586 MILK 



If, for instance, one wishes to feed an infant 20 ounces of milk 

 that contains 1.5 per cent, of fat, 5 of sugar, and 0.75 per cent, 

 protein, he will have to prescribe a milk dilution somewhat on 

 the following order: Cream 2 ounces, milk 2 ounces, water 15 

 ounces, and sugar i ounce. 



If one wishes to make up a mixture of 20 ounces that contains 

 3 per cent, of fat, 5 per cent, of sugar, and 1 per cent, of protein, 

 he should prescribe a milk dilution composed of the following: 

 Cream 4 ounces, milk Ij ounces, water 13| ounces, and sugar 

 f ounce. This is on the basis of 4 per cent, of fat in milk and 12 

 per cent, of fat in cream. In all of the older formulas lime-water 

 was added to the milk mixture to reduce the acidity of the cow's 

 milk, but at present lime-water is not used very extensively. 

 To make the dilution more simple some authors advise the use of 

 top-milk in the place of cream. 



The second system of infant feeding the caloric is based on 

 metabolic experiments done on children by Heubner and Rubner. 

 Rubner found that an infant under six months of age needed 

 100 calories per kilogram of weight, or 40 to 50 calories per pound 

 of weight. Knowing the caloric value of milk, Heubner suggested 

 three mixtures, one consisting of one-third milk and 8 per cent, 

 of lactose, the second of half milk and 10 per cent, of lactose, and 

 the third of two-thirds milk and 12 per cent, of lactose. 



Although both the percentage and caloric systems of milk modi- 

 fication are extensively followed, they are not entirely satisfactory. 

 The percentage method of milk modification is valuable in that it 

 aims at an accurate adjustment between cow's milk and human 

 milk. However, even after the most careful adjustment, cow's 

 milk is found to differ materially from human milk in the quality 

 of its protein, its salt, and its other constituents. The objection 

 most commonly raised to the caloric formula of Heubner is that 

 the solutions he advises call for too high a percentage of sugar, 

 which has a tendency to disturb the digestive balance in delicate 

 infants. 



The question as to the kind of sugar best adapted for use in 

 artificial feeding is one that has been answered differently by dif- 

 ferent authorities. There are some that favor the use of lactose, 

 others that advocate the use of a sugar which combines dextrin 

 and malt, and still others that prefer ordinary cane-sugar. Most 

 normal children do well on any kind of sugar, but experience with 

 a large number of feeding cases has shown that dextrimaltose is 

 more applicable to feeding than either cane-sugar or lactose. 

 Both cane-sugar and lactose are generally too laxative in their 

 effects. Lactose has the added disadvantage of being hard to 

 sterilize. It might be of interest in this connection to note what 



