Wherever a reliable milk laboratory is available, the simplest and best method is to write a prescription for modified milk, according to the table, and to have the requisite amount for each feeding dispensed in a separate bottle.

The table below shows the average percentages employed by 117 physicians for the feeding of 224 healthy infants.

The percentages are given in the round numbers nearest the actual percentages employed, and are approximate.

Theoretic Basis For Feeding A Healthy Infant

Note

The percentages given above may be considered slightly high for the average, as they represent only the modifications employed for perfectly healthy infants.

As the composition of human milk does not vary regularly to any great degree, after the secretion has become well established, and as the variations in any one case may exceed the difference between the theoretic normal standard for any one time and an average artificial imitation of human milk, we may adopt a single formula in the absence of a reliable milk laboratory. The following prescription may be taken as a basis for a single day's ratilon:

Milk..........................422 c.c.

Cream........................ 80 c.c.

Physiologic salt solution, up to.. .900 c.c. Lactose in powder.............. 46 grams.

About 1/3 of this total amount will be required for the first week, 1/2 in the second and third weeks, about 1 1/3 for the last month or so before weaning.

Various dippers, graduated bottles etc., may be used for combining ordinary milk, top milk (the upper part of milk that has stood 3 - 4 hours or more), cream, water, lactose etc. The choice among these methods must be made according to the authority of the proposer. Most are fairly accurate, if the directions are followed carefully.

Thompson advises using the top fifth of milk that has stood in an ordinary quart bottle, 1 part; water (better physiologic salt solution), 2 parts, and adding to every four ounces of the mixture a heaping teaspoonful of milk sugar.

Holt advises the use of equal parts of ordinary fresh milk (shaken if the cream has begun to rise) and cream (containing 25% of fats), and, to each part of the mixture, adds four parts of water (salt solution preferred), and lactose as in Thompson's mixture.

Top milk and, a fortiori, true cream, contains much more fat than milk and only a trifle less protein. The addition of water or salt solution, including sodium citrate which is at present in vogue, lime water etc., reduces the proportion of fat and protein to about that in human milk but also reduces the lactose much below the normal standard. By dilution, the coagulation occurs in smaller masses than usual for cow's milk, thus approaching the curds of human milk.

Various mucilaginous diluents may be employed for the same purpose: ordinary gelatin, Iceland moss, Irish moss, agar, acacia, barley, oatmeal and other cereals in water. All should be freshly prepared by boiling. For example, we may use

Top milk, 1/2 pint

Barley water, 1 pint

Lactose, 6 heaping teaspoonfuls.

This amount is about sufficient for a day, during the second month.

After the seventh month, we may substitute:

Top milk (or Holt's mixture of equal parts of milk and cream) 19 oz

Barley water.........................................19 oz

Lactose ............................ 6 heaping teaspoonfuls