PEDIATRICS 
1896, i, 1. 
INFANT FEEDING-A REVIEW. 
By A. JACOBI, M. D. 
Clinical Professor of Diseases of Children in Columbia College, New York INFANT FEEDING—A REVIEW. 
A. JACOBI, M. D.( 
Clinical Professor of Diseases of Children in Columbia College, New York. 
IN the last decade great and successful strides have been made 
in medical therapeutics as well as in surgical. The former 
have been improved partly through the aid of phar- 
maceutical preparations and of the products of biological 
research, partly through new methods and appliances for 
hygienic and preventive purposes. It is mainly the infectious 
diseases which have been served by the former, and both public 
and individual hygiene by the latter. Early life has been par- 
ticularly benefited, and by nothing more than by careful 
endeavors to improve the diet of the young, and thereby to 
remove the dangers of intestinal disorders and the sources of 
excessive mortality. 
Sterilization.—Nothing has been more successful in that direc- 
tion than the widespread practice of sterilization (and pasteur- 
ization) of cow’s milk. Both are the logical development of the 
plan of treating milk by boiling, which I persistently advised 
these thirty-five years at least, and detailed in my “Infant 
Diet,” in Gerhardt’s Handbook, in Buck’s Hygiene, in “Intes- 
tinal Diseases of Infancy and Childhood ” * and in my clinical 
lectures delivered during the last third of a century. 
Now what is it that boiling can and will do ? Beside expel- 
ling air it destroys the germs of typhoid fever, Asiatic cholera, 
diphtheria and tuberculosis, also the oidium lactis which is the 
*P. 18. “After boiling, milk destined for the use of a baby during the day 
should be kept in clean bottles containing from three to six ounces, filled up to 
the cork, and the bottles then turned upside down in a cold place; such will 
keep longer than milk preserved in the usual way. Before being used it should 
be heated in a water bath; and by repeating this heating of the whole amount 
of the day’s milk, several times during the twenty-four hours, fermentation 
will be retarded, and digestibility improved.” 2 
PEDIATRICS 
cause of the change of milk sugar into lactic acid and of the 
rapid acidulation of milk with its bad effects on the secretion of 
the intestinal tract. Some varieties of proteus, and most of 
bacterium coli are also rendered innocuous by boiling. Thus 
it prevents many cases of infant diarrhoea and vomiting—not all 
of them. For the most dangerous of all the bacteria are not 
influenced either by plain boiling or the common methods of 
sterilization. Besides, “diarrhoea” is but a symptom of many 
causes, and “cholera infantum” is a name for a condition 
occasioned by many. Ebstein emphasizes the fact that babies 
at the breast are subject to cholera infantum, particularly in 
southern climates, also in public institutions. The influence of 
external temperature is a very important factor; its sudden 
changes produce intestinal disorders. Babies, taken from a hot 
railroad car to the deck of a lake steamer, from a warm bed to a 
draughty room, may develop a catarrhal enteritis which disposes 
to worse forms of disease. For the morbid condition of the 
epithelium caused by such sudden changes is a proximate cause 
of disease because it opens the way to all sorts of infecting sub- 
stances. Poisons in the food of cows, indigestible baby foods— 
either indigestible per se, or through a morbid condition of the 
digestive organs—produce diarrhoea of many varieties. It need 
not even depend on ingested food; for according to W. Scliild’s 
recent investigations (Zeitsch. f. Hyg. u. Infect XIX.) germs of 
diseases may be found in the intestine of the newly born in from 
ten to seventeen hours after birth (min. 4, max. 20). The 
meconium of the newly bora being free of germs, is supplied 
through the mouth with the bacterium coli and through the 
anus with the bacillus fluorescens, subtilis and proteus (even 
adults are infected through the same inlet). Linen, the bath, 
the air, the blood are sources of local invasion. In such cases, 
what is the sterilization of artificial food to accomplish ? They 
are not reached by it. 
Not even the natural food, breast-milk, is free of germs 
possibly attended with dangers. M. Cohn and H. Neumann 
found germs in the healthy breast-milk even after the mamma 
and nipples had l>een washed with alcohol and with solutions of 
corrosive sublimate. A. Palleske met with the staphylococcus 
pyogenes albus in one-half of all healthy women, F. Honigmann 
(Z. f. Hyg. u. Inf. XIV) in most of them, and H. Knocheustein 
(Inaug. Diss. 1893) in the mammae of eight puerperal and 
nursing women. Evidently they had immigrated from outside; 
they proved innocuous. But who can doubt but that if the 
epithelium of the milk ducts had been morbid, there would 
have been a chance for a mastitis, or if the staphylococcic milk 
had got into contact with a sore stomach or intestine, there 
would have been an opportunity for gastritis or enteritis. 
Nor is boiling, nor sterilization, a safe protection under all PEDIATRICS 
3 
circumstances. Aerobic bacteria, the so-called hay or potato 
bacilli, with very resistent spores, which are found in cow dung 
and in the dust of stables, of the soil and streets, and of hay, 
peptonize casein and liquefy it and render the milk bitter. 
They are very poisonous; their pure culture gives young dogs a 
fatal diarrhoea. It takes hours of sterilization to kill them; in 
some instances it required five or six hours. Even the bacillus 
butyricus takes an hour and a half. But such a protracted 
sterilization, beside being far from certain in its effect, is at all 
events a clumsy procedure and one not calculated to benefit the 
milk. Thus hay feeding is an absolute necessity, for the bacilli 
are destroyed by a six weeks’ drying. Besides, it is urged to 
keep the stables carefully clean, to avoid dirt and dust, to 
employ peat instead of straw for bedding, to wash the udder and 
tie the tails before milking, to waste the first milk, and to re- 
move foreign material from the milk by centrifuging. But no 
absolute security can be guaranteed. That is why Flugge adds 
to his expositions a warning against some wholesale manu- 
facturers who, always anxious about somebody’s—their own— 
welfare are known to conceal by coloring the glass of their 
bottles the changed condition of the milk and the separation of 
butter particles. 
Whatever I have here brought forward, is certainly not to dis- 
parage the boiling of the milk; it is meant to prove the danger 
of relying on a single preventive when the causes of intestinal 
disorders are so many. It is true, however, that the large 
majority of the latter depends on causes which may be met by 
sterilization; but not by sterilization only; also by pasteuriza- 
tion, that is, heating the milk to 70° C=165° F, and keeping 
it at that uniform temperature for thirty minutes—a procedure 
which destroys the same germs that are killed by a more 
elevated temperature, without much change in flavor and taste. 
One of the questions connected with the employment of 
sterilized or pasteurized milk is this, whether the milk to be 
used for a child ought to be prepared at home, or whether the 
supply may be procured from an establishment wdiere large 
quantities of milk believed to become immutable by sterilization 
for an indefinite period, are kept for sale. In regard to this 
problem Flugge plaintively expresses his regrets that “we have 
allowed ourselves to be guided by people who are neither 
hygienists nor physicians, but chemists, farmers, or apothecaries, 
and whose actions have been based on three false beliefs. Of 
these the first is that boiling for three-quarters of an hour 
destroys germs, the second that whatever bacteria remain 
undestroyed are innocuous, and the third, that proliferating 
bacteria can always be recognized by symptoms of decomposi- 
tion.” Nothing is more erroneous. Soxhlet himself, the German 
originator of sterilization, knew at an early time, that the fer- 4 
PEDIATRICS 
meriting process is now and then but partially interrupted by 
boiling, that butyric acid may be found in place of lactic acid, 
that a strong evolution of gas may be caused after such boiling, 
and that such milk may give rise to flatulency. Aye, milk winch 
happens to contain the resistent spores of bacteria becomes a 
better breeding ground for them by the very (diminution of 
lactic acid, and the longer such sterilized milk is preserved and 
offered for sale, the worse is its condition. It may be true that 
these conditions are not met with very frequently, but an 
occasional single death in a family caused bv poisonous milk 
will be more than enough. Therefore, the daily home steriliza- 
tion is by far preferable to the risky purchase from wholesale 
manufacturers who can not guarantee, localise in the nature 
of things they cannot know, the condition of their wares. 
Another alteration of a less dangerous character, but far 
from being desirable, is the separation of cream from sterilized 
milk which is preserved for sale. Ronk, (Arch. f. Hyg. XVII) 
found it to take place to a slight extent during the very first 
weeks, but later to such a degree that 43.5 per cent, of all the 
cream contained in the milk was eliminated. 
Sterilization has been claimed to be no unmixed boon 
because of its changing the chemical constitution of milk. Still, 
the opinions on that subject vary to a great extent, the occur- 
rence of changes being both asserted and denied by apparently 
competent judges. But what I have said a hundred times, is 
still true and borne out by facts, viz: That no matter how 
beneficial boiling, or sterilization, or pasteurization may l>e, they 
cannot transform cow’s milk into woman’s milk, and that it is a 
mistake to l)elieve that the former, by mere sterilization, is a 
full substitute for the latter. It is true, that when we cannot 
have woman’s milk, we cannot do without cow’s milk. There is 
no alleged substitute that can be had with equal facility or in 
sufficient quantity. But after all it is not woman’s milk. 
Babies may not succumb from using it, and may but seldom 
appear to suffer from it, indeed they will mostly appear to 
thrive on it, but it is a makeshift after all and requires modifica- 
tions. Hammarsten was the first to prove the chemical differ- 
ence l)etween the casein of cow’s and woman’s milk. Whatever 
was known on that subject at that time I collated in Gerhardt’s 
Handb. d. Kind. 1st VoL 1875, (2 ed. 1882). But lately 
Wroblewski demonstrated the difference in solubility of the two 
milks. Woman’s casein retains, during pepsin digestion, its 
nuclein (proteid rich in phosphorus) in solution, it is fully 
digested; in cow’s casein the nuclein is not fully digested, a 
“ paranuclein ” is deposited undissolved and undigested. Be- 
sides, woman’s casein contains an additional albuminoid which 
is not identical with either the known casein or albumin. (H. 
Koplik in .V. Y. Mai. .Jounml, April 13th, 1895.) PEDIATRICS 
5 
Ergo : Cow’s milk is not woman’s milk. It is not identical 
with it. Sterilization does not change its character. It merely 
obviates such dangers as result from the presence of pathogenic 
germs, and from premature acidulation. The substitution of 
cow’s milk, or of sterilized milk for woman’s milk as the 
exclusive infant food is a mistake. Experience teaches that 
digestive disorders such as constipation or diarrhoea, and con- 
stitutional derangements such as rhacliitis are frequently pro- 
duced by its persistent use, and it appears to be more than an 
occasional (at least cooperative) cause of scurvy. 
Admixture of Cereals.—Since the advisability of finely divid- 
ing and suspending the casein of cow’s milk and of adding to 
the nutritiousness of the latter caused me always to teach the 
admixture of cereals to it, even in the very first days of 
infancy, the subject of infant feeding has never been lost 
sight of by medical men, pure scientists and tradesmen. No 
subject has been treated more extensively, more eagerly, some- 
times even more spitefully, than that of infant feeding. The 
philosopher’s stone has not been so anxiously sought for, 
nor been so often found in medical journals, books and soc- 
ieties, as the correct infant food and the appropriate treatment 
of cow’s milk. After the finally faultless thing had been 
discovered very many times, it was therefore not a surprise 
but a source of gratification to me to meet, in the Berl. Klin. 
Wocli., No. 10, 1895, an article of Heubner’s who, after having 
contributed for years as much as any Avriter, if not more, 
to the literature of the subject, recommends the “utilization 
of flour in the intestines of young nurslings.” Basing his 
remarks firstly on the researches of Scliiffer, KoroAvin and 
ZAveifel, (quoted in my early writings on that Arery topic more 
than tAventy years ago) who by experimentally proving the di- 
gestibility of a certain amount of starch in the saliva (and pan- 
creatic juice) of young infants* justified my empirical findings 
of many previous years, and secondly, on what he is pleased to 
call “Jacobi’s practical experience,” — the Berlin physician 
recommends in intestinal diseases of the very young the simplest 
flours, mainly of rice and oats (which have a finer microscopical 
structure than wheat). He pointedly adds: “ very young in- 
fants do better on a dilution of milk Avith a thin . .rice decoction 
than Avitli mere milk sugar solution. Practical experience sur- 
passes theoretical conclusions. ”f There is but one point in 
which the famous teacher does not yet agree Avitli me, for in his 
♦Bias dies hard. While it took Heubner more than twenty years to avail 
himself of very accessible physiological experience, a celebrity of equal rank 
(Philip Biedert, Handbuch der Kinderkrankheiten 11th ed. 1894. p. 39) still ap- 
pears to approve of the opinion that a nursling must have “no amylacea” 
because of their indigestibility, before the protrusion of teeth. Before long, 
more than to-day it will be a generally accepted axiom that cereals must be 
given to make teeth when milk food alone does not suffice for their development, 
t “Probire n geht iiber Studiren.” 6 
PHDIATRICS 
expositions we meet with the remark, that he “ cannot approve 
of the colossal dilution recommended by the authority of Jacobi.” 
The “colossal dilution” alluded to is that of milk in 4 or 5 parts 
of oatmeal or barley water for the use of the newly born. In 
regard to this dilution also I trust I shall see my illustrious col- 
league siding with me yet. The demands of pepsin digestion, 
and of rapid growth and of the necessity of restitution of losses ex- 
perienced by eliminations and excretions are just as many 
reasons for extra allowances of water in the diet of very young 
infants who have to rely on the services of others. Older chil- 
dren know how to find it and how to serve themselves. In ad- 
dition, it is certainly true that a large amount of water passing 
through the kidneys removes the inconveniences and dangers of 
the peculiar physiological process which takes place in the first 
three weeks of every life, viz., uric acid infarctus, the results of 
which are gravel, renal calculus (by no means rare) and nephri- 
tis. Indeed, since the rather frequent adoption of my plan of 
supplying the very young with quantities of water, I hear less of 
renal complaints in them than I did dozens of years ago. 
Perhaps the tide is beginning already to turn in my direc- 
tion. Norbert Auerbach, whose researches on the difficulty of 
destroying the hay bacillus and the bacillus butyricus are very 
meritorious, recommends larger percentages of water in infant 
feeding than the customary ones. His mixtures for the first 
and second months of life are three parts of water and one of 
milk, for the third and fourth, two and one, for the fifth and 
sixth, one and one, for the seventh and eighth, one and two. 
His figures are, therefore, not exjictly like mine, but even they 
may appear heretic to my critic. In connection with this sub- 
ject I am also pleased to state that Auerbach agrees with me on 
another subject. The sugar he adds to the milk food of infants, 
is not milk sugar but cane sugar, of which he gives twenty 
grammes daily, and, also according to my old teaching, more 
during constipation. He prefers cane sugar undoubtedly for the 
reasons which guided me in my recommendations, though it is 
true that milk sugar is lxdng stripped of its dangers in the same 
degree as boiling, sterilization, or pasteurization are carefully 
practiced. 
Virtually, sterilization has been practiced by me these more 
than forty years, and has been taught by me these thirty-five 
years, both in lectures and in books and essays. My method 
has been referred to. I always urged that safety increased 
with the number of boilings. Still even lately New York gen- 
tlemen have been pleased to say, and one of them has printed 
though he was told of his mistake before printing, that Jacobi 
was an opponent of sterilization. 
Actual sterilization according to Soxhlet was introduced in 
New York by A. Caille. Then, manufacturing firms took it up PEDIATRICS 
7 
as a matter of course. One of tliem was prevailed upon by me 
to execute a device of Dr. A. Seibert, who advised the determina- 
tion of the amount of sterilized food, and the graduation of the 
feeding bottles, according to the weight of the infant. In most 
cases this plan is good, for the condition of the child can mostly 
be measured by the increase of its weight. Only fat, clumsy, 
rhacliitical children make an exception; in them the rapid increase 
of weight is rather a morbid condition than a symptom of 
healthy development. Besides, he improved his food by adding, 
in conformity with my practice and sterilizing at the same time 
with the milk, either barley or oatmeal water. A recommenda- 
tion of his sterilizer is its cheapness, which makes it more ac- 
cessible to the poor. His plan—developed later—to filter milk 
before sterilization, is identical with that recommended by 
Auerbach. 
The writings and practical instruction of Dr. Rowland Godfrey 
Freeman have been a great advantage to New York, particularly 
to its poor population. He insists upon pasteurization as a 
sufficient method of safety. As the adviser of Mr. Nathan 
Strauss in his successful endeavors to supply thousands with a 
safe article of food, he has benefited the city and aided in set- 
ting an example which should and will be imitated. 
Modified Milk.—Pasteurization is also employed by Rotcli. 
In a paper read before the American Pediatric Society at 
Boston, May 4th, 1892,* he presented amongst others the 
following statements which I gladly repeat as I know his 
teachings to have done a great deal of good. Indeed I was 
so much impressed by them that I encouraged the gentle- 
man who had conducted a milk laboratory on Dr. Botch’s 
plan in Boston to establish a similar institution in New York. 
Some of Dr. Rotcli’s lucid statements are as follows: 
“ What the profession needs is the knowledge that they may 
have milk laboratories where the materials are clean, sterile, 
and exact in their percentages. Slight changes in the three ele- 
ments of the milk, of which we have the most accurate knowl- 
edge, namely, the fat, sugar and albuminoids, are of real practi- 
cal value in managing the digestion and nutrition of the infant, 
(normal percentage in milk of fat 2.02-4.37, of milk sugar, 5.70- 
7.10, of albuminoids 1.08-3.07, of mineral matter 0.12-0.20.) The 
digestive capabilities of the infants differ, just as those of adults, 
and nature, therefore, provides a variety of good breast-milks 
adapted to the individual idiosyncrasy of the special infant. 
With this fact impressed upon us,we can well see that in artifi- 
cial feeding no routine mixture will, in all cases, prove success- 
ful, f We are in need of a means by which wTe can prescribe 
* The value of milk laboratories for the advancement of our knowledge of 
artificial feeding. By T. M. Botch, Trans. Am. Ped. Soc., 1892, iv. 244. 
| All this proves also that nature allows a great deal of latitude, for the milk of 
a woman is changing and sometimes quite rapidly so, and still the baby continues 8 
PEDIATRICS 
exactly according to the idiosyncrasy of the digestion we are 
dealing with.” 
“A separator with many thousands of revolutions in a min- 
ute, separates from the milk foreign material and divides it up 
into a cream of a stable percentage and separated milk. The 
milk sugar and the albuminoids, also the mineral matter of this 
milk is fairly well-known, and thus the laboratory worker 
is enabled to put up any prescription, which for a healthy baby 
of four months would read fat 4, milk sugar 7, albuminoids 1.50. 
Put up 8 tubes, each 4 ounces, (with lime water 5 per cent.) 
Pasteurize (75°C-167°P) for twenty minutes. In this mixture 
the lime water is just sufficient to slightly alkalinize the cow’s 
milk.* In this way the food of the child can be modified act- 
cording to age, and to changed conditions of health.” 
to thrive. It also proves that an attempt at regulating the percentages of 
milk according to invariable rules, while circumstances of surroundings and 
individual health—perceptibly changed or not—mav differ, is liable to be very 
deceptive. Altogether, no iron clad rule holds good for a living body, in which 
organic assimilation is not regulated by the fixed laws of crystallization. This 
is, indeed, proved by nothing better than by the variability of the constitu- 
ents of good milk. According to the very figures presented by Dr. Rotch him- 
self fat may vary from 2.02 to 4.37, albuminoids from 1.08 to 3l27, and still the 
milks exhibiting these wide differences are “ normal.” 
In regard to the percentages of fat in cow’s and in woman’s milk the results 
of chemical analysis have lately changed in favor of the latter. But tbt 
general principles in regard to fat feeding, its effect on digestion, and the 
normal occurence of fat in the healthy ftecesof an infant fed on normal nourish- 
ment (breast-milk) are not therefore altered. 
Neither mathematics nor chemistry alone direct the organic economy. If 
that were so, the chemist Soxhlet—otherwise so deserving and Justly famous— 
would be justified in the advice hecooly gives the physician, to mid milk sugar 
when there is no fat in the food and thereby to obtain the necessary amount 
of carbon-hydrates. Fortunately organic chemistry is not identical with phy- 
siology 
Th»- methods of Biedert and Arthur Meigs are based upon these modern 
anal) jes of milk. The former pre[*ares a cream mixture which contains 1 per 
cent of casein, 2 of fat and 4 of sugar. It is to be mixed with milk in different 
proportions. One of the reasons urged by him for the addition of cream is 
the greater dilution (accomplished by my cereal decoctions) of the cow casein, the 
difficult digestion of which he takes for granted. The mixture of Dr. Meigs is 
well thought of by many physicians. But it is too easily influenced by irregu- 
larities and by accidents happening to the cream while being obtained, and to the 
milk sugar solution, to be proof against frequent failures and to become popu- 
lar among the masses. (Jacobi, Intestinal Diseases, p. 32.) 
*Cow’s milk is either alkaline, or neutral, or acid. The constant recommen- 
dations of five per cent, of lime water for the purpose of alkalization is there- 
fore far from exact, and from strictly scientific. Besides, how much alkalization 
is effected by one and a half drachms of lime water ? They contain exactly* or 
are presumed to contain, one-eighth of a grain of lime. 
Lime water, the liquor calcis, is a saturated aqueous solution of calcium 
hydrate whose percentage % ;i t ies with its temperature. At 59° F it contains 
somewhat over 0.17 per cent (1:600), in rising temperature less, at the boiling 
Kint 1 part of lime in 1"t <>f water. It redissnlves as the liquid cools. If the 
)d containing lime water be given at a temperature of eighty or ninety 
degrees,part of the lime is thrown out. Lime water warmed loses most of its alka- 
line reaction ; it is markedly alkaline when eold.onlv faintly so when boiled. An 
experiment made with good milk from the household supply gave the following 
results; reaction acid, also on boiling. One-twentieth part of lime water 
added to it changed the reaction but slightly, it remained acid. The mixture 
b eing boiled, reaction remained the same. When again cooled and shaken up, 
it was still acid, but slightly less so than before the dilution of the milk with 
lime water. PEDIATRICS 
9 
In a case of duodenal jaundice, in a girl of six years, the doc- 
tor prescribed fat 0.5, milk sugar 6, albuminoids 4, give 4 ounces 
every 2 hours. Send 12 tubes, each 4 ounces, lime water one 
tenth. In a case of summer diarrhoea in a girl of four months 
fat 2, milk sugar 5, albuminoids 1, send 20 tubes, each 1 ounce 
and 1 drachm. At time of each feeding, add lime water 3 
drachms. Sterilize at 212 °F. 
One of the beliefs guiding the author of this method is as 
follows : “ The constituents of the nutriment which nature has 
provided for the offspring of all animals and human beings that 
suckle their young, is essentially animal and not vegetable. 
Human beings in the first 12 months of life are carnivora. An 
animal food entirely and always free from any vegetable con- 
stituents, has been proved to be the nutriment on which the 
greatest number of human beings live and the least number 
die.” 
Those who followed my teachings at any time during this one- 
third of a century, know that I take some exception to this 
broad statement. Saliva and pancreatic juice are good for 
something better than idle elimination, and “nature” prepared 
the animal young from the first moment for more than mere 
pepsin digestion. The proof Dr. Rotcli refers to can be ex- 
perience only. Mine has taught me somewhat differently from 
the axiomatic positiveness of his assertion. But it must be far 
from me not to present Dr. Botch’s case in full. His standing 
and merits are such as to give him a hearing wherever and 
whatever he discusses. His rules, which moreover may be 
modified by my method at any time, are thoroughly good, they 
are scientific, exact and well thought out. Moreover, they are 
proven to be practicable. No matter whether it is the care- 
ful handling of a cautiously prepared milk, the methodical com- 
position according to percentages, or the faithful pasteurization, 
or all of them,the results are good. I know of a number of babies 
who in health and disease have done well on the protracted use 
of the laboratory milk. Only one observation struck me in a 
few cases. The formation of the muscles and particularly of 
the bones appeared to be slow, the teeth came a number of 
weeks or even months too late, the cranial bones turned slightly 
soft in a few instances. In a few such cases I had to add animal 
broths or juice before the usual time ; in one I tried phosphorus 
(elixir phosphori) which was rejected; in others it was well 
borne and useful. But taken all in all, the method appears to 
be sound and successful, as far as it can be so with cow’s milk 
and the casein of cow’s milk. It is to be deplored that for the 
present, it is a method only for the rich; mine has the advan- 
tage of being one for the people, both rich and poor. If, or as 
long as, the circulars of the laboratory will keep free of preten- 
tious exaggerations—they have been taking that turn lately— PEDIATRICS 
10 
the profession will do well to rely on it, or its like, as one of the 
means of furnishing the baby a food deprived of dangers, and 
in most cases sufficient. When found insufficient as regards tissue 
building, cereals can always be furnished in the same mixture. 
The empirical knowledge of their beneficial effects, with which 
we have been furnished for more than a generation, has lately 
again been tested experimentally by Springer, of Paris, who 
improved the development of bone by a decoction of mixed 
cereals boiled for hours in succession. This long duration of 
the boiling process is, however, not demanded. 
Like Professor Rotcli, Professor G. Gaertner,* of Gratz, em- 
ploys the centrifugef for the purpose of obtaining a milk resemb- 
ling that of woman. The latter was found by Escherich to 
contain casein 1.82, fat 3.10, sugar 6.23 per cent. The average 
of many examinations of cow's milk resulted in casein 1.76, and 
fat 1.81, and sugar 2.4 per cent. That of “fat milk” contained 
casein 1.76, fat 3, and sugar 2.4 per cent. This “fat milk is 
obtained by so arranging the tube which expels the cream 
from the centrifuge separator that just one-lialf of the milk con- 
tained therein is expelled and collected. In this way, as casein, 
sugar and minerals are not affected at all by the process of cen- 
trifuging, the percentage of the latter is not changed at all, 
while that of the fat is doubled. The difference between 
Gaertner’s and Rotcli’s methods is this that the former is applica- 
ble to the large majority (but that only) of infants who require 
cow’s milk appropriately prepared; and that the latter permits 
of all sorts of changes and percentages, and of all adaptations to 
the requirements of both the well and the sick, according t<> the 
opinions and intentions of the physician in every individual 
case. 
* Uber die Herstellung der Fettmilch. 
Prof. Escherich, Die Gaertnersche Fettmilch, eine neue Methode (ler 
Siiuglingsemahrung. Both in Wiener Med. Woch. 1894. 
for the preparation of children’s milk In my “ Intestinal 
Diseases.” 1887. p 23. PEDIATRICS 
AN ILLUSTRATED SEMI-MONTHLY DEVOTED TO THE 
DISEASES OF CHILDREN. 
owner 
DILLON BROWN, M.D. 
New York. 
EDITOR 
GEO. A. CARPENTER, M.D. 
London. 
JTEDICINE :—A. J acobi, M.D., New York, Professor of Diseases of Children in 
Columbia College. 
Frederick Forchheimer, M.D., Cincinnati, Ex-President of the American 
Pediatric Society, and Professor of Diseases of Children in the 
Medical College of Ohio. 
SURGERY :—Henry R. Wharton, M.D., Philadelphia, Surgeon to the Children’s 
and the Presbyterian Hospitals. 
Frederick S. Eve, F. R. C, S. Eng., London, Surgeon to the London Hos- 
pital and to the Evelina Hospital for Children. 
ORTHOPEDICS:—Henry Ling Taylor, M.D., New York, Assistant Surgeon to 
the Hospital for Ruptured and Crippled. 
Frederic R. Fisher, F. R. C. S. Eng., London, Senior Surgeon to the National 
Orthopedic Hospital and late Surgeon to the Victoria Hospital for 
Children. 
GASTRO-ENTERIC DISEASES Morris Manges, M.D., New York, Physi- 
cian to Mt. Sinai Hospital and Editor of “ Ewald’s Diseases of the 
Stomach.” 
J. Boas, M.D., Berlin, Editor of the “Archiv fur Uerdauungs-krankheiten.” 
THERAPEUTICS:—Dawson Williams, M.D., London, Physician to the East 
London Hospital for Ch ildren. 
MATERIA MEDICA:—Henry H. Rusby, M.D., New York, Professor of Materia 
Medica and Botany in the College of Pharmacy. 
TERATOLOGY :—Egbert H. Grandin, M.D., New York, President of the County 
Medical Society; and Obstetric Surgeon to the Maternity Hospital 
and Gynecologist to the French Hospital. 
LARYNGOLOGY :—Wm. C. Glasgow, M.D., St. Louis, Professor of Laryngology 
in the Missouri Medical College. 
Mark Hovell, F. R. C. S. Ed. London, Surgeon to the Throat Hospital and 
Aural Surgeon to the London Hospital. 
DERMATOLOGY :—James Nevins Hyde, M.D., Chicago, Professor of Skin and 
Nenereal Diseases in Rush Medical College. 
Leslie Phillips, M.D., Bermingham, England. 
OPHTHALITOLOGY:—Myles Standish, M.D., Boston, Ophthalmic Surgeon to 
Carney Hospital and to Mass. Char. Eye and Ear Infirmary. 
William Arthur Brailey, M.D., London, Ophthalmic Surgeon to Evelina 
Hospital for Children, and Guy’s Hospital. 
NEUROLOGY :—Joseph Collins, M.D., New York, Physician to the Hospital 
for Nervous Diseases. 
William R. Gowers, M.D., London, Consulting Physician to the Univers- 
ity College Hospital; Physician to the National Hospital for Par al- 
iped arid Epileptic; and late Professor of Clinical Medicine in the 
University College. 
editorial Staff: $2 OR 8.1 A YEAR 
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