The Journal-Lancet E-Book

Various

• Herausgeber: Science & Technology Publishing
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 97

Veröffentlichungsjahr: 2025

Beschreibung

The Journal-Lancet Vol. XXXV, No. 5, March 1, 1915, stands as a significant historical publication, serving as the official journal of the Minnesota State Medical Association and the recognized organ for both the North Dakota and South Dakota State Medical Associations. This issue, published during a pivotal era in medical history, offers a comprehensive snapshot of early 20th-century medical practice, research, and professional discourse in the Upper Midwest. Within its pages, readers will find a diverse array of articles, case studies, editorials, and reports that reflect the medical challenges and advancements of the time, including discussions on public health, infectious diseases, surgical techniques, and the evolving standards of medical education and ethics. The journal also features updates on association activities, legislative matters affecting the medical profession, and correspondence from practitioners across the region, providing valuable insight into the concerns and priorities of physicians in 1915. Rich in period detail and professional commentary, The Journal-Lancet Vol. XXXV, No. 5, is an essential resource for historians, medical professionals, and anyone interested in the development of healthcare in the American Midwest during the early 20th century.

Leseprobe

TheJournal-Lancet

The Journal of the Minnesota State Medical Associationand Official Organ of the North Dakota and South Dakota State Medical Associations

PUBLISHED TWICE A MONTH

VOL. XXXV   Minneapolis, March 1, 1915   No. 5

The Journal-Lancet

FEEDING OF THE HEALTHY INFANT [1]

DISCUSSION

THE INEBRIATE [2]

FORMS OF INEBRIETY

RESULTS

SUMMARY

DISCUSSION

DIAGNOSIS OF INTRACRANIAL COMPLICATIONS IN DISEASES OF THE MIDDLE EAR AND ACCESSORY SINUSES OF THE NOSE [3]

MENINGITIS

THE TREATMENT OF GONORRHEAL OPHTHALMIA

VAGINAL HYSTERECTOMY UNDER SPINAL ANESTHESIA: REPORT ON A CASE

The Journal-Lancet

March 1, 1915

A NEW REMEDY FOR PYORRHEA ALVEOLARIS

LOWERING THE MILK GRADE

“LEAVES OF HEALING!”

OWNERSHIP OF THE JOURNAL-LANCET

MISCELLANY

REPORTS OF SOCIETIES

MINNESOTA ACADEMY OF MEDICINE

CORRESPONDENCE

THE LOYALTY OF NURSES

BOOK NOTICES

NEWS ITEMS

The Battle Creek Method in Diabetes

PUBLISHER’S DEPARTMENT

QUAKER OATS

ELECTRO-THERAPY

BOREMETINE—A NEW EMETINE PREPARATION FOR PYORRHEA

OCONOMOWOC HEALTH RESORT

BATTLE CREEK SANITARIUM

ARMOUR & COMPANY

THE DELICATE SCHOOL GIRL

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FEEDING OF THE HEALTHY INFANT [1]

By E. J. Huenekens, A. B., M. D. Instructor in Pediatrics, University of Minnesota MINNEAPOLIS

[1] Read before the Hennepin County Medical Society, Nov. 2, 1914.

The science of infant-feeding has been revolutionized in the last twenty years, and, in the process, it has advanced too radically in many directions. Lately, the pendulum has been swinging backward, so that the most advanced knowledge of today probably represents a middle ground between extreme radicalism and extreme conservatism. In no other direction is this more manifest than in the feeding intervals. The religious adherence to the four-hour feeding interval is giving way to a more rational system. I am one of the firmest adherents of the longer interval: the food is better digested, the stomach has a period of rest, and the general well-being of the infant is better furthered than with more frequent feedings. But there are certain infants who do not receive enough nourishment in this interval, especially young breast-fed infants in whom it can be demonstrated by accurate weighing, before and after nursing, that they receive considerably more milk in twenty-four hours with the three-hour interval. This is the more important in that Rosenstern has demonstrated that a large proportion of infants up to the age of six weeks require more than the usual 100 calories per kilogram of body-weight. One hundred calories represents 150 grams of breast-milk, so that a five-kilo, or eleven-pound, baby should receive a minimum of 750 c.c. of breast-milk in twenty-four hours.

By far the best food for the healthy infant in every way—and this cannot be emphasized too strongly—is mother’s milk. There are certain alimentary disturbances in which it may be advisable to replace breast-milk with certain artificially prepared foods, such, for instance, as albumin milk in alimentary intoxication; but this is never true of the normally healthy infant. While, as regards growth and freedom from digestive disturbances, certain artificially prepared foods may, when used with exceeding care, produce as good results as breast-milk; nevertheless, this is only one function of breast-milk. The other function which can be imparted to no artificial food is the passive immunization of the child against infection. Ehrlich (Zeit. f. Hyg. u. Infectionskr., 1892, xii, 183) has proved that antibodies, antitoxin, and agglutinins are transmitted directly through the milk from mother to child; and it has been shown that the blood of a breast-fed child is considerably more bactericidal than the blood of a bottle-fed infant.

The practice of weaning the baby for trivial reasons has increased in the last decade, and can be laid largely at the door of the medical profession. For all practical purposes the only absolute indication for weaning the baby is open tuberculosis in the mother. For the last few years I have been making a systematic inquiry at the University Dispensary and Infant Welfare Stations as to reasons for weaning young infants; and in nine cases out of ten, the answer has been that “the milk gave out.” In only a very small proportion of cases has an ordinarily well-nourished mother insufficient milk; far oftener the fault lies with the child. Insufficient and late development of the sucking reflex prevents these infants from completely emptying the breast, which in time “dries up.” This period can be tided over by nursing from both breasts, by temporarily increasing the number of nursings, or temporarily employing “allaitement mixte.” In cases in which, after long, patient effort the supply of milk is still insufficient, either supplementary or complementary feeding of cow’s milk can be given. Where this mixed feeding is employed a minimum amount of cow’s milk should be given; and the opening in the nipple should be as small as possible, otherwise the child gets too much cow’s milk, and with too little effort, and gradually refuses the breast.

Another excuse, and one fostered to some extent by physicians, is, that certain breast-milks are “poison for the baby.” This has even less foundation in fact; and here again the fault must be looked for in the baby rather than in the mother. Outside of certain variations in the fat-content, all breast-milks are alike in composition. In proof of this Finkelstein has fed these babies at the breast of tried wet-nurses with absolutely no benefit, while the children of the wet-nurses would thrive at the breast of the “poison-milk mother.”

Abscess of both breasts may force a temporary cessation of nursing, but the breast should be regularly emptied until the inflammation has subsided; and then the nursing should be re-established. Cracked or sunken nipples may render nursing impossible, but they do not stop the flow of milk. In both these latter conditions the milk may be manually expressed or removed with the breast-pump. In this connection I wish to recommend the improved Jaschke pump, in which, by means of a releasing valve, the sucking movements of the child can be very closely imitated.

Where artificial feeding must be started early, cow’s milk is almost universally employed. Whenever possible, “certified milk” should be used; the ordinary milk, however, can be boiled with little or no harm. In diluting and preparing this milk, we have the choice of several methods. The so-called percentage feeding, favored in America, is difficult and cumbersome, and has no advantages over its simpler rivals. Pfaundler’s rule may be safely employed. It is as follows: One-tenth body-weight of milk, one one-hundredth body-weight of sugar diluted up to one liter; give 200 c.c. five times in twenty-four hours. Even simpler is the following: One-third milk for the first month, one-half for the second month, two-thirds for the third and fourth months, each with the addition of 4 to 6 per cent sugar. Either milk-sugar or ordinary granulated sugar may be employed. The malt sugars and extracts should be reserved for sick children. After the second month, oatmeal water may be used as a diluent in place of plain water.

Recently Friedenthal, a Berlin physiologist, has attempted an exact imitation of mother’s milk, including that important element, the salt, which had, until recently, been entirely neglected. Langstein is very enthusiastic over this milk as a food for healthy infants; but Finkelstein, in a personal communication, assured me that it has not as yet proved itself. Schloss, dissatisfied with the results of the Friedenthal milk, has modified it in the direction of casein milk by replacing the milk-sugar with the malt preparations, and increasing the protein content. He claims good results, and is supported by Leopold, of New York, who has used it extensively. But we must leave the final word as to both these milks for the future to decide. From the sixth to the ninth month for both breast-fed and bottle-fed babies, cooked cereals, toast, and vegetables should be gradually added to the diet. At the ninth month, unless this is one of the hot summer months, the nursling should be weaned, and a small amount of cow’s milk substituted. The weaning should be gradual by omitting one nursing period each week. The one important exception to the foregoing rules for the first year of life, is the premature infant. In the ninth month of fetal life, reserves of calcium and iron are stored up in the body, which the infant gradually uses up during the first nine months of extra-uterine life. The premature infant lacks this store, and manifests it in different ways. As early as the second or third month a breast-fed premature infant may develop a most extensive craniotabes. This is not due to a true rachitis, i.e., disturbance of calcium metabolism, but to a want of calcium in the body. Small amounts of cow’s milk, which contains much more calcium than human milk, or calcium in the form of calcium lactate or chloride, will remedy this condition. A similar process happens in the case of iron. The premature infant is born with a hemoglobin percentage of 100 to 110; by the third or fourth month this may sink to 40 per cent, and for this reason green vegetables should be added to the diet as early as the fourth month.

The diet of healthy children in the second year should include cooked cereals, vegetables, toast, cooked fruits, and meat-juices; and the quantity of cow’s milk should be limited to one and one-half pints in twenty-four hours. The question of the addition of meat to the diet is important. Some authors have recently advocated the giving of meat as early as the ninth month. During the past year, working in Finkelstein’s laboratory, I have been able to gather some facts which have a direct bearing on this question. (Zeitschrift für Kinderheilkunde, July, 1914.) By means of the new electrometric determination of absolute acidity (that is, the number of H ions), I was able to show that the acidity of the stomach before the eighteenth month of life is insufficient to permit any peptic, i. e., protein, digestion. Solomon, working in the same clinic, in a report not yet published, has shown the same thing from a clinical standpoint. He found that on a meat diet up to the end of the second year large quantities of muscle fibers passed through with the bowel-movement unchanged; but after that age they rapidly decreased in number. It is, therefore, worse than useless to add meat to the diet before the beginning of the third year.

Eggs frequently produce profound disturbances in young infants, perhaps on account of the absorption of egg albumin, unchanged, in the blood-stream; and they should be kept from the diet-list until the beginning of the fourth year.

These rules for feeding are generalized, and there may be many exceptions. Each child is to some extent a law unto itself, and this is especially true of those children with nervous or exudative diathesis.

In conclusion, I wish to make a plea for greater uniformity in our rules for infant-feeding. Even more than in strictly medical affairs has the public the right to demand information. Heretofore, every new book and every public lecture on infant-feeding has deviated markedly from its predecessors, until the confused laity, and even general practitioners, have turned in disgust to proprietary foods and formulas. Pediatrics is a new science, and as such is bound to undergo rapid changes and conflicting opinions. But that need not hinder us from agreeing on certain fundamental facts which can be given as guides to the general practitioner and to the public.

I believe that the simple rules for infant-feeding here laid down are neither too conservative nor too radical to serve as a basis of agreement upon which the medical profession may show to the public a united front on this important question. Such uniformity of opinion—and the sooner it can be reached the better—will not fail to have a beneficial effect on both the profession and the public.

DISCUSSION

Dr. Jacob Hvoslof: I would like to ask about the value of lime-water added to the milk. I recently had an experience where I mixed an ounce of lime-water to a pint of milk, as I thought that would improve it. but for some reason or other the baby would not digest his milk. After a while I left the lime-water out, and everything went well. Whether this is a “post” or “propter” I should like to find out.

Dr. O. R. Bryant