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Restlessness during sleep.This may be due to the presence of colic, adenoids, large tonsils, rickets, or a constitutional disease.

Vomiting. This must not be confused with regurgitation. Ar infant with an overfilled stomach, if carelessly handled, will reject some of the stomach contents. Vomiting, on the other hand, may be due to decomposed milk, teething, or the onset of some infectious or chronic constitutional disease. In the tropics malaria is common.

Convulsions.—May be due to indigestion, constipation, intestinal parasites, teething, the onset of an infectious disease, rickets, meningitis in some form (cerebral or spinal), etc.

Teething.-In well-nourished children there are four periods when teeth erupt, and give rise to more or less general disturbances during the first two years. They are about the sixth, eighth, twelfth, and eighteenth months. The time is uncertain, and may vary one or two months from the periods named. The disturbances may take the nature of constipation, vomiting, diarrhea, convulsions, vicarious rashes, restlessness, fever, and irritability, particularly at night. The better nourished the child is the less likely are any of them to occur. If the gum over the incoming tooth is swollen and tender it can be relieved by the use of friction over it by means of a dull, hard, clean instrument, and the tooth rubbed through. An aseptic finger nail is convenient and thoroughly satisfactory.

Skin diseases.-Eczema, and other skin irritations are probably due to the lack of a properly balanced diet. Observe carefully to

1. Boil the nursing bottles before they are filled.
2. See that the holes in the nipples are not too large, or the

infant will nurse too rapidly; or too small, or the infant

exhausts itself in the effort of nursing. 3. Keep the nipples in saturated boracic acid solution when

not in use. 4. Always taste the mixture before bottling to see that no

decomposition has taken place. 5. When the infant cries between feedings, it may be water

and not food that it wants. 6. Weigh the baby occasionally. Increase in weight takes

place more rapidly the first few weeks than later. 7. When a child is not thriving never forget the possibilities of

some constitutional disease, and seek the advice of the doctor.

RECIPES.

Barley water.-One tablespoonful of pearl barley, after being washed, is added to 1 pint of cold water and soaked for 10 or 12 hours; then strained and the water discarded. One quart of cold water is then added and boiled slowly for 2 hours. Water is added from time to time so that the final product consists of 1 pint. It is then seasoned with half a teaspoonful of salt and strained through muslin or a fine sieve.

If Robinson's patent barley is used, Koplik recommends the following method of preparation : A heaped teaspoonful is suspended in a pint of cold water until the lumps have disappeared. The mixture is then placed in a small saucepan over the fire and stirred constantly for 15 or 20 minutes after it begins to boil. Water is then added to make the mixture up to 1 pint.

Oatmeal jelly.This is made as follows: One cup of rolled oats is soaked in two cups of cold water for 10 or 12 hours, then strained through a fine sieve or muslin. One cup of cold water is now added to the oatmeal water and the mixture is gently boiled for 2 hours, stirring frequently. One-half teaspoonful of salt is now added, and when allowed to cool the product jellies. Two to four teaspoonfuls of this jelly can be added to each bottle after the infant is 9 months old. It is particularly valuable if there is a tendency to constipation.

Chairman Rose. This paper is now open for discussion.

Mr. H. R. ESTES (Flint, Mich.). What is the youngest age at which you would recommend feeding orange juice?

Doctor DEEKS. We begin when the baby is a week old, giving 5 or 10 drops daily, and increase it gradually so that at the end of the month the baby is given a teaspoonful daily. We increase the amount about a teaspoonful a month until at the end of the year the baby is getting about 14 ounces daily.

Capt. John GOLDING (National Institute for Research in Dairying, Reading, England). What are the calorie requirements?

Doctor DEEKS. You are asking me something I can not answer specifically. In any case, I do not believe in the generally accepted theory of calorie feeding in people of any age for the reason that a great deal of the food which we consume does not become assimilated as such, but some of it undergoes fermentation or putrefaction in the alimentary tract, and for that reason can not be considered as nutriment. We give the baby a formula approximating the composition of mother's milk, in standard quantities and intervals of feeding, and are guided by the increase in weight of the child.

Dr. G. C. SUPPLEE (director of research, Dry Milk Co., New York). What is the influence of the flavor of evaporated milk and the powdered milk on the appetite of the infant?

Doctor DEEKS. None whatever. He takes one just as well as the other.

Dr. A. H. FLICKWIR (health office, Houston, Tex.). I would like to ask Doctor Deeks if he prefers this evaporated or powdered milk to certified dairy milk. If they could carry on the dairy industry there and deliver the right kind of certified milk to the natives to give to their children, would he still consider evaporated milk preferable to the right kind of cow's milk.

Doctor Deeks. In the Tropics the grass is poor and we do not get rich milk. Owing to the ignorance prevailing among the people in caring for the milk, it is not practical to feed our babies in that way. We have fed hundreds of children in the Canal Zone according to our methods, and when the parents have brought them north on vacation they have carried their condensed milk with them and continued this method of feeding. The children do beautifully and the method sa ves everybody considerable time and money.

Mr. O. F. HUNZIKER (Blue Valley Creamery Co., Chicago, Ill.): Have you found any difficulty, Doctor Deeks, in the suitability of milk powder which is not made right?

Doctor DEEKS. We have had practical experience with only one form of milk powder-that manufactured by the Merrell-Soule Co. Our experience has not been extensive, but it has proven satisfactory: Owing to the success which we have had with the evaporated and condensed-milk method, our doctors are slow about changing to a new method. We do not get fat babies by this method of feeding, but we get strong muscular babies, which we believe is more desirable.

Mr. NATHAN LOEWENSTEIN (Chicago, Ill.). Doctor Deeks, in making this modified milk, isn't there a difference in the way the fat is

broken up!

I am very

Doctor Deeks. We have had no difficulty with the fat content in feeding the baby as we do. Of course, the finer the fat emulsion the more digestible it is.

Doctor SEARS (Syracuse, N. Y.). One very fine brand of powdered milk is manufactured by a firm in this city, and I know they would be glad to welcome any delegates. Klim is one of our best powdered milk products made here in Syracuse.

I think the point Doctor Deeks made regarding ignorance in handling milk is very well taken. We who have good milk available here frequently recommend powdered milk for that reason. glad to know that the problem of milk is being solved through the evaporating of milk. I hope some of you delegates will get in touch with the Merrell-Soule Co., who manufacture Klim.

Chairman Rose. Is there an official interpreter here? It will be necessary to close the discussion now, in order to get on with our program. Unless you ask for it definitely, I shall assume that it is not desirable the questions be interpreted.

The next subject is, “ Observation on milk supply under tropical and subtropical conditions,” by Dr. C. P. Sherwin, of Fordham University, who has just been making a survey of milk conditions in the Tropics. [Applause.]

OBSERVATIONS ON MILK SUPPLY UNDER TROPICAL AND SUB

TROPICAL CONDITIONS.

CARL P. SHERWIN, Sc. D., M. D., Dr. P. H., LL. D., professor of chemistry,

Fordham University, New York City. That part of America which stretches from the Rio Grande south through Mexico and Central America and includes the northern countries of South America offers in many ways a most interesting field for the study of milk conditions in relation to the influence of these conditions upon the use of milk in the United States. In these tropical and subtropical areas we find, carried to a much greater degree, those problems which confront us in many sections of North America. As a field for research and study, Mexico, Central America, and northern parts of South America provide a most fertile ground. The population is quite dense in certain sections, with all the problems of supplying milk to an urban population. In others, it is exceedingly sparse, and there are all the problems of getting milk under poor delivery methods or no delivery methods at all. We find here an accentuated condition of poor feed for such cattle as are to be found. We find many sections where there is almost a total absence of cattle. In

other sections, we find cattle of such low grade that the milk they provide is at best of an inferior quality. There is, naturally, little or no attempt to safeguard the milk supply by providing for a health and condition standard for cows. In addition to the scanty supply of cow's milk, there may be found in certain sections a supply of goat's milk, and in other sections ass's milk is used to a certain extent. It is an unorganized field so far as milk supply is concerned. In some sections, where tropical vegetation flourishes in the rainy season, one finds a liberal supply of milk during certain months, to be followed by long months when there is practically none.

So far as the adult is concerned, there is every indication of a lack of milk in the daily diet, but our greatest concern is naturally in regard to the problem of the feeding of the growing child and the infant unable to enjoy the advantage of a normal supply of healthy mother's milk.

Naturally, the scanty and inferior supply of fresh milk is augmented by condensed and dried milk, and in all this section one is able to find, therefore, a most interesting field for research as to the influence of dried, condensed, and evaporated milks. Inasmuch as dried, condensed, and evaporated milks are in such wide use in the United States, it was especially interesting to study comparative influences of these products in tropical and subtropical sections where conditions were in every case accentuated.

It is a fact that the infant in Mexico, Central, and northern South America is likely to be nursed for a longer period of time than is the case in the United States, but where a substitute for mother's milk is necessary in the majority of cases sweetened condensed milk is to be found. In fact, sweetened condensed milk seems to be the outstanding milk product widely and generally in use in these countries.

As one compares the use of condensed milk in the feeding of infants and young children between northern Mexico and southern Mexico and Central America, a striking condition presents itself. It is evident that the general condition of the infant and the child, as well as the adult, in the districts farther to the south is better than that to be found in the arid area farther to the north.

Investigating further, one finds that in these rather primitive sections the natural tendency is to partake heavily of fruit wherever fruit is grown. One finds, too, that the liberal use of fruit and fruit juices becomes more and more a part of the diet of the child and the infant as one progresses farther into the regions where vegetation is heaviest. It is most interesting to note the gradually improved condition of the infants and children, as well as grown people, progressively with the added use of fruit and fruit juices.

In this connection, we find an interesting analogy between feeding condensed milk in tropical regions and its use in the United States

. I have noticed from time to time criticism of the use of condensed milk for infant feeding on the grounds that its high sugar content leads to complications. On the other hand, there are so many manifest advantages in the use of sweetened milk in certain instances that it is well worth while trying to overcome the drawbacks. It is indicated in certain tests and experiments made in Mexican and

Central American cases that the difficulties which may arise in the use of sweetened condensed milk alone, in certain cases, are often satisfactorily overcome if a liberal quantity of fruit and fruit juices is used with a formula having sweetened condensed milk as its base.

This striking difference in the condition of children in particular can hardly be due to any marked changes or differences in climatic conditions. In the various sections milk seems to be fed in much the same way, though, of course, in different quantities in different sections and in different seasons, but the difference in conditions seems to be largely due to the supplementary diet, and this supplemen tary diet, which varies with different sections, is largely a difference in the amount of fruit and fruit juices enjoyed. Children in all these areas seem to be permitted to have at any time of day just about any article of food which the adult has and which the child may find to its liking. In the fruit sections, this naturally results in the almost constant eating of one sort of fruit or another, and the influence is apparent. This also supports many of the modern theories regarding the value of fruit and fruit juices, not only because of the roughage" value but because of the vitamin content.

The value of these fruit juices is not only marked in the case where the infant is fed on prepared milk, particularly condensed milk, but also in the case of the quality of the milk supplied by the nursing mother on whom it seems to have a most notable influence.

Naturally, the object of this congress is to determine in every way possible how to better the results to be obtained from the use of milk and how to increase the use of milk. In this paper, therefore, limited as it must of necessity be, I am trying to limit myself, then, to the influence of fruit and fruit juices when fed in conjunction with canned milk, and particularly sweetened condensed milk.

Sweetened condensed milk has so many natural advantages from the standpoint of sterility, distributing facilities, general distribution, and the easy digestibility of the product that it is naturally advisable to study the influence of the use of fruit and fruit juices fed in conjunction with condensed milk when for one reason or another mother's milk fails and a substitute must be supplied.

It must be borne in mind that in case substitutes are desired for infant feeding the utmost care must be taken in furnishing the food accessories so necessary in this case, and it should also be borne in mind that the simplest way of obtaining these fruit juices of the native plants is through the use of the natural fruit itself and that it is not necessary to resort to many of the patent foods or remedial preparations which are supposed to contain fruit juices. It might also be wise to emphasize the fact that where sweetened condensed milk is used in our own country it should be accompanied from the beginning with fruit or fruit juices, this being without doubt even more important than the scientific exactness with which the formula is prepared.

Chairman Rose. Would you like to discuss this paper of Doctor Sherwin's?

Doctor Deeks. There is just one point to which I would like to draw attention in connection with the reason why the sweet con

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