A Reform in Artificial Infant-Feeding, 
WITH AN 
Improved and Inexpensive Sterilizer 
and Nursing - Bottles,* 
A. SEIBERT, M. D. 
Professor of Diseases of Children, New YorR "Polyclinic, and Physician to the Children’s 
Department of the German Dispensary. 
All food entering the body above its physiological quantities is 
useless for nutrition, a hindrance to digestion, and a danger to health. 
This fact, known to the medical men of all countries, so important to 
the welfare of all, and particularly to that of the bottle-fed babies, has 
been disregarded to such an extent that it really seems surprising to find 
that, while animated discussions have been carried on for decades in 
medical journals and text-books regarding the proportion of milk and 
gruel, casein, Sugar and fat, and nearly every authority has given 
to the world his own proportions, not until lately have any of them 
thought it important enough to give precise data concerning the 
quantity of food to be taken. Gerhardt (in his text-book on Diseases 
of Children, 1887) does not even mention the word quantity in his 
chapter on nutrition. Jacobi (in his book on Intestinal Diseases of 
Infancy and Childhood, 1887) makes the following statements concern- 
ing the quantity of food to be given to infants: “ Practically it is not 
very difficult to regulate the quantity of nourishment taken. Healthy 
children will fix the proper limit themselves. The same rule will apply, 
with slight differences, in an equally good condition of health, for the 
nourishment artificially prepared. But it is impossible to lay down as 
a uniform rule that some particular quantity must be considered as 
normal for all children.” “ The child ought to drink fro?n the breast or 
bottle until it has had enough." 
This state of affairs has left a wide field for every practitioner, 
midwife, and mother to individualize, and die result has been that, 
almost without exception, every artificially fed infant has been overfed. 
The ordinary nursing-bottle contains six or eight ounces at least, and 
this quantity was an-d~4s--sfalT.gi.Yen to the new-born as well as to the 
* Read before the NdW fifark.TVeaderay. fknuarv 23 1890. 
kcNciW'S nrr/rr 2 
EIMER & AMEND, NEW YORK. 
three-months-old baby, and when the youngster begins to regurgitate 
food, becomes dyspeptic and constipated and even loses flesh, the com- 
parative merits of the proportion of fat, sugar and casein are consid- 
ered and the different methods of the authors are tried, one after the 
other. At last some patent food is resorted to, and, as the weak 
stomach finds it less laborious to overcome the large quantity of this 
pseudo-food than that of diluted milk, the mother and the doctor are 
once more convinced that this patent food has saved the life of the 
baby. 
Biedert (in the ninth edition of Vogel’s text-book, 1887) makes 
this statement: “ The amount of food regulates itself so that food is 
never given oftener than every two hours; and if the child keeps quiet, 
wait still longer, and give less if the child vomits, and more if it shows 
ravenous hunger.” 
Escherich was the first to call attention to this deficiency in precise 
regulations as to the quantities in infant-feeding. In a table arranged 
to correspond with the tables and figures of Pfeiffer (Wiesbaden), who 
determined the quantities of milk taken by nursing infants by weighing 
his own baby before ’and after nursing during a whole year, Escherich 
gives precise figures as to quantity and proportionate dilution of the 
milk according to the age of the children. His volumetric method of 
artificial infant-feeding (Wien. klin. Woch., No. 40, 1889) is certainly an 
improvement, and if the bottles devised by him, showing the exact 
amounts and proportions of milk and water, would be used as he has 
directed, not alone according to the months but even the weeks of life 
the child has existed, no doubt many little ones would be all the better 
off for it. But his method is an ideal one, and therefore deals with 
ideal mothers who will put just so much food in the bottle large enough 
to hold much more, no matter how much their offspring clamor for 
more, and will never think that “ a child ought to know best when it 
has had enough,” and never act accordingly; and he deals with ideal 
children, all of one size and one weight, who always gain in flesh and 
in proportions of stomach-capacity according to the rules laid down in 
Gerhardt’s text-book on Diseases of Children, Vierordt’s Physiology, 
and Pfeiffer’s tables, never varying in the least. 
But mothers will give their infants more food without hesitation if 
they only notice that the youngster keeps on sucking its finger after the 
bottle is empty, and especially if a large bottle is given them to feed 
with; and the infants will not invariably increase their digestive power 
and the capacity of their stomachs according to text-books and tables; 
they will even be born with different-sized stomachs, and will not gain in 
flesh and weight as Escherich seems to believe, but will arrange that en- A REFORM IN ARTIFICIAL INFANT-FEEDING. 
3 
tirely according to circumstances coming up during these twelve months 
of life — circumstances that either promote or retard the digestive ability, 
size of the stomach, and weight of the child. Only one thing really 
does keep on increasing steadily, and that is the age of the infant. 
Escherich makes the same error that Fleischmann and Ahlfeld com- 
mitted when both weighed children of the same age to determine the 
amount of food taken by them. Their results were far from even, 
which led Jacobi (Intest. Diseases, p. 86) to the following sarcasm : 
“ Can there be anything more exact ? Both forget that the nursing, 
which occupies a child fifteen to thirty minutes, represents no invariable 
quantity, and that the whole quantity can not be found at any time 
entirely in the stomach.” 
In venturing to answer this question of the father of modern infant- 
feeding I hope not to be deemed impertinent when I say that there is 
something more exact, and these experimenters did not succeed, and 
could not succeed, because they weighed out the stomach capacity of 
babies of one age and not of one size and weight! This is not exact 
and never will be, for the weight and size of infants of the same age vary 
as do their faces, and hence necessarily the capacity of their stomachs also. 
For the last two years I have paid more attention to the stomach 
capacity and digestive power of infants than formerly, and, seeing large 
numbers of children run down by disease, retarded in growth by im- 
proper food and feeding, or naturally small by heredity, and, on the 
other hand, children above the usual size and weight and yet of one 
age, it naturally occurred to me that it would be entirely improper to 
regulate their food so as to give them all the same quantity. And so I 
took to weighing these infants, and was at first astonished to find them 
vary so much in weight. Thus, it has been nothing unusual to see two 
infants in the same hour at my clinic corresponding in age and varying 
in weight so as to show the one to have fourteen and the other but 
seven pounds of body-weight. The second conclusion I came to, after 
having weighed a greater number of infants, was that it was quite easy 
to determine the bulk of food a child could take, or, better, ought to 
take. The success of arranging the feeding in this manner was very 
gratifying, and so gradually I was able to arrange a table in my mind 
similar to the one you have in your hand, which has since guided me in 
determining the quantity and composition of food. Since October, 
1888, I have frequently written out this table on the blackboard in the 
Children’s Department of the New York Polyclinic for the benefit of 
my class; so in reality this is not a new method with me. 
It would have hardly occurred to me that others did not, to an 
extent at least, work in the same direction, had it not been for one of DirectionsWeigh the naked baby, and then find 
the amount and composition of its food and the 
manner of feeding on the table. 
! WEICHT 
IN 
POUNDS. 
NUMBER 
OF 
BOTTLE. 
SIZE 
OF 
BOTTLE. 
AMOUNT 
TIME OF FEEDING. 
OF MILK. 
OF GRUEL. 
OF SUCAR 
HOW OFTEN 
IN 24 HOURS 
FROM 
6 A M to 6 PM 
FROM 
6 P M TO 6 A M 
6, 7 and 8 
I. 
3 ounces. 
1 ounce, or 
2 tablespoons 
full 
2 ounces, or 
4 tablespoons 
full 
i 
teaspoon full 
1 bottle full 
every 2 hours 
8 bottles 
6 bottles 
2 bottles 
9 and 10 
II. 
4 ounces. 
IA ounce, or 
3 tablespoons 
full 
2 A ounces, or 
5 tablespoons 
full 
i 
teaspoon full 
I bottle full 
every 2 hours 
8 bottles 
6 bottles 
2 bottles 
11, 12, 13 and 
14 
III. 
5 ounces. 
2A ounces, or 
5 tablespoons 
full 
2 A ounces, or 
5 tablespoons 
full 
i 
teaspoon full 
1 bottle full 
every 2 A hrs 
7 bottles 
5 bottles 
2 bottles 
15 and 16 
IV. 
6 ounces. 
3A ounces, or 
7 tablespoons 
full 
2 A ounces, or 
5 tablespoons 
full 
1 
teaspoon full 
1 bottle full 
every 2A hrs 
7 bottles 
5 bottles 
2 bottles 
17 and 18 
V 
7 ounces. 
5 ounces, or 
10 tablespoons 
full 
2 ounces, or 
4 tablespoons 
full 
1 
teaspoon full 
1 bottle full 
every 3 hours 
6 bottles 
5 bottles 
1 bottle 
19 and 20 
VI. 
8 ounces. 
All milk and 1 teaspoon full of sugar 
1 bottle full 
every 3 hours 
6 bottles 
5 bottles 
1 bottle 
THE WEICHT. NOT THE ACE, OF THE INFANT DETERMINES ITS FOOD PROPERLY. 
HOW TO IF1 IE ZED -A.3ST INFANT, 
Devised by A. SEIBERT, M. D. 
Never use a larger bottle than the one indicated 
by the child’s weight. A REFORM IN ARTIFICIAL INFANT-FEEDING. 
5 
the latest articles of Escherich (Wien. klin. Woch., No. 40, 1889), in 
which lie pleads for reform in artificial infant-feeding in reference to the 
amount of food. As mentioned before, he adheres to the method of 
feeding according to the age of the children. Escherich does not even 
mention the fact that the capacity of the infantile stomach varies very 
considerably in children of the same age. On a closer inspection of 
recent writings on infant-feeding, 1 found that Biedert (in Vogel’s text- 
book, 1887) remarks: “ In case the digestion is very easily disturbed, a 
more exact regulation of diet would be necessary, so as to give two 
hundred cubic centimetres of properly diluted milk to every kilo of the 
child’s weight.” Rotch, in the August number of the Archives of 
Paediatrics, 1889, thus calls attention to the different sizes of infantile 
stomachs: “ Of the different causes which regulate the gastric capacity, 
the weight of the infant has the greatest influence, and it is perfectly 
possible for a poorly developed infant of small weight to have a gastric 
capacity no greater than a normally developed infant of half the age.” 
These few remarks made by Biedert and Rotch are all I could find 
bearing directly on our subject. The determination of the bulk of food 
by weighing infants before and after nursing was practiced long ago, 
but no one has been so exact as Pfeiffer, of Wiesbaden (Jahrb. f. Kin- 
derheik.), with his own child. But in arranging our table we could not 
go by this one case, as it was that of a healthy child of medium weight. 
The figures I present in this table are the result of careful notes on 
about two hundred different children. The manner of obtaining the 
figures was simple enough. After weighing the child, the composition 
4nd bulk of food were ordered, the latter usually being considerably 
smaller than before. If regurgitation of food, constipation, and dilata- 
tion of the stomach and the intestines, with restlessness at night and 
occasional wind-colic, would not disappear, then the bulk and strength 
of the food were diminished still more, until the apparent normal 
boundary line was reached. This was done in all cases. The increase 
in the food was not ordered until increase in weight had previously 
indicated it. Whenever the bulk and strength of the milk mixture was 
increased too rapidly, the infant would invariably indicate this by regur- 
gitating the superfluous amount. 
Handled in this manner, I have often had the pleasure of seeing 
infants get well and thrive on three ounces of food that had heretofore 
been stuffed and starved with five ounces of diluted milk, sterilized and 
often peptonized in the most approved style. I am at a loss to see why 
the dilatation of the stomach in infants, which indicates the true condition 
of affairs in every case as distinctly as the Indian figure shows the 
cigar-store and the red-white-and-blue pole the shop of the hair-cutter, 6 
EIMER & AMEND, NEW YORK. 
has been, is, and probably will be for some time to come, overlooked 
by the medical attendant. No doubt Escherich is right when he makes 
the statement that insufficient training of medical students regarding 
even the very fundamental principles of paediatrics has been the chief 
cause of the slow progress of this branch of medicine, and the sceptic 
and conservative feeling among general practitioners regarding any- 
thing new, and, in particular, any tables and charts. 
My figures do not alone pertain to healthy but also to convalescent 
children. If an infant ten months old has been reduced to seven 
pounds by ailments of any kind, but three ounces of food at the utmost 
are indicated. If you give more, that baby will vomit, and, at best, not 
pick up nearly so quick as if handled properly. 
On the other hand, a child weighing ten pounds at birth ought to 
have more and stronger food than one weighing three to four pounds 
less. The talk about some children of the same size eating more than 
others is but talk. It takes no more food in one body to keep up the 
same functions than in another, provided these bodies are of the same size 
and do the same amount of work.. Infants do about the same amount 
of work, so their weight is the only guide left. 
I have nothing more to add regarding this method of determining 
the amount and composition of food for artificially fed children. It is 
only a new method in detailing and specifying what the most conscien- 
tious authorities in paediatrics have long ago emphasized, and over and 
over again urged upon the minds of medical men. No doubt my table 
is deficient, and others will sooner or later make changes, and neces- 
sarily it will in each case be left to the physician to individualize; but, 
on the whole, I do think that this reducing artificial infant-feeding to 
“ facts and figures ” will prove a step in the right direction (as Dr. A. 
Jacobi has been kind enough to call it), and may serve as a practical 
medium in impressing physicians and parents with the important neces- 
sity of not giving infants more food than their stomachs will hold, and 
of only giving such mixtures as can be digested and assimilated with 
ease and benefit. 
To practically carry out this idea, I deemed it necessary to at first 
do away with all of the nursing-bottles now in use, including not alone 
the well-known flat arrangement with the long rubber tube, invented 
only for promoting the laziness of mothers, but also the Soxhlet bottle, 
which is entirely too large for the new-born and entirely too small for 
children weighing more than fourteen pounds. Escherich had this 
same notion exactly at the same time (his article on his new apparatus 
arriving here while my sample bottles were being made), but he de- 
signed large nursing-bottles, graduated by marks. For reasons given A. REFORM IN ARTIFICIAL INFANT-FEEDING. 
7 
before, I did not deem it wise to furnish mothers with larger-sized 
bottles than the size and weight of their offspring indicates, and there- 
fore I designed six different sizes of bottles, ranging from three to eight 
ounces. 
Following up the idea of not leaving any part of this feeding 
method to the judgment of mothers and nurses, I had the bottles 
properly marked so as to show on the one side the precise mark up to 
which milk should be filled in, and the word “ milk ” impressed below 
this mark. This simple arrangement permits the omission of first pour- 
ing the milk into measures, as designated by Soxhlet and Escherich, or 
of using a tablespoon of doubtful cleanliness. On the other side of the 
bottles the direction will be found : For child weighing (so and so 
many) pounds. 
These specifications may seem unnecessary to some, but I believe 
that when Goethe in his Faust made the remark, “ For all that you 
have black on white, contentedly may carry home,” he once more 
proved himself to be one of the best judges of human nature. If a 
proper-sized bottle is placed in the hands of a mother, if the exact 
amount of milk and gruel is marked and written upon that bottle, and, 
besides, that it must only be used for a child of a certain size or weight, 
the chances are that this mother will more readily follow these direc- 
tions than if they were not there “ black on white,” warning her con- 
stantly not to disobey this written rule. 
My next object in view necessarily was to design the bottles so 
that they could be easily cleaned. This Avas simple enough. I merely 
did away with the long neck, so that with a pencil, for instance, we 
may easily touch any part of the interior of the bottles. The neck I 
had so constructed as to leave not a particle of space between the stopper 8 
EIMER & AMEND, NEW YORK. 
and its glass surrounding, a decided deficiency in the Soxhlet bottle, 
which leaves a furrow of sufficient size to retain a portion of the milk, 
which, after sterilizing, must invariably decompose later in the dayr 
especially in warm weather, and while the child is drinking must neces- 
sarily reinfect the milk passing over it before it enters the mouth and 
stomach of the infant. 
The question of a proper and cheap way of closing the sterilized 
bottles had, up to date, not been solved, as Escherich wrote but a few 
weeks ago. The stopper designed by me answers all 
purposes well. It is simple, practical, and cheap. The 
furrow in its lower third allows the steam to escape dur- 
ing the process of sterilizing, and by a simple turn the 
bottle is closed air-tight. This is not alone an improve- 
ment on the Soxhlet stoppers on account of being less 
expensive, but because the aseptic condition of the food 
is more perfect, as after boiling twenty minutes no glass stoppers are 
put into the bottle, which, handled by the unclean hands of the mother,, 
are brought in direct contact with the food again, thus creating a possi- 
ble danger for reinfecting the food and harming the child. The ten 
minutes of further boiling after the glass stoppers are pressed in (during 
which time they often fly out and fall on the stove or even the floor) is 
too short a time to kill any germs that undoubtedly have entered the 
bottle, as Hiippe (Arbeiten aus dem Reichsgesundheitsamt) showed as 
early as 1884. 
The tray I designed holds the bottles in position and permits the 
steam to surround them at all sides during the process of sterilization. 
This tray is so constructed as to be movable and to be fitted for all 
sizes of these bottles. The holes in its lower part are so constructed 
that the steam courses up directly in close proximity to each bottle, but A REFORM IN ARTIFICIAL INFANT-FEEDING. 
9 
its chief virtue lies in the fact that it may be placed in any ordinary pot 
used for cooking in every household, thus again doing away with a 
greater expense and another object for care and work for the mother. 
My method of sterilizing is the following: After the bottles are 
properly filled the rubber stoppers (which fit all sizes) are put into the 
openings so as to leave the upper end of the furrows or gutters just 
above the rim of the bottle, allowing steam to escape. Then two cup- 
fuls of water are put into the pot (or the Soxhlet tin pail or the Arnold 
cooker), the lid is placed on the pot, and the latter placed over a brisk 
fire. Within five minutes steam appears under the lid of the pot, and 
counting from its appearance, the pot is left in position thirty minutes 
(in cool weather, from November ist to May ist). The pot is then 
removed, the tray is taken from the pot, and the stoppers are turned 
tightly into the bottles, and the food is safely sterilized. 
Hiippe, in 1884, showed that steam-sterilizing was far more 
effective than that done by boiling in water. 
My tests I made with milk thus handled proved this to be correct. 
In warm weather (from May ist to November ist) I deem it necessary 
to steam fully forty-five minutes, as the milk brought then to the houses 
of city people is in a far more advanced stage of decomposition than in 
winter time. (See my report on Cholera Infantum and the Weather, 
Med. Record, March 24, 1888). To do this it is necessary to use three 
instead of two cupfuls of water for steaming. 
The warming of the bottles is also done by steaming. A circular 
piece of wood or pasteboard, large enough to cover any ordinary tin 
pint or quart measure (as used in every household), is cut in so as to 
have an opening wide enough to admit the neck of the bottle to the 
center of the board, so the bottle is suspended in the tin hanging over 
the water. A small quantity of water is put in the tin, this placed on 
the gas, oil, or ordinary stove, and in exactly a minute and a half the 
bottle is warm enough for drinking. Any one who, like myself, has 
had any personal experience in getting up at night and “ warming the 
bottle for the baby,” will appreciate this simple device, for it takes fully 
fifteen minutes to do this according to Soxhlet’s method. But this 
steaming is not alone safer for the food and child, but also safer for the 
bottles, as there is no chance at all for cracking them by placing them 
suddenly into hot water, as so far has always been done by cooks, 
nurses, and mothers to accelerate the proceedings. 
~ — l' - ~ 
It is my plan to have all druggists in the populous districts sell 
this apparatus, and to have them weigh the children for the inhabitants 
of the tenements, and accordingly to determine the exact size of bottles 
needed in each case. The arrangement is made that the druggists will 10 
EIMER & AMEND, NEW YORK. 
take back the smaller bottles and give the next size when indicated, 
with an apditional charge of about twenty-five cents. 
This brings us to the price of this apparatus. With a written sigh, 
Escherich exclaims in his last article that the Soxhlet apparatus is too 
expensive, and therefore does not reach those that need it most—the 
poorer classes. My apparatus—which in every respect but in the fun- 
damental principle of sterilizing in bottles is new and decidedly more 
exact and less troublesome to handle—has been devised for the special 
purpose of becoming the infant-feeder for the laboring classes, among 
whom infant-mortality in summer time has baffled the skill of medical 
men and health authorities for ages back. 
It is Soxhlet’s idea to sterilize milk in small bottles for infant-feed- 
ing, and his apparatus has done much good in preventing infants getting 
sick and dying of milk-poisoning; but it costs five dollars, and therefore 
is entirely too expensive for the working classes, not to speak of the 
outlay of frequently buying new bottles to replace those cracked during 
boiling in the water-bath. It is patented in Germany, and has been 
imitated and is sold at the same figure here, though nothing is paid to 
the patentee. 
Escherich’s improved sterilizer has been spoken of, and will be 
hardly less expensive. His bottles are large and graded by lines, and, 
to my mind, can hardly be used with success by any but very careful 
mothers. He closes his bottles with the nipples or with cotton (not 
absorbent)—a manner unfit for practical and ordinary handling. 
The Arnold cooker leaves the choice of bottles to the mother, and 
in that respect must be called a backward step, though the steaming 
is an improvement. 
The six-ounce bottles, filled with sterilized milk, that have lately 
been brought in the market here, are entirely too large for infants and 
ought not to be used for infant-feeding, aside from the fact that their 
price would only suit very rich people, who pay $1.20 each day for 
this food. 
Following the advice of Professor A. Jacobi and Professor J. Lewis 
Smith, who have both been kind enough to inspect my sample appar- 
atus, the firm of Eimer & Amend (corner of Eighteenth Street and 
Third Avenue) have cut down the price of my apparatus, so that it can 
be retailed all over the land at $i. It includes the tray, eight bottles 
with stoppers, and two nipples. 
It is not patented and will not be patented, and if imitated abroad, 
as I sincerely hope it will be, it will push its way, naked and pure, for 
what it is worth, as a present to the children of the poor man all over 
the world, from a member of the New York Academy of Medicine, 
which deems it improper to patent articles used for the prevention and 
cure of disease. A REFORM IN ARTIFICIAL INFANT-FEEDING. 
11 
Directions for Steaming.—Fill the bottles up to the mark with 
pure, fresh bottled cow’s milk, obtained from a milkman and not from a 
store, early in the morning, and above the mark with barley or oatmeal 
gruel, or plain, fresh water. Then add sugar. After filling the bottles 
as directed, place them in the tray; then put rubber stoppers on them, so 
as to leave a small opening at the side of the stopper ; then put two to three 
teacupfuls of water in any clean pot ten inches wide and eight inches 
high, place the tray in it, cover it with the lid, and place it over a 
strong fire. In cool weather (November ist to May ist) steam fully jo 
?ninutes, in warm weather (May ist to November ist) steam the bottles 
fully 45 minutes. During steaming the lid of the pot remains closed. 
Then remove the pot from the fire, uncover it, and turn stoppers tight into 
the bottles. Never open a bottle until feeding-time. Bottles are best 
kept in a cool, dry place. 
Directions for warming a Bottle at Feeding-time.—Pour four table- 
spoonfuls of water in an ordinary tin quart measure; then put the neck 
of the closed bottle through a round piece of pasteboard or paper, big 
enough to cover the opening of the tin ; place the perforated half of 
a blacking-box in the tin so as to serve as a second bottom; loosen the 
stopper, place the tin on the stove, and steam for two minutes; then 
remove the stopper and put the nipple on the bottle. 
Caution.—Never put the bottles in the water on the bottom of the 
tin, as they will crack instantly. PRESS OF 
W. S. Gottsberger & Co., - 
II MURRAY ST., N. Y.