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Hygiene of the Nursery.

Chapter IX.

Dietary.

In the preceding chapter so much attention has been devoted to the subject of the artificial feeding of infants, and so many formulas have been given for the preparation of cows' milk as a substitute for the natural food, or human milk, that it will only be necessary here to refer briefly to a few milk mixtures, some of which have been recommended by other writers. After describing these, the methods of peptonization will be discussed, and, finally, the mode of preparing a number of dishes adapted to the nursery whether occupied by well or ill children. In regard to the latter, however, the dishes that ordinarily come upon the table will not be referred to, as any good cook ought to know how to make them.

Milk Foods.

Arrowroot Food.

Milk,
Cream,
Lime water,
Arrowroot water ... Of each 2 tablespoonfuls.
Sugar... 1 teaspoonful.

This is the later Dr. J. F. Meigs' formula for a child of about nine months of age. The arrowroot water is made in the proportion of one teaspoonful of arrowroot to a pint of boiling water.

Chavasse's Milk Food.

New milk,
Water, warm... Of each equal parts.
Table salt ... A small pinch.
Lump sugar ... A sufficient quantity to slightly sweeten the mixture.

Let the milk and water be of the same temperature -- 90° F. -- before mixing. This preparation does well for a child of three or four months; the total quantity for each meal being from eight to twelve teaspoonfuls.

Condensed Milk.

Condensed milk ... 1 teaspoonful.
Water ... 6 tablespoonfuls.

Use hot water; mix by stirring and let the temperature fall to ordinary heat before administration.

Milk and Cinnamon.

Milk sugar ... 1 teaspoonful.
Brandy ... 1 teaspoonful.
Milk ... 1/2 pint.
Powdered cinnamon ... A sufficiency to flavor.
Mix thoroughly.

Useful in diarrhoea; may be administered warm or cold.

Milk and Oatmeal.

Bethlehem oatmeal (fine powder) ... 1 teaspoonful.
Water ... 2 tablespoonfuls.
Milk ... 5 tablespoonfuls.
Cream ... 1 tablespoonful.
Sugar of milk ... 1 teaspoonful.

Heat the water just short of boiling; stir in the oatmeal slowly until a smooth white mixture is obtained; then add the other ingredients.

This is adapted for an infant of three months, and forms a useful mixture in cases of constipation.

Milk-Sugar Food.

Milk ... 1 tablespoonful.
Cream ... 2 tablespoonfuls.
Lime water ... 2 tablespoonfuls.
Milk-sugar solution ... 3 tablespoonfuls.

For a child under a month, quantity to be increased as age advances, but no change to be made in quality until after the eighth or ninth month.

The milk-sugar solution consists of 17 3/4 drachms -- a little over 17 teaspoonfuls of milk sugar to a pint of pure water.

This is the food recommended by Dr. A. V. Meigs.

Milk and White-of-Egg Food

The whites of three eggs.
Lime water ... 3 tablespoonfuls.
Milk ... 1 pint.

Shake the egg and lime water forcibly together for five minutes; then add the milk slowly with constant stirring, occupying ten minutes in the process; keep in a cool place.

Peptonized Foods.

For the process of peptonization, or predigestion, the Extractum Pancreatis, prepared by Fairchild Bros. and Foster, of New York, gives, in my experience, the most satisfactory results, and in all the receipts given below, this preparation is to be used.

Peptonized Milk, No. 1.

One peptonizing tube.
Water ... 1 teacupful.
Milk, fresh and cold ... 1 pint.

Put the powder contained in the tube into a clean quart bottle; add the cold water and shake well; then pour in the milk and shake the mixture thoroughly again. Place the bottle in water of about 115° F., or so hot that the whole hand can be held in it without discomfort for a minute, and keep the bottle there for about twenty minutes. Then put the bottle in contact with ice to check further digestion and keep the milk from spoiling.

Peptonized milk should have a slightly, but not decidedly, bitter taste. It may be made palatable by serving with grated nutmeg, sugar, or a little brandy, or it may be taken with Apollinaris or Vichy water. In the latter case put the water first into the glass, then pour in the peptonized milk and drink while effervescing.

Peptonized Milk, No. 2.

Mix the peptonizing powder, water and milk in a bottle, and place in a hot-water bath exactly as directed in the above. Let the bottle remain in the hot water for two hours, then pour into a saucepan and heat to boiling. This specially peptonized milk is used in making jellies, etc. It may be immediately used if required hot, or set aside on ice for punches, etc.

The object of raising the liquid to the boiling point is to abolish the activity of the pancreatin, so that it may not act secondarily upon other substances prepared with the milk.

Slight Peptonization.

Take the same ingredients and mix them as before, but immediately put the bottle on ice without subjecting it to any further heat.

This preparation is useful in cases of enfeebled digestive power, or as a means of returning from predigested, to ordinary milk. It has no especial taste.

Peptonized Milk Gruel.

One peptonizing tube.
Wheat flour or arrowroot ... 1 heaping teaspoonful.
Water, cold ... 1/2 pint.
Milk, cold ... 1 pint.

Make a smooth mixture of the arrowroot and water; heat this with constant stirring until it has boiled briskly for three minutes; next add the milk; strain into a pitcher and stir in the peptonizing powder; let the mixture stand in the hot-water bath, 115° F. for thirty minutes; then pour into a clean bottle and place on ice.

Peptonized Milk Punch.

Fill an ordinary thin glass tumbler one-third full of cracked ice; pour on it from one to four teaspoonfuls, according to the child's age, of St. Cruix rum, and a dash of curaçoa; add sugar to taste, and then fill the glass with peptonized milk; shake well and grate a little nutmeg on top; strain.

Effervescing Milk Punch.

Prepare the tumbler and ice as in the above, squeeze in the juice of half a lemon, add sugar to sweeten, and fill the glass with half Apollinaris and half peptonized milk. The milk used in this punch must be prepared by the second process.

Peptonized Beef Tea.

To one-quarter of a pound of minced raw beef, entirely free from fat, add one-half pint of cold water; cook over a slow fire, with constant stirring, until it has boiled a few minutes, then pour off the liquor and beat or rub the meat to a paste; put the latter into a jar with one-half pint of cold water, and pour in the liquid previously obtained. Add to this mixture thirty grains of Extract of Pancreas and twenty grains of bicarbonate of sodium; shake all well together, and keep at a temperature of 110° F., stirring occasionally, for three hours. Next boil quickly, strain, and serve as required.

Peptonized Oysters.

(Originally suggested by the late Dr. N. A. Randolph.)

Take half a dozen large oysters with their juice and half a pint of water. Heat in a saucepan until they have boiled briskly for a few minutes. Pour off the broth and set aside. Mince the oysters fine in a wood bowl, and reduce them to paste with a potato masher. Next put the oysters in a glass jar with the broth that has been set aside and add the contents of a peptonizing tube. Let the jar stand in hot water or in a warm place, where the temperature is not above 115° F., for one and a half hours. Next pour into a saucepan and add half a pint of milk; heat over the fire slowly to boiling point, and flavor with salt to taste, and serve hot.

"Humanized Milk."

Peptogenic milk powder ... 1 measure
[the proper measure is furnished with each box of powder]
Milk, fresh and cold ... 4 tablespoonfuls.
Water ... 4 tablespoonfuls.
Cream ... 1 tablespoonful.

Heat cautiously over a flame for six minutes, stirring cautiously with a spoon and tasting often, so that it shall not get too hot to be sipped -- 115° F. Then put into a nursing bottle, let it cool somewhat, and it is ready for administering. The cup should be held by the hand, over the flame, thus making it easy to regulate the heat to which the milk is exposed.

It is important to follow these directions absolutely, for should the temperature of the mixture not be maintained at a sufficiently high point, the Pancreatin contained in the powder will perform its work imperfectly; on the other hand, should the heat be too great all digestive activity will be suspended.

Humanized milk so prepared is adapted to the average infant's digestion. As age advances, the proportion of milk must be increased and the total quantity of the mixture augmented. As an increase in quantity is made, it is necessary to preserve the relations of the peptogenic powder to the liquid; namely, one measure to each four ounces and a half.

Sometimes it will be found necessary to carry the process of predigestion further than can be accomplished by following the directions already given. This may be readily done by increasing the length of the time of heating. One can thus easily produce in the milk any degree of change up to complete peptonization, when the liquid becomes clear and very bitter. Conversely, when it is desirable -- in case of returning health, for instance -- to resume a plain milk diet, the time of heating is gradually shortened until the powder is added to the milk mixture just at the time of feeding. When the time comes to abandon the digesting powder entirely, it is most important to supply its place in the food by an equal bulk of milk sugar.

The milk and cream referred to are of such quality as can be obtained from a reliable city server; extra rich milk or cream may, under some circumstances, require to be more diluted.

Meat Broths, Etc.

Beef Tea, No. 1.

Take one pound of lean beef and mince it; put it, with its juice, into an earthen vessel containing a pint of clear water at a temperature of 85° F., and let the whole stand for one hour. Strain well through stout muslin, squeezing all juice from the meat; place on the fire, and, while stirring briskly, slowly heat the liquid just to the boiling point. Then remove at once and season with salt.

When administering this, be careful to stir up whatever sediment may be present.

Beef Tea, No. 2.

Take half a pound or a pound -- according to strength required -- of rump steak; cut it into small pieces; free it completely from fat and tendon, and put it, with one pint of clear, cold water, into a covered saucepan. Place by the side of the fire for five hours; then let it simmer gently for two hours, and finally skim thoroughly. The meat used should be as fresh as possible, and the saucepan should be of copper or tin, or be enameled on the inner surface.

Beef tea must never be allowed to boil, and in reheating be careful to raise it only to the proper point for drinking.

Beef Tea in Fifteen Minutes.

Scrape one pound of lean beef into fibres, and, after placing it in a clean saucepan, pour on half a pint of boiling water; then cover the saucepan closely, and place it by the side of the fire for ten minutes; next strain into a teacup; place this in a basin of ice-cold water and remove all fat from the surface of the liquid, first with a spoon and finally with a piece of stale bread or blotting paper; then pour into a warm cup and heat gently to the temperature for drinking.

Beef Essence, No. 1.

Thoroughly mince one pound of rump steak; place it with three tablespoonfuls of water in a mortar; pound it well and put it aside to soak for two hours. Then put it, with a pinch of salt, in a covered earthen jar; cement the edges of the cover with dough and tie a piece of cloth over the top. Place the jar in a pot half full of boiling water, and keep the whole on the fire, simmering, for four hours. Then, through a coarse sieve, strain off the liquid essence, which will amount to about six ounces.

One teaspoonful will be sufficient for a young child.

Beef Essence, No. 2.

Half a pound of fresh beef must be minced as finely as possible; add to this half a pint of pure cold water, an eggspoonful of salt and five drops of pure muriatic acid. Mix well, and after standing an hour, pass through a conical sieve without pressure, refiltering until the liquid runs clear. Next, a second half pint of water is poured on the residue upon the sieve and allowed to filter through without pressure.

The dose of this is two tablespoonfuls for a child of twelve years, a teaspoonful for one under one year.

Raw-Beef Juice.

Take one pound of sirloin of beef; warm it in a broiler before a quick fire; cut into cubes of about one-quarter of an inch, and after placing in a lemon squeezer or meat press, forcibly express the juice; remove the fat that rises to the surface after cooling.

This may be given warm, or cold, and seasoned with a little salt, in doses of one teaspoonful every two hours to a child of six months to a year old.

The meat must never be actually cooked.

Clear Brown Soup.

Cut a shin of beef into pieces; put it into a saucepan with just enough water to cover it; when it boils, skim it, and add a bundle of sweet herbs, a little turnip, carrot, onion and celery, and a little pepper and salt. Let the whole boil until the meat is quite tender; then strain, and let it stand until the next day. After clearing it thoroughly from fat, heat it again, adding as much browning as will make the soup the color you like. Beat up two eggs, with their crushed shells, till they are quite a froth. Put them into the soup with a whisk; let it boil gently for ten minutes; then strain it through a cloth, and it will be perfectly bright. (Dr. Ellis.)

Consommé.

Make a beef broth by taking one or two pounds of beef, according to the strength required, from the leg, round or chuck; wash well; cut in pieces and put on to boil in three quarts of cold water. While boiling, skim frequently, and when reduced to one quart, take from the saucepan and strain; after which return to the saucepan with a few thin slices of onion, and half a pound of lean beef, chopped fine, and well mixed with three raw eggs; beat all thoroughly with the broth, which is to be returned to the fire and boiled for about half an hour, or until perfectly clear.

Chicken Broth.

A small chicken, or half of a large fowl, thoroughly cleaned, and with all the skin and fat removed, is to be chopped, bones and all, into small pieces; put these, with a proper quantity of salt, into a saucepan and add a quart of boiling water; cover closely and simmer over a slow fire for two hours; after removing, allow to stand, still covered, for an hour, and strain through a sieve.

Mutton Broth.

Lean loin of mutton ... 1 pound (exclusive of bone).
Water ... 3 pints.

Boil gently until very tender, adding a little salt of onion, according to taste; strain into a basin, and, when cold, skim off all the fat. Warm, when served.

Should barley or rice be added, they must be first separately and thoroughly boiled, and added when the broth is heated for use.

Veal Broth.

Lean veal ... 1/2 to 1 pound, according to strength required.
Cold water ... 1 pint.

Mince the meat; pour upon it a pint of cold water; let it stand for three hours; then slowly heat to boiling point, and after boiling briskly for two minutes, strain through a fine sieve and season with salt.

Oyster Soup.

Drain one pint of oysters through a colander for five minutes, to remove the liquor, and then pour over them one pint of boiling water, which must be thrown aside; add to the liquor already drained a pint of boiling water and put over the fire in a porcelain-lined saucepan. Boil until all the scum has risen and been skimmed off; then add half a pint of fresh milk, one water cracker rolled to a powder, a piece of butter, and a little salt and pepper; boil ten minutes, and just before the soup is to be served turn in the oysters from the colander and let them scald for three minutes.

Arrowroot Pudding.

Mix a tablespoonful of arrowroot with cold water; put it over the fire in a porcelain-lined saucepan; add a pint of boiling milk -- stirring constantly -- and one egg well beaten with a tablespoonful of white sugar; let it boil five or ten minutes.

If baked pudding be preferred, it may be mixed in the same way and baked, in a moderately quick oven, for twenty or thirty minutes.

Blanc Mange.

Gelatine ... 1/2 ounce.
Water ... 1/2 pint.
Cream ... 1 pint.
White sugar ... 3 ounces.
Extract of lemon ... Sufficient to flavor.

Dissolve the gelatine in the water by means of heat, meanwhile whipping the cream and sugar together and adding the lemon. Next, while the gelatine solution is still warm, pour in the cream slowly, and beat until stiff enough to drop from the spoon; finally pour in moulds.

Milk may be used instead of water in this preparation.

Hominy Grits.

Two tablespoonfuls of hominy, having been boiled soft, are rubbed up with butter until quite light; then, half a pint of boiled milk is added slowly, with constant stirring; next strain through a sieve and boil again; flavor with sugar or salt, and serve hot. Rice may be prepared in the same way.

Junket.

Milk ... 1 pint.
Essence of pepsin (Fairchild's) ... 2 teaspoonfuls.
(Wine of pepsin or liquid rennet may also be used.)

Heat the milk just to a temperature that can be readily borne in the mouth, and add, with gentle stirring, the curdling agent; allow to stand until firmly curded, and serve with sugar, nutmeg, or cream as desired.

Junket with Egg.

A good custard may be made by adding two eggs, beaten to a froth and sweetened with four tablespoonfuls of sugar, to the pint of milk, and then curdling with essence of pepsin. It is well to pour this, when prepared, into coffee cups, one of which will be enough to serve at a time.

Milk and Gelatine.

Gelatine ... 1 tablespoonful.
Barley water, hot ... 1/2 pint.
Powdered sugar ... 2 tablespoonfuls.
Milk ... 1 pint.

Dissolve the gelatine in the hot barley water, add the sugar, and then the milk; stirring all together.

Rice-Milk.

Rice ... 2 tablespoonfuls.
Corn-starch ... 1 teaspoonful.
Milk ... 2 pints.

Boil in a farina boiler until each grain of rice becomes saturated, and the whole creamy in color.

Rice Pudding.

Take three ounces of rice, and swell it very gently in one pint of new milk. Let it cool; then stir into it one ounce of fresh butter, two ounces of pounded sugar, the yelks of three eggs, and some grated lemon rind. Pour this into a well-buttered dish, but do not quite fill it, and then lay lightly over the top the whites of three eggs which have been well beaten up with three tablespoonfuls of sifted sugar. Put the pudding directly into the oven, the heat of which must be moderate, and bake it for about twenty minutes, or till the egg crust has become lightly browned.

Oatmeal Gruel.

Mix a large tablespoonful of oatmeal with two tablespoonfuls of cold water, stirring to bring to a state of uniformity; this pour into a pint of boiling water in a saucepan, and boil and stir well for ten minutes. Flavor with salt or sugar.

If the boiling be continued for half an hour, the mixture thickens into a porridge.

Sago Jelly.

Take two tablespoonfuls of sago; wash carefully; soak for four hours in a half pint of cold water, and then add half a pint of hot water, a pinch of salt, a tablespoonful of sugar and a little grated lemon peel; boil gently fifteen minutes, stirring constantly. A little port wine or sherry may be added just before removing from the fire.

May be served hot or cold.

Tapioca.

Wash tablespoonfuls of the best tapioca; soak in fresh water over night; add a little salt, a pint of milk or water, and simmer until quite soft, stirring frequently if milk be used; then pour into a bowl and stir while cooling, at the same time adding sugar, some flavoring substance and wine if required.

Tapioca Pudding.

Beat the yelks of two eggs with half an ounce of sugar; stir into a pint of tapioca mucilage made with milk, as directed above, and bake in a slow oven.

Egg-and-Brandy.

Brandy ... 8 tablespoonfuls.
Cinnamon water ... 8 tablespoonfuls.
The yelks of two eggs.
White sugar ... 1 tablespoonful.

Rub the yelks and sugar together; then add the cinnamon water and spirit.

A dessertspoonful to two tablespoonfuls may be given every two hours, according to the age of the child.

Wine Whey.

Boil a pint of fresh milk; while boiling, pour in eight tablespoonfuls of sherry wine; bring it to the boil a second time, being careful not to stir it; so soon as it boils, put it aside until the curd settles, and pour off the clear whey.

Flaxseed Tea.

Whole flaxseed ... 1 ounce.
Bruised licorice root ... 2 teaspoonfuls.
Water, boiling ... 1 tablespoonful.

Pour the boiling water over the flaxseed and licorice; cover lightly; digest for three hours near a fire, and strain. Two tablespoonfuls of lemon juice may be used as the flavor, instead of the licorice.

The following preparations are useful as additions to milk in bottle feeding:--

Caraway Water.

Caraway seeds, crushed ... 2 tablespoonfuls.
Water ... 1 pint.

Enclose the seeds in a small muslin bag, and boil in the water until the latter is reduced to half a pint.

One or two teaspoonfuls may be added to the bottle in case there be colic.

Barley Water.

Put two teaspoonfuls of washed pearl barley into a saucepan with a pint of clear water, and boil slowly down to two-thirds of a pint; strain through muslin.

Employed to prevent the formation of large, compact curds.

Gelatine.

Put a piece of plate gelatine, an inch square, into half a tumblerful of cold water, and let it stand for three hours; then turn the whole into a teacup, place this in a saucepan half full of water, and boil until the gelatine is dissolved. When cold, this forms into jelly.

From one to two teaspoonfuls may be added to each bottle of milk food.

Employed for the same object as the above.

Flour Ball.

Take a pound of good wheat flour -- unbolted, if possible -- tie it up very tightly in a strong pudding-bag; place it in a saucepan of water and boil constantly for ten hours; when cold remove the cloth; cut away the soft outer covering of dough that has been formed, and reduce the hard, baked interior by grating.

In the yellowish-white powder obtained, almost all the starch has been converted into dextrine by the process of cooking, and the proportion of the nitrogenous principle to the calorifacient is as one to five -- nearly the same as in human milk.

This acts both mechanically and as a food.

Lime Water.

Take a piece of unslaked lime as large as a walnut; drop it into two quarts of filtered water contained in an earthen vessel; stir thoroughly; allow to settle, and use only from the top; replacing the water, and stirring as consumed.

Oatmeal Water.

First prepare an oatmeal porridge; take a heaping teaspoonful of this, put it into a quart of cool water, heat, with constant stirring, to the boiling point, and strain.

This may be used in milk foods as a substitute for ordinary water if constipation be present.

Pearl Barley Jelly.

Put two tablespoonfuls of washed pearl barley into a quart saucepan with a pint and a half of clear water and boil slowly down to a pint; strain, and allow the liquid to set into a jelly.

Used for the same purpose as barley water.

Rice Water.

Put two tablespoonfuls of rice, thoroughly washed, into a quart of water and place near the fire, where it may soak and be kept warm for two hours; then boil slowly for one hour, or until the water is reduced one-half, and strain.

Useful as a diluent for milk in cases of diarrhoea.

Whey.

Milk ... 1 pint.
Essence of pepsin (Fairchild's) ... 2 teaspoonfuls.

Heat the milk up to a point that can be agreeably borne by the mouth, and add the pepsin with gentle stirring; let the whole stand until firm coagulation has taken place; then beat with a fork until the curd is finely divided, and strain.

Nutritious Enemata

The process of peptonization, already described, is very useful in the preparation of food for absorption by the lining membrane of the rectum. Any of the predigested foods may be used in this way, the only caution being to administer them in small quantities -- not over four tablespoonfuls -- and at intervals of not less than four hours. It is essential, too, in rectal feeding to keep the lower bowel clear by a daily laxative injection of warm water.

When the materials for proper peptonizing are not at hand, one of the following enemata may be used with advantage:--

Meat Enema with Pepsin.

Essence of meat, No. 2 ... 8 tablespoonfuls.
Gelatine ... 1 tablespoonful.
Pepsin ... 4 grains.
Muriatic acid ... 4 drops.

First mix the essence and gelatine, and warm in a water bath at 112° F.; then dissolve the pepsin in a teaspoonful of warm water by the aid of the acid; stir it into the first mixture and let the whole remain warm for two hours.

Administer warm with two drops of laudanum to secure retention.

The bulk of this enema is adapted for a child of eight to twelve years.

Beef-Tea and Brandy Enema.

Strong beef tea ... 3 tablespoonfuls.
Cream ... 1 teaspoonful.
Brandy ... 1 teaspoonful.

Stir all together, and administer gently and slowly.

Should this injection not be retained, add two drops of laudanum at each administration.

The best syringe for these injections is shown in Fig. 22.

Figure 22. Syringe for nutritious enemata.


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