugar added to it and the whole brought to the boiling point. It is then allowed to cool and the four ounces of sixteen ounce top milk added to it and thoroughly mixed. This mixture is the food the baby requires. At this age an infant takes one and a half ounces of this food every two hours during the day and twice at night. It is best to provide enough nursing bottles to last through the day; in this case, nine bottles. One and a half ounces of the mixture are put into each bottle, the tops carefully closed with cotton and all placed in the refrigerator.
 At each feeding time one bottle is taken out, the cotton removed, the rubber nipple (which has previously been cleansed and boiled) is attached to the bottle; the whole bottle is shaken gently until the food is mixed. It is then immersed in warm water until the food is sufficiently warm to be taken (about body heat). It is now ready for the baby.
 A flannel bag to cover the bottle will retain the heat, prevent the bottle from slipping, and absorb moisture.
 When the bottle is empty, it is thoroughly washed with hot water and soap, and cleansing brushes which are sold for that purpose are used to reach the inner surfaces of the bottle. The rubber nipple is treated in the same way and must be carefully cleansed. This is best accomplished by turning it inside out. The nipples and bottles are boiled or steamed for 15 minutes in a double boiler or sterilizer immediately before refilling.
 A 16 ounce glass graduate is very convenient for measuring, and a spoon with a long handle similar to those used at soda fountains is best for mixing the formula.
 A wide month nursing bottle with no shoulders or rims, having a smooth surface inside and outside, is the best. Such a bottle is that known as the Hygeia, and sold at most drug stores. Instead of using cotton to close the neck of this bottle, it is more convenient to use the inverted nipple.
 The nipple which goes with this bottle is satisfactory in the majority of cases. A nipple with a medium sized opening should usually be selected. There is no one nipple that is best for all babies, and sometimes a little experimenting is necessary before a satisfactory one is found. Different babies seem to prefer different shaped nipples. A nipple which cannot be turned inside out should be avoided, and the softer the rubber, the better. Sore mouths are frequently caused by too hard nipples as well as unclean nipples.
 Utensils : The utensils necessary for preparing the food in this way are as follows :
 One Chapin dipper.
 One long handled teaspoon.
 One tablespoon.
 One 16 ounce glass graduate.
 One heavy glass or agate ware funnel.
 Two 2 quart sauce pans of agate ware, with handles.
 One dozen nursing bottles and nipples.
 One wire basket for holding the bottles upright.
 One large double boiler or covered vessel for sterilizing bottles and other utensils.
 Sterilized absorbent cotton for stopping bottles should be procured in sealed packages at the drug store, several of the smallest size packages being preferred. Only one package should be opened at a time.