MILKe^ 
 
 E,F. BRUSH, MJ>, 
 
CORNELL UNIVERSITY 
 ITHACA, N. Y. 
 
 SItbcatg 
 
Cornell University Library 
 SF 251.B91 
 
 Milk. 
 
 3 1924 003 035 429 
 
The original of tliis book is in 
 tine Cornell University Library. 
 
 There are no known copyright restrictions in 
 the United States on the use of the text. 
 
 http://www.archive.org/details/cu31924003035429 
 
MILK 
 
 By E. F. Brush, M. D. 
 
 Physician, Veterinarian and Dairyman. 
 
 Wynkoop Hallenbeck Crawford Co., 
 PRINTERS, 
 
 NEW YORK AND ALBANY, 
 
 1898, 
 
PREFACE. 
 
 This volume is simply a collection of essays 
 contributed to the various medical societies and 
 journals during the past seventeen years. It 
 would be vain for the author to claim that 
 there was no other motive than that of love for 
 scientific truth impelling the work. However, 
 as a physician and veterinarian, it cannot be 
 judged dishonest for him to say that there has 
 been a sincere desire to reach the truth and 
 follow it. And, on the other hand, as a dairy- 
 man trying to produce the best milk that is 
 within human possibility, there has been, of 
 course, more or less trade interest. Therefore, 
 if these two designs can be allowed without 
 prejudice on the part of the reader, there is hope 
 that the work will benefit others as well as the 
 author-. 
 
 Mount Vernon, N. Y., April, 1898. 
 
MILK.* 
 
 The position that milk occupies in scientific 
 works at the present day is very unsatisfactory to 
 the medical practitioner. Almost every author 
 gives a different analysis, and many of the phe- 
 nomena still remain unexplained. The lacto- 
 meter which has been merely a source of dispute 
 in the past is now abandoned. The majority of 
 works on milk analysis lack precision in details, 
 because they mostly leave out albumen as a con- 
 stituent of milk and mass together all the milk 
 salts as sugar. This, of course, is very unsatis- 
 factory and misleading, for it is a fact regarding 
 these substances, that on the proportion existing 
 between them and the caseine the quality of the 
 milk depends. I have previously stated in the 
 New York Medical Journal the fact that, as case- 
 ine decreases, the milk, sugar and the albumen 
 increase, and vice versa. By ascertaining these 
 we can determine the wholesomeness of any 
 given specimen of milk. 
 
 *An essay read before the MedicalSociety of the County of Westchester 
 at the Annual Meeting, held at White Plains, Tuesday, June 21, 1881. 
 
6 Milk. 
 
 But, in examining milk, we must consider 
 another point, that is the position it occupies as 
 a producer and distributor of disease. Compared 
 with this acknowledged fact, simple dilution with 
 water is of slight importance. Diseases may be 
 conveyed by milk taken from an animal suffering 
 from disease, or by milk contaminated in the 
 dairy, or by contact with diseased or infected 
 persons. There is no definite law forbidding the 
 sale of milk from diseased animals. On reading 
 the last Report of the Department of Agricul- 
 ture, I find a statement made by a dairyman on 
 Long Island, in which he declares to the com- 
 missioners that for twenty years he has had cases 
 of pleuro-pneumonia in his herd. In this disease 
 the flow of milk is not usually entirely suspended, 
 and it is only lessened slightly during the first few 
 days of active fever. When the flow is suspended, 
 it is during the extreme heat of summer, when the 
 disease attains its utmost violence — that is, 
 when the animal is about to die. There can be 
 no doubt that the milk of a cow sufifering from a 
 disease of this character must be poisonous. On 
 analysis of milk thus diseased, I have discovered 
 an increased amount of albumen as the only dif- 
 ference. Garget, an inflammatory condition of 
 the internal substance of the udder, is another 
 vaccine disease which causes unwholesomeness 
 
Milk, 7 
 
 in milk. In cases of foot-and-mouth disease. — 
 a disease producing in the cow aphtha, diarrhoea 
 and enlarged glands — Dr. Joseph Weil writes 
 that the " raw milk produces a feverishness, 
 swelling of the tonsils and submaxillary glands 
 and pemphigenous eruptions on the lips and 
 tongue." I need not, even if time permitted, 
 enumerate all the other diseases which infect 
 milk. But this dissemination of disease by dis- 
 eased milk is a fact which we medical men ought 
 to recognize. We ought to bestir ourselves to 
 procure legislation defining the duties of milk- 
 producers as regards the health of their animals. 
 At present the whole law seems to have been 
 made for the pecuniary protection of corpora- 
 tions and herdsmen. In fact, half of the laws are 
 enacted to protect butter and cheese factories 
 from skim-milk and oleomargarine. It is signifi- 
 cant that the first law passed in this State re- 
 specting milk was passed, not to prevent the 
 Orange County Association from selling dis- 
 eased milk, or for protecting the thousands of 
 children whose food it supplies, but to prevent 
 their agents from defrauding them. The whole 
 tenor of the law is in the same direction. There 
 is indeed a law saying unhealthy milk must not 
 be sold, but the definition of " unhealthy," as 
 given in the law, is " milk from cattle feeding on 
 
8 Milk. 
 
 distillery swill, or on any substance in a state of 
 putrefaction." The factories are further pro- 
 tected by the prohibition of the sale of tainted 
 milk, or milk kept in dirty vessels. They are also 
 protected by a law prohibiting the sale of skim- 
 milk. This insane law is the only definite one, 
 except the one against the addition of water. 
 We all know that if the same energy had been 
 directed by the New York Board of Health 
 against diseased milk, which has been directed 
 against watered milk, the lives of thousands of 
 children would have been saved. From what I 
 have seen of the dairies in Westchester county, 
 and from what I have learned by conversations 
 with dairymen, I am convinced that the greatest 
 cause of disease among infants in New York city 
 actually arises from the use of diseased milk, and 
 the mixture of colostrum with sound milk. This 
 is a most serious and important subject, and 
 utterly neglected by the law. Calves taken im- 
 mediately from their mothers, " bob-veal," is de- 
 nounced because it produces disease in his 
 majesty the adult citizen. But no law prohibits 
 the wholesale administration of colostrum to the 
 luckless infant. In none of the numerous works 
 that I have consulted, either scientific or in- 
 tended for farmers, have I found any allusion to 
 this evil. Thus, even the conscientious man has 
 
Milk. 9 
 
 no warning and no guide. Many of the milkmen 
 informed me that the third milking after calving 
 was considered fit to mix with other milk. In 
 the course of conversation I casually inquired 
 what effect the third milking would have on a 
 calf three months old. The farmer innocently 
 replied, "It would probably give him the scours." 
 This disease in the calf corresponds to cholera 
 infantum. Last summer I attended a child suf- 
 fering from cholera infantum. I proposed to 
 give it whey, and to procure it I took some of 
 the milk on which the child had been fed, and 
 attempted to coagulate it with rennet. I failed 
 utterly. I threw the specimen away and sent to 
 the same place for some more milk. The same 
 result ensued. I then left out the rennet and 
 boiled the milk. It coagulated on boiling. As 
 this is what takes place in colostrum, the cause 
 of the attack was plain. By changing the diet 
 the child recovered. This would be an easy test 
 if it were not for the fact that the colostrum is 
 mixed in most cases with a large proportion of 
 milk, and hence only negative results would be 
 attained. In regard to the time when milk is fit 
 to use after calving, I am undecided, as I am still 
 engaged in the investigation. If I succeed in 
 interesting medical men to procure legislation 
 on this subject, I shall be able to give definite 
 
lo Milk. 
 
 and scientific rules. I will say here that, accord- 
 ing to Lehman, colostrum corpuscles remain till 
 the third or fourth day, and occasionally to the 
 twentieth day, and as a general rule returns 
 when any disease supervenes after dehvery, or 
 in case the mother is attacked by any acute affec- 
 tion. Colostrum becomes acid more rapidly than 
 milk, and contains less sugar. Let me beg of 
 you not to forget this matter; we owe it to the 
 community to protect their children. I would 
 even go so far as to desire that every dealer in 
 milk be compelled to take out a license, and that 
 in every death-certificate of an infant the name 
 of the milkman supplying it with milk be in- 
 serted. The officials of the Board of Health 
 would thus be able to see if the same name oc- 
 curred repeatedly, and to take steps to stop his 
 sale of poisonous milk. I hope to see the day 
 when the matter will receive due scientific and 
 legislative attention. 
 
 There are, of course, other items of great im- 
 portance relating to the milk of the cow. As we 
 who use the milk belong in the animal kingdom 
 to the non-ruminants, we have to study cows' 
 milk as designed for the stomach of ruminants. 
 If it were possible for us to feed children on the 
 milk of non-ruminant animals, as the human 
 being or ass, there would be much less difficulty 
 
Milk. i i 
 
 attending the artificial feeding of children. 
 Looking at it in this light, there is no doubt we 
 could mend the matter considerably. Calves 
 always regurgitate and chew the milk before it 
 enters into the digesting stomach. Some people 
 argue that milk, when drawn from the gland and 
 kept, loses at once its vital principle, and thus 
 seek to account for its indigestibility. To my 
 mind this is proved to be false reasoning by the 
 fact that the most successful stock-raisers do not 
 allow the calves to suck. This is not from econ- 
 omy. I can cite a case in point. A farmer with 
 a herd of pedigree stock, in which he took a 
 great pride, allowed his calves to suck. They 
 became so fat as to excite the admiration of ail 
 beholders. When, the weather became hot they 
 all died. The mode of death was peculiar. They 
 gave a strange cry, which attracted the attention 
 of the farm-hands, reeled round, and, before the 
 men reached them, were dead. One after another 
 they all thus perished. Since then the breeder 
 has fed his calves from a trough with about half 
 the milk from their mothers, and none have died 
 in this manner. These breeders, I need scarcely 
 add, are very particular about the colostrum. 
 
 In regard to some of the popular modes of 
 feeding children artificially, I will here explain a 
 few of them. We will first consider boiled milk. 
 
12 Milk. 
 
 By this procedure we, of course, lower its nutri- 
 tive value by coagulating the albumen, thus ren- 
 dering it insoluble. Boiling kills the lactic 
 germs, thus delaying the development of lactic 
 acid, and also deprives milk of whatever vitality 
 it may have. It emphatically benefits milk pol- 
 luted with colostrum, and probably the coagula- 
 tion of the caseine in the stomach is less rapid. 
 The addition of lime-water or soda — a favorite 
 method — may be beneficial from the fact that 
 coagulation takes place more slowly and that we 
 are not apt to have the large, leathery coagulum. 
 Last summer, while talking to an eminent prac- 
 titioner on the subject of feeding infants by arti- 
 ficial means, he stated that one of his children 
 was not doing well with ordinary dilute milk 
 with sugar, and had all the symptoms of defective 
 nutrition. He stopped the milk and gave cream 
 diluted with water. From the very first the child 
 improved and was kept on cream till weaned. 
 In commenting on the case the doctor expressed 
 some surprise, as he considered that cream con- 
 tained nothing much but fats. In this he was 
 mistaken, as the following analysis will show. 
 I removed eight ounces of cream and carefully 
 avoided any removal of milk with it. From this 
 cream I removed twenty-nine and one-half 
 drachms of butter, one hundred and thirty-nine 
 
Milk. 13 
 
 and one-half grains of caseine, eighteen grains 
 of soluble albumen by coagulation through heat, 
 and thirty-eight grains of sugar. The analysis 
 proves that in buttermilk we have a wonderfully 
 nutritive fluid. Even after the caseine is re- 
 moved, the amount of nutrition in the whey of 
 buttermilk is quite large. This fact is enforced 
 by the experience of the Orkney Island fisher- 
 men. They precipitate the caseine from butter- 
 milk by boiling water, immediately after churn- 
 ing, and place the whey in small kegs. This they 
 take with them on their voyage, and subsist on it 
 for several days without other food or drink. 
 
ACUTE MILK-POISONING.* 
 
 Many of the diseases affecting the digestive 
 organs in infancy are nothing more nor less than 
 milk-poisoning. This is absolutely the cause of 
 cholera infantum. I think we should be justified 
 in dropping entirely from our nomenclature the 
 term cholera infantum, and calling the disease 
 which has hitherto borne this misleading name 
 by its real term, " acute milk-poisoning." We 
 would thus simplify the treatment by keeping 
 before the practitioner the true cause of the dis- 
 ease, and no other suggestion would be neces- 
 sary to indicate that the poison ought to be 
 stopped. This is not done now, nor do the text- 
 books point out the absolute necessity of this 
 being done. There is no doubt, too, it will not 
 be done as long as we account for the disease by 
 teething, excessive heat, brain troubles, and so 
 forth. When I tell you, gentlemen, that I have 
 looked to the health and feeding of more than 
 two hundred children this summer, and have not 
 lost one by any acute intestinal disturbance, you 
 may concede to me the right to speak; and when 
 I have given you the facts winnowed from a 
 
 • Read before the Westchester County Medical Society, 1885. 
 
 IS 
 
i6 Acute Milk-Poisoning. 
 
 year's observations of diseases caused by milk, 
 I cannot but feel you will agree with my con- 
 clusions. 
 
 Even if we had not facts it seems to me that 
 we could theorize to the same conclusions. Our 
 cows are secreting milk abnormally, and I use 
 the word "secreting" in the sense we understand 
 it physiologically. We keep up the activity of 
 the mammary gland from parturition to par- 
 turition, this is, through heat and pregnancy. 
 This process being carried on through gen- 
 erations in the bovine race has resulted 
 in the mammary becoming an excretory 
 gland. When a milking cow eats food which 
 would cause diarrhoea in other animals, she 
 simply gives more milk, and the bowels are 
 seldom much disturbed; but the poison is con- 
 veyed to the infant. As on this fact much of my 
 argument is based, and to show that it is no new 
 fact of which I am the solitary observer, I quote 
 the following statement from J. P. Norton, M. A., 
 Professor of Scientific Agriculture at Yale Col- 
 lege: "All the effects of poisoning may be pro- 
 duced by the milk without the cows being appa- 
 rently affected by the pasture." Now the condi- 
 tions that render milk poisonous are: 
 
 1st. Feeding. — The sudden change from the 
 dry food of winter to the full flush of grass, pick- 
 
Acute Milk-Poisoning. 17 
 
 ing up green fruit, eating brewers' grains which 
 make the milk more albuminous and therefore 
 more prone to putrefaction with the increase of 
 summer temperatures, eating poisonous weeds, 
 and drinking poisonous stagnant waters. 
 
 2d. Treatment. — Dairy farmers endeavor to 
 have their cows calve in spring time when the 
 grass is plentiful, because then the feeding is 
 cheapest and the amount of milk to be got is 
 greater. Now if a cow calves in May she is usu- 
 ally in heat again in forty days, this brings the 
 period to the last of June or the beginning of 
 July. If she were allowed to become pregnant 
 then, her calving time would occur too early 
 next year to get the flush of milk at grass time. 
 Consequently she is allowed to worry and quite 
 often excite the entire herd. This condition 
 affects milk so perniciously that cheesemakers 
 exclude it from the factory; the odor sometimes 
 is perceptibly putrid, and almost always easy to 
 detect when the milk is heated in a water bath. 
 Again, the milk is affected when the cow takes 
 the bull. I have found by observation of my own 
 cows that the milk following the act is always 
 decidedly acid. In the subsequent pregnancy- 
 there can be no doubt that the nutritive quality 
 of the milk is lowered. Last, but not least in 
 the treatment of milch cows as a cause of poison- 
 2 
 
i8 Acute Milk-Poisoning. 
 
 ous milk, is the cruel abuse to which they are 
 subjected. 
 
 3d. Diseases which space will not at this time 
 permit me to enumerate. — I will, however, here 
 record my observations on a very common dis- 
 ease in milch cows — common because it occurs 
 frequently and requires little or no treatment, 
 and the milk thus affected finds its way to the 
 market, to convey poison to the children. Last 
 winter I made an experiment on one of my own 
 cows. I bruised one-quarter of the udder, thus 
 producing traumatic garget. This often occurs 
 in pastures by the cow striking the udder against 
 stumps and the like. I found the milk from the 
 gland in the affected quarter for a number of 
 days stringy, lumpy and pus-like, but always 
 alkaline. The milk from the three unaffected 
 quarters presented no abnormal appearance; but, 
 while the traumatic condition existed, was always 
 decidedly acid. When this condition had lasted 
 four days, I gave to one of my own children, 
 aged 16 months, about four ounces of this acid 
 normal-appearing milk. This was five o'clock in 
 the evening. The child fell asleep, but was 
 awakened in two hours, crying, apparently with 
 stomach-ache. She was kept awake till past 
 midnight, and a large quantity of gas was 
 avoided per rectum. The next day the bowels 
 
Acute Milk-Poisoning. 19 
 
 were slightly disturbed. It is easy to imagine if 
 four ounces had this effect, what would be the 
 condition if the child had been fed continuously 
 on such milk. 
 
 Returning to the results of treatment, I will 
 cite the following case: One Saturday afternoon, 
 while watching some boys playing ball on the 
 common, I noticed a herd of ten cows feeding in 
 an adjoining lot, attended by the owner, a milk- 
 man. Suddenly a cow came running to the herd 
 and mounted the first cow she reached. The 
 owner of the herd picked up some stones and 
 pelted the offending cow, but was unable to drive 
 her away. She continued to mount the cows as 
 they came near her, till finally the entire herd 
 became excited. Then a woman, the owner of 
 the bulling cow, came and attempted to drive 
 her horpe, but could not do so. Then her boy, 
 a lad of 10, armed with a big stick, came and 
 pounded the cow considerably, but without sepa- 
 rating her from the herd. Finally, the old man 
 made his appearance, carrying in his hand a 
 heavy whip. He walked up to the cow, gently 
 holding out his hand as if to feed her, and when 
 close to her laid on the whip quite severely, with 
 the effect of calming her immediately. She 
 trotted for home, he running behind her, giving 
 her a blow every time he came close enough 
 
20 Acute Milk-Poisoning. 
 
 When she was in the yard, a small enclosure, he 
 beat her for several minutes, and after she was in 
 the stable I could hear an occasional blow. This 
 all occurred before milking time. I was deterred 
 from making an attempt to prevent this cruelty, 
 because of the opportunity thus presented to ob- 
 serve the effect of milk from a cow thus treated, 
 in the feeding of children. This occurred in my 
 own immediate neighborhood, and I knew that 
 if any children were taken sick I would hear of it. 
 As soon after the occurrence as possible I called 
 on my friend. Dr. Campbell, and related the 
 affair to him, asking him to find out who received 
 milk from the cow, as the owners were patients 
 of his. On Sunday evening he was called to see 
 a child, 8 months old, who had been attacked 
 on Saturday night with sharp pains. It had 
 been kept awake all night; it had suffered mild 
 attacks of diarrhoea during the summer, but had 
 never before been disturbed during the night, 
 the attacks always passing away with treatment. 
 This attack, besides keeping the child awake, 
 was accompanied by constant vomiting, which 
 had not characterized any of the previous attacks, 
 and there had been eighteen movements of the 
 bowels in twelve hours, mostly green and un- 
 digested milk, an occasional discharge of dirty, 
 mud-colored, watery and offensive material. 
 
Acute Milk-Poisoning. 21 
 
 The child was very sick, and developed profound 
 symptoms of cholera infantum. The doctor in- 
 quired on what the baby had been fed, and the 
 answer was, " The bottle, with the milk of one 
 cow." On further inquiry, he learned the milk 
 had been procured from the above-related cruelly 
 abused cow. The child recovered because the 
 poison was stopped, although he was sick for 
 several days. 
 
 This accidental observation is not an unusual 
 occurrence; it, or something like it, is happening 
 every day, though we may not be able to follow 
 it up so closely. Take, for instance, the small 
 dairy, with its four or five cows, not sufficient to 
 pay the expense of keeping a bull. The rutting 
 period occurs in the hottest weather; one of the 
 farm hands is directed to drive the cow to the 
 bull, perhaps a distance of two or three miles. 
 Usually he is armed with a big stick, and the 
 cow, especially in this condition, is loth to leave 
 the herd without some emphatic persuasion. 
 She is prodded, attacked, run round the corners, 
 and the ordinary farm-laborer, when he has run 
 fifteen minutes, is apt to get mad. There is no 
 doubt that cases of this kind, if we follow them 
 up, would reveal a like result of acute milk- 
 poisoning. 
 
22 Acute Milk-Poisoning. 
 
 The following cases of acute milk-poisoning, 
 arising from causes not discovered, are interest- 
 ing as illustrating this condition: 
 
 On a Sunday afternoon a friend of mine called 
 me hurriedly to see his child, a baby lo months 
 old, and bottle-fed. As he thought it was dying, 
 I obeyed, and was soon at the house. On my 
 arrival I found the child in a profound tonic con- 
 vulsion. I learned from the parents that I was 
 called in the absence of their regular physician, 
 who had seen the child three hours previous. 
 The sickness had commenced the day before. 
 When this physician had seen the child that day, 
 he inquired on what it was fed, and was told 
 " milk and one of the patent foods." He ap- 
 proved of the diet, and left some medicine. The 
 parents had no idea the child was very sick, so 
 they fed it, and it went to sleep. They went 
 down to dinner, but returning afterward to the 
 room where the baby was, they found it strug- 
 ghng in a convulsion — the convulsion it was 
 in when I came. I immediately wrapped the 
 child in a cold, wet blanket, and endeavored to 
 get a little brandy into its mouth, abstaining from 
 any other treatment, as I knew the attending 
 physician would be in immediately. He came a 
 few minutes after my arrival, when I surrendered 
 the case to him. The father wished me to stay. 
 
Acute Milk-Poisoning. 23 
 
 and I did so, simply watching the case. When 
 the child was recovering from the convulsion it 
 vomited several large masses of solid caseine, 
 and its bowels were moved several times. When 
 the convulsion had completely subsided I took 
 my departure, but was again called between 6 
 and 7 in the evening. When I reached the house 
 the child was dead. 
 
 On the next day (Monday) I was called to see 
 a child, 9 months old, bottle-fed, who received 
 his milk from the same farm, and had been suf- 
 fering from a severe diarrhoea since the preced- 
 ing Friday. I found the child very sick, vomit- 
 ing and purging. The alvine discharges were 
 mostly green and watery, occasionally mud- 
 colored. I directed that he should receive no 
 milk under any circumstances whatever, but be 
 fed on beef solution and oatmeal-water, and re- 
 ceive every hour a teaspoonful of the following: 
 
 R Tr. opii mj. 
 
 Tr. ferri mviij. 
 
 Aqua Ij. 
 
 The next day I found there had been no abate- 
 ment in the number of movements of the bowels, 
 but there had been no vomiting. I changed his 
 food to kumyss and he required no further treat- 
 ment till two weeks later, when I put him on 
 
24 Acute Milk-Poisoning. 
 
 other food simply for economy. He has con- 
 tinued to do well ever since. Is there any reason 
 why we should not call these cases "milk-poison- 
 ing? " One with treatment and a continued use 
 of the milk died; the other, with no treatment to 
 speak of but stopping the milk, made a good re- 
 covery. I cite these cases not because they were 
 the only ones observed, but because occurring 
 simultaneously, and getting their poison from 
 the same source, they illustrate the necessity of 
 calling the disease from which they both suffered 
 " acute milk-poisoning." 
 
 Usually the beginning of summer complaints 
 in fed babies is at the time when imperfect, worm- 
 eaten green apples are falling; it is continued 
 through the rutting, bulhng and conceiving 
 period, to reach its fiercest condition when the 
 pastures are dried by the usual autumn droughts, 
 when the cows eat the poisonous herbs that they 
 had avoided when the grass was green and 
 plentiful. 
 
 Some years ago in the Alleghany districts, 
 owing to some poisonous herbage, the cows se- 
 creted a milk which was poisonous. As this 
 region was remote from a city market, the na- 
 tives were compelled to consume their own milk, 
 and were not long in finding that a disease from 
 which they all suffered was caused by the milk. 
 
Acute Milk-Poisoning. 25 
 
 Its use was quickly stopped and every visitor to 
 the district was advised to abstain from it. They 
 had no statistical tables to consult, and did not 
 therefore find that the sickness increased as the 
 thermometer rose; they had no way of account- 
 ing for the disease except from its simple cause, 
 milk, and therefore they called it simply " milk 
 sickness," and invoked the power of the govern- 
 ment to suppress it. 
 
[Report from The Archives of Pediatrics, April, 1886.] 
 
 INFANT FEEDING.* 
 
 Without endeavoring to impress on you any 
 opinions of the necessity of mothers nursing their 
 children, or of the advisability or danger of em- 
 ploying wet-nurses, I shall endeavor in this paper 
 to point out some simple methods of feeding an 
 infant when it is deprived of the breast. I prom- 
 ise you that I will not attempt to be very scien- 
 tific, because I believe that much harm is occur- 
 ring from the intensely scientific features of baby 
 feeding to-day. Peptones, indeed, are only sec- 
 ond in prominence to bacteria. Probably there 
 is no greater satire on the medical profession at 
 present than the number of patent foods and 
 refuse material offered for infant feeding. It 
 would seem that any one, outside of the profes- 
 sion, can compound a mixture for baby feeding, 
 and through the efforts of the medical profession 
 itself can create a large sale. How many of us 
 know anything certain of the actual composition 
 of the patent foods we are continually recom- 
 
 *Read at the Annual Meetings of the Medical Society of New York, 1886. 
 
 27 
 
28 Infant Feeding. 
 
 mending? Certainly great men have tried their 
 skill in compounding a universal infant diet. We 
 all remember the eclat with which " Liebig's 
 Food for Infants " was received by a trusting 
 medical world. Although some foods styled 
 " Liebig's " are still advertised, nevertheless 
 " Liebig's food " is out of use; and we ask why? 
 Simply because it was altogether too scientific. 
 It was a chemical compound, not a food. Dr. 
 King Chambers said publicly after a fair trial, 
 " Laputa never devised anything more prepos- 
 terous than Liebig's Food for Infants." Now 
 let us examine this once famous food, and we 
 shall at the same time understand why some of 
 the more recent chemical compounds are not ful- 
 filling their promise. Liebig's food was com- 
 posed of milk, wheat-flour, malt, bi-carbonate of 
 potassa, and water. On going over this list of 
 ingredients, seriatim, we conclude that the trouble 
 did not come from the milk, unless that was bad 
 to begin with; the wheat flour possibly could 
 create a disturbance, but this is modified in the 
 preparation by the malt, and the malt itself could 
 not possibly be the offending agent. But when 
 we come to the bi-carbonate of potassa we hesi- 
 tate. It is only recently that we have been so 
 ably warned against the free use of alkalies before 
 this very society. Professor Jacobi in telling us 
 
Infant Feeding. 29 
 
 of the great danger we incur in the use of chlor- 
 ate of potassa, said also " we are not very care- 
 ful in the doses of alkalies in general." A new 
 and popular food for infants has lately appeared 
 containing instead of the bi-carbonate of potassa, 
 exactly the same proportions of the bi-carbonate 
 of soda. An ordinary infant needs three pints 
 of food or more daily. Who would think of 
 giving an infant forty-five grains or more of 
 either of the salt of potassa or soda? Professor 
 Alfred Stille, in a lecture on " Acute Rheuma- 
 tism," advises the use of bi-carbonate of soda in 
 doses of less than six grains every three or four 
 hours for an adult; and says, regarding it, " The 
 alkaline treatment relieves the pain and saves the 
 heart by lessening the amount of iibre in the blood." 
 Now, if doses of less than six grains have this 
 effect on the adult, what shall we expect to be the 
 effect of much larger doses administered to an 
 infant? There is no doubt that with strong 
 alkali the process of nutrition is reversed — that 
 is, the nutritive material is dissolved out of the 
 economy. The so-called, peptonized milk, re- 
 commended by Dr. Roberts, of England, and 
 made popular in this country by advertising and 
 medical testimonials, is likewise a chemical com- 
 pound, and I think can be classified as an albumi- 
 nate of soda. Dr. Roberts, in his very readable 
 
30 Infant Feeding. 
 
 little monograph recommending the food, cites 
 some experiments he made with kittens, two of 
 which he fed on natural milk and two on pepton- 
 ized milk. Of those fed on the peptonized milk, 
 one shows an absolute loss of twelve grains in 
 two days, while those fed on natural milk showed 
 a steady gain; at the end of ten days these two 
 had gained ninety-five grains, while the two fed 
 on the peptonized milk gained but forty-seven 
 grains. There is very little doubt that if he had 
 examined the blood of the very badly-nourished 
 kittens he would have found it less coagulable 
 than that of the naturally fed felines. 
 
 I mention the chemical foods, not because 
 they are the only ones in vogue, but because I 
 regard them as the most dangerous, and I wish 
 to protest against the tendency to take infant 
 feeding into science too deeply, and again using 
 the words of Professor Jacobi, " to give at least 
 one of the million instances in which the indi- 
 vidual judgment is biased and medical progress 
 is liable to be thwarted by enthusiasm not com- 
 plicated with reason." 
 
 It does seem to me, gentlemen, that a physi- 
 cian ought to be able, out of the multitude of 
 simple articles within reach, to prepare for the 
 infant a suitable food to meet the requirements 
 of any or every case. One of the greatest ele- 
 
Infant Feeding. 31 
 
 ments of failure in the artificial feeding of infants 
 is the desire to give one variety of food under all 
 circumstances. When you fail with a food that 
 you have yourself prepared, then you have, at 
 least, a knowledge as to what your failure arises 
 from. But when you fail with a food, with the 
 composition of which you are not acquainted, 
 then you are lost indeed. It is then with the 
 hope that I can get some appropriate article of 
 diet which you yourselves can teach the mother 
 or nurse to prepare, that I essay to read this 
 paper. 
 
 First, we will take the child at birth. After 
 twelve or twenty-four hours, I give the following 
 as the best substitute for colostrum: The white 
 of one fresh egg, two teaspoonfuls of granulated 
 sugar, two teaspoonfuls of sweet oil, a pinch of 
 salt, and one pint of water. Beat together in a 
 saucer, the albumen, sugar, oil, and salt, with 
 a fork as in making a salad-dressing. When they 
 are thoroughly beaten together, drop in slowly 
 from a spoon, meanwhile continuing the beating, 
 five teaspoonfuls of cold water. Then pour the 
 mixture into a pint bottle and shake it well. This 
 mixture should be given from a nursing bottle, 
 warm; it should be warmed carefully, as too 
 much heat coagulates the albumen. The child 
 is fed on this for three or four days; then I begin 
 
32 Infant. Feeding. 
 
 adding to each meal a teaspoonful of milk, and 
 increasing the amount of cow's milk until the 
 mixture is half and half. Then I substitute 
 whatever dilutent I decide to be necessary in the 
 case. Now, this is very simple, and washes out 
 the digestive track. If for any reason, the 
 cathartic efifect is not decided enough, more 
 sugar can be added, and likewise more oil if 
 necessary. Now, on the other hand, if the 
 cathartic action is too brisk, the addition of cow's 
 milk will lessen the effect. 
 
 We are now through with the colostrum 
 period, and are confronted with the question, 
 What is the best staple food? Without hesita- 
 tion I answer " Cow's milk." I am, however, 
 appalled at the task of telling all the conditions 
 that render it unfit, poisonous, cathartic, consti- 
 pating, ill-nutritious, too nutritious, and likewise 
 the very best food for the artificial feeding of in- 
 fants. As long ago as 1879, I made a classifica- 
 tion of milks, separating the product of the cud- 
 chewers from that of the non-cud-chewers. As 
 this simple classification enables us to clearly un- 
 derstand some of the difficulties the human 
 young experience in digesting milk designed by 
 nature for bovine young, I will allude to it here 
 but briefly. The milk of all the non-cud-chew- 
 ers, to which class belong the human, equine, 
 
Infant Feeding. 33 
 
 canine, and others, contains a variety of caseine 
 which is precipitated in fine flakes, thus allowing 
 the digestive juices to attack it more readily. 
 Now, the other class is that of the cud-chewers, 
 which includes the bovine, ovine, and hircine and 
 others. The later all chew the cud soon afterbirth; 
 therefore, the milk designed for their use contains 
 a variety of caseine which with them coagulates 
 into a mass, sufficiently hard and consistent to be 
 regurgitated and chewed. Therefore, when an 
 infant fed on cow's milk vomits a hard, leathery 
 curd, the indications are that the milk must either 
 be prevented from coagulating, or coagulated 
 and subdivided before entering the stomach. 
 Now, when the rejected matter has a distinctly 
 sour smell, it is undoubtedly due to the souring 
 of the milk, and the amount of any alkali neces- 
 sary to overcome this tendency would simply be 
 too great. What I am in the habit of giving in 
 these cases is milk with some of the caseine re- 
 moved and the remainder broken up. This I do 
 with the pepsine mixture, made as follows: 
 
 Pepsine (Hawley's), 3 j; 
 Acid, hydrochloric, C.P., 3 j; 
 Glycerin, § j. 
 Water, gj; 
 3 
 
34 Infant Feeding. 
 
 One teaspoonful of the foregoing mixture will 
 precipitate the caseine for one pint of cow's milk. 
 The whey resulting from this precipitated milk I 
 mix with whole milk, half and half, and heat 
 until coagulation takes place. Then I beat the 
 curd up into fine flakes. Now, on the other 
 hand if the curd rejected from the child's stomach 
 has not a distinctly sour smell, we can infer that 
 the caseine coagulates before the digestive juices 
 can act. In this class of cases, the addition of 
 lime water to the food will often overcome the 
 difficulty by making the milk just sufficiently 
 alkaline to allow the digestive process to start 
 before coagulation commences. With this agent 
 the amount of alkali necessary is very small. The 
 following is the mixture which I have found the 
 best: lime water, two tablespoonfuls; water, four 
 tablespoonfuls; and milk, six tablespoonfuls. 
 Here we have less than one grain of lime, which 
 is preferable to any of the other alkaline salts, 
 and there is no other alkali which requires so 
 small a quantity to do the work, and which does 
 not keep the stomach in an alkaline condition 
 sufificient to interfere with the digestive func- 
 tions. Very often in these cases of vomiting 
 hard curds, the stools are very acid and of a vivid 
 green color. This acid condition of the intes- 
 tines is very often caused by the administration 
 
Infant Feeding. 35 
 
 of an alkali, because when the stomach is acid the 
 intestines are alkaline, as they should be; but 
 when you make the stomach alkaline, as is too 
 commonly done by the physician, then the intes- 
 tines become acid. Usually it will be necessary 
 to continue the use of the lime water for some 
 time, but the precipitated caseine mixture need 
 only be used for a few days. Now, on the other 
 hand, when a child is being fed on cow's milk 
 properly diluted and sweetened, (?) and has an 
 acute attack of diarrhoea, the indications are to 
 stop the milk immediately. There are many 
 conditions of the cow that render her milk totally 
 unfit for food. The first are her own physical 
 infirmities. I have found that when a cow takes 
 the bull the milk is intensely acid, and will cause 
 a colicky diarrhoea in the infant that takes the 
 milk at this time. Then when the cow is far ad- 
 vanced in pregnancy the nutritive value of the 
 milk is diminished, and, furthermore, some food 
 the cow takes affects the milk perniciously. 
 Calves have been known to die sucking mothers 
 who have eaten buttercups. I mention this 
 plant because it is the most common. The cow 
 is a voracious animal, and when she can get 
 nothing better will eat all kinds of poisonous 
 weeds, and this with impunity when she is giving 
 milk. The same herbage which would and does 
 
36 Infant Feeding. 
 
 kill animals that are not in milk is eliminated by 
 the milk-giver to kill the one who consumes the 
 milk. Then again the brutal usage to which a 
 cow is sometimes subjected, like the severe men- 
 tal shock which often render'sthehumanmother's 
 milk poisonous, also affects the milk of the cow. 
 I have recorded several instances of violent diar- 
 rhoea occurring in infants fed on milk from cows 
 subjected to cruel treatment. When milk is 
 stopped in acute diarrhoea, the food I use with 
 good results is raw oat-meal water. The oat- 
 meal water is prepared with one teacupful of oat- 
 meal in one pint of cold water; let it stand fifteen 
 minutes with an occasional stirring, and when 
 the meal has settled, pour off only the clearwater, 
 and give this cold, ad libitum, either from a nurs- 
 ing bottle or a drinking vessel. The directions 
 seem simple enough, but when I tell you in my 
 experience not one mother or nurse out of ten 
 will follow the directions, you will understand 
 why I tell you to get this food prepared properly; 
 you will be obhged to do it yourself the first time, 
 and perhaps again and again. I do not know 
 that this is to be much wondered at, for it does 
 not seem to the casual observer to be a very nutri- 
 tious looking fluid. But I have kept infants for 
 several days on raw oat-meal water without ap- 
 parent loss of weight. In many cases of acute 
 
Infant Feeding. 37 
 
 diarrhoea all the treatment you will find neces- 
 sary will be the substitution of this raw oat-meal 
 water for the milk they had been taking. Now 
 as much depends on the proper preparation of 
 this meal water, let me impress on you again the 
 absolute necessity of you preparing the first por- 
 tion yourself, and of seeing that the oat meal is 
 good. Some of the oat meals in the market are 
 prepared from damaged oats, which are partially 
 cooked. When you attempt to prepare a raw 
 oat-meal water from such a variety of meal, you 
 will get too much starch in solution, and as a 
 consequence the diari'hoea will be aggravated. 
 Oat meal — the Ohio meal — is the best. I have 
 never made a complete analysis of this oat-meal 
 water, but I have determined the amount of fat in 
 a given quantity; also the amount of solid matter 
 held in solution, and demonstrated the presence 
 of sugar. Therefore,' you see we have some- 
 thing like milk in composition, fat, sugar, and 
 nitrogenous elements. In one ounce of raw oat- 
 meal water I found four and a half grains of solid 
 matter. I extracted three-quarters of a grain of 
 fat. Usually the child with acute diarrhoea is 
 feverish, and will drink a large quantity; but it 
 is easy to compute how much solid material they 
 are getting. Notwithstanding all the scientific 
 data that a child needs more food in proportion 
 
38 Infant Feeding. 
 
 than an adult, it is surprising how little they will 
 get along with if that Httle is appropriate. This 
 appears, likewise, to be the case of the young of 
 other species. I have raised a calf on hay-tea 
 from birth, and in a good, well-nourished con- 
 dition. 
 
 Now, as I said before, it is always well to get 
 the child back on its ordinary milk diet as soon 
 as possible. Always boil the milk for the first 
 two or three days when resuming it, after diar- 
 rhoea, and it is a safe proceeding to change the 
 milk-man about this time. 
 
 It may not be out of place, right here, to tell 
 you the kind of a cow best adapted to supply 
 milk to an infant, and how the cow should be 
 cared for to produce the best variety of milk. In 
 the selections I exclude the Alderney and her 
 cousins the Jersey, and Guernsey. In the first 
 place they are exceedingly nervous, and there is 
 little doubt that they are more prone to tuber- 
 culosis than any other breed, owing to the close 
 in-breeding. Next, their milk contains the fat 
 in a very poorly emulsified condition, which ac- 
 counts for their good butter qualities. The fat 
 exists almost entirely as free fat, and very little, 
 if any, is combined with the albuminoids. The 
 best cow to supply milk for infant feeding is the 
 common-grade cow. In my experience the big 
 
Infant Feeding. 39 
 
 red breed is the most quiet and gentle in disposi- 
 tion, a good feeder, and not excitable even in 
 heat. She should be stall-fed at all seasons when 
 supplying milk for an infant. Her fodder should 
 be fresh hay the first thing in the morning, after 
 milking give her a breakfast of cut hay wetted 
 and mixed with one pint of cornmeal, two quarts 
 of bran, one pint of oil meal, one ounce of bone 
 meal, one ounce of, salt. She then should be 
 curried and turned out for exercise into a yard 
 where there is abundance of clean water. At 
 noon she should have half a bushel of cut-roots, 
 either carrots, mangel-wurtzel, or ruta-bagas. 
 After milking in the evening give her the same 
 allowance that was given at breakfast. 
 
 As I have been recommending stall-feeding 
 the question naturally occurs, why is not the milk 
 rendered poisonous by the weeds in the hay as 
 well as in the pasture? This question at first 
 staggered me, but when we come to know that 
 almost invariably they owe their poisonous prop- 
 erties to a volatile principle which becomes inert 
 by drying, the difference is understood at once. 
 
 When we rely on the milk-man for a supply, 
 never take one cow's milk, for it never is uniform, 
 while that of a large dairy will be uniformly good 
 or bad. 
 
 All the difficulties with insufficiently fed child- 
 
40 Infant Feeding. 
 
 rert are not included in vomiting and diarrhoea. 
 We also have obstinate constipation to deal with. 
 In these cases I add cream and use raw malt 
 water as a dilutent for the milk. Get whole- 
 malted barley; in cities it is readily obtainable at 
 the breweries; grind it in a coffee mill; soak half 
 a pound in a pint of cold water for several hours 
 and strain; dilute one-half with milk. In cases 
 of badly-nourished children^ who have but one 
 movement in three or four days, and then the 
 feces consist of a large white mass with a very 
 bad odor, the malt water, in my hands, has 
 usually regulated the bowels, giving a good soft 
 yellow fecal discharge daily. In this same class 
 of cases if the bowels become too loose, boil the 
 half pound of ground malt with the pint of water 
 for fifteen minutes and strain; dilute with it the 
 milk in the same proportion, half- and half. 
 When malt water is being used, the milk requires 
 no other sweetening. 
 
 In acute dysenteries occurring in artificially- 
 fed infants, I have used the raw-beef solution, and 
 have found in many cases when children have 
 been doing well on this, that the administration 
 of even one additional meal of milk would aggra- 
 vate the dysenteric symptoms. In this disease I 
 am not talking from a very large experience, but 
 I went through one very severe epidemic, and the 
 
Infant Feeding. 41 
 
 experience gained at that time has been con- 
 firmed by my observations in sporadic cases 
 since that time. I prepare the raw-beef solution 
 as follows : one pound of lean beef, cut very fine, 
 place in a quart fruit jar, then mix one pint each 
 of boiling water and cold water; after they are 
 mixed pour them on the beef; with a fork whip 
 the beef up in the jar for fifteen or twenty min- 
 utes, or until the meat is all washed out, leaving 
 it white ; this allows the beef to settle, then pour 
 off the clear solution; this should always be fed 
 warm. My experience is that cold drinks are 
 always bad for infants with dysentery. Some- 
 times I use this beef solution as a change of diet 
 in other conditions, in which cases I add a little 
 salt, or sometimes lemon juice, and administer it 
 ice-cold in febrile conditions. But in dysenteries 
 I make no addition whatever and always admin- 
 ister it warm. 
 
 Food and drink are synonymous terms to in- 
 fant feeding; therefore the food should always be 
 largely diluted. The kinds of food found in com- 
 mon use are often more correct than the methods 
 of their preparation or administration. Usually 
 each food substance carries with it a digestive 
 ferment. Bread made with baking powder 
 should not be used as food for children; such 
 br^ad contciins chemical substances which are not 
 
42 Infant Feeding. 
 
 wholesome. It must be remembered that food 
 that spoils quickly digests quickly; but it must 
 also be borne in mind that in infant feeding the 
 digestive process should precede the spoiling 
 process. This is not of so much importance with 
 the adult where there is a stronger gastric juice 
 to check the spoiling process. Therefore all pre- 
 served foods have their nutritive value lowered 
 in proportion as their keeping qualities are in- 
 creased. Letheby's tables of nutritive equiva- 
 lents place human milk at lOO, and Herring's at 
 914. The difiference in digestive capacity is 
 more than compensated by the difiference in 
 nutritive value. 
 
 With the short space of time allowed at such 
 an important meeting as the present, I have made 
 my remarks brief and pointed. If, however, I 
 have succeeded in rescuing the infant from the 
 multitude of fictitious commercial compounds, 
 and saving it for a more natural, simple, and ap- 
 propriate diet, I have not wasted your time, nor 
 yet my own. 
 
[Reprinted from the "Archives of Pediatrics," July, 1888.] 
 
 FERMENTED MILK. 
 
 From the most ancient times milk has been 
 esteemed as of great value for human food. 
 Among the more civilized races of mankind this 
 article has been used fresh, and manufactured 
 into butter and cheese, but among the uncivil- 
 ized and semi-civilized races the latter prepara- 
 tions are little known, and the milk of their ani- 
 mals is principally used after it has undergone 
 various forms of fermentation. Thus the Scyth- 
 ians, Tartars, the nomadic tribes of the Russian 
 steppes and Western Siberia, transform their 
 milk into kumyss. The Arabians use a fermented 
 milk called leban, the Turks also ferment their 
 milk and call it yaourt, while some of the other 
 Oriental tribes designate their fermented milk as 
 keschk, karagart, and jourt. In some parts of 
 Asia, where the natives like to season their drink 
 with red pepper, they relieve the burning of the 
 mouth by drinking milk that has undergone a 
 spontaneous lactic fermentation — that is, com- 
 mon, sour milk. This variety of milk is now be- 
 
 43 
 
44 P'ermented Milk. 
 
 ing sold in New York as one of the fermented 
 milk foods. The Caucasian mountaineers fer- 
 ment their milk and call it kephir. This bever- 
 age attracted the attention of the medical men 
 on the Continent because in some respects it re- 
 sembled kumyss. Professor Struve was, I think, 
 the first to call attention to it, but, according to 
 this authority, its preparation was surrounded 
 with mystery, and the ferment used could only be 
 obtained from the mountaineers. The ferment 
 was called kephir grains. P. Kern seems to have 
 been the first to procure these grains from the 
 Caucasians, and described them in 1882 in the 
 Bot. Ztg. and in the Bulletin of the Moscow Im- 
 perial Natural Society; he called these granular 
 masses dispora Caucasica. Because of the mys- 
 tery surrounding this ferment and the manner in 
 which it was presented to the public, the beverage 
 formed by its action attracted considerable at- 
 tention in Russia and Germany. Such men as 
 Hueppe, De Bary, and others took up the sub- 
 ject, and it became quite popular. Still, the 
 source from which the Caucasian mountaineers 
 obtained their ferment remained a mystery; nev- 
 ertheless, like many other medical profundities, 
 these kephir grains suddenly became an article of 
 commerce, and the market was well supplied at 
 a high rate. When this Continental beverage 
 
Fermented Milk. 45 
 
 was at the height of its popularity, I procured 
 half an ounce of the grains at a price of one dollar 
 and a half. After extended experiments with 
 the ferment, I reached the conclusion that it was 
 very weak in its vinous action, as a larger amount 
 of the milk-sugar was changed into lactic acid 
 (and this change is what takes place spontan- 
 eously in milk when no agent is added), and the 
 amount of alcohol obtained by the kephir was 
 very small, being in all cases less than one per 
 cent. It is a well-known fact that in conducting 
 the process of alcoholic fermentation, the more 
 we complete the vinous destruction of sugar the 
 more completely do we guard against the other 
 and more dangerous changes that take place in 
 nitrogenized foods. 
 
 Now let us see what this kephir ferment is. 
 Professor A. De Bary, of the University of Stras- 
 burg, says, " The hay-bacillus-scum is properly 
 zoogloea, with a special characteristic form; form- 
 ations, more or less like it, are found often 
 enough in fluids containing decomposable or- 
 ganic bodies; highly characteristic zoogloea de- 
 veloped in a fluid are the frog spawn, bacterium 
 of the sugar-factories and bacterium of kephir." 
 Thus we see that kephir is largely a zoogloea, 
 very much like the mother of vinegar and such 
 like diseased masses of fermentative bodies. De 
 
46 Fermented Milk. 
 
 Bary further says, " The kephir grains are in their 
 first living state white bodies, usually of an irreg- 
 ular roundish form, equal to or exceeding a wal- 
 nut in size, chiefly composed of rod-shaped bac- 
 teria and numerous groups of sprouting fungi, 
 living and growing in common with the bac- 
 teria." Crookshank, in his " Manual of Bacter- 
 iology," describes the kephir ferment as bacillus 
 Caucasicus, " rods forming two spores, one at 
 each end, otherwise similar to bacillus subtilis: 
 they occur in the form of whitish lumps, in com- 
 pany with saccharomycetes mycoderma." Thus it 
 will be seen that in these kephir grains we have 
 a mass of micro-organisms procured from the 
 dirty skin-sacks of an uncivilized race of dirty 
 people. In this age of bacteriology, in which we 
 are able to separate and cultivate any of the germs 
 we wish to produce a desired effect, it seems 
 strange that we should go to an uncivilized race 
 and procure the accumulating mass of diseased 
 germs that has been gathering for years in their 
 dirty skin milk-sacks. And this simply because 
 some one proclaimed the derivation of the fer- 
 ment a mystery. 
 
 But the strangest part of this kephir craze in 
 Continental Europe was the discovery, by Alex- 
 ander Levy, in 1886, that effervescing alcoholic 
 kephir can be procured without any kephir grains 
 
Fermented Milk. 47 
 
 whatever, by simply bottling the milk and shak- 
 ing it with sufficient violence while it is turning 
 sour. This form of fermented milk gives nearly 
 double the percentage of alcohol that is obtained 
 from milk to which the kephir grains had been 
 added. Thus we see that the addition of these 
 masses of zoogloea rather retards than acceler- 
 ates the change we wish to produce. Professor 
 De Bary, who had devoted a good deal of atten- 
 tion to kephir, describing the process with 
 minuteness, after he had verified, with the assist- 
 ance of Professor Schmiedeberg, the correctness 
 of Levy's discovery, says, " Our former explana- 
 tion must therefore be abandoned, and there is 
 no other at present ready to take its place. But 
 the case is full of instruction for our warning." 
 
 Since the pricking of this Caucasian milk-bag 
 in Continental Europe, thus destroying the mar- 
 ket for the sale of kephir grains, the French and 
 German kephir manufacturing companies are es- 
 tabHshing themselves here, and using the old and 
 exploded medical testimonies to develop the 
 business which had exhausted itself in their own 
 land. 
 
 Professor Taylor, of Cincinnati, in the May 
 number of the Archives of Pediatrics, makes some 
 statements in his article on " Kephir, and its Use 
 as an Infant Food," which I wish to question. I 
 
48 Fermented Milk. 
 
 do not, for an instant, doubt the correctness of 
 his observations of cases, but it is a well-known 
 fact in all hospital experience that in the trial of 
 all new preparations, no matter what the ulti- 
 mate result may be, the patient seems to get bet- 
 ter, and the explanation of this phenomenon, 
 plain enough to many a hospital interne, is that 
 while patients are under observation for the trial 
 of new treatment, the care and attention given 
 them is always much greater than that bestowed 
 on patients undergoing a routine method of 
 treatment. We can all remember articles that 
 raised our hopes from the glowing accounts col- 
 lected at the hospitals, and that were finally 
 abandoned as useless. But the professor's state- 
 ment that " the presence of lactic acid has a 
 germicidal action upon a large class of micro- 
 organisms, and thus acts as a purifier of the 
 milk," is decidedly wrong. The large class of 
 micro-organisms which he adds in his kephir fer- 
 ment certainly do not seem to be afifected. Lac- 
 tic acid in milk is not a purifier, it is simply a fore- 
 runner of putrefaction. In his description of the 
 putrefactive process in " animal alkaloids," 
 Brown says in his book, " The mass-residue ex- 
 hibits a progressive role of fermentation; at first 
 the lactic, then the butyric, and so on, giving the 
 finishing characteristics of the putrefactive con- 
 
t'ERMENTED MiLK. 49 
 
 dition." This is simply what takes place in milk 
 exposed to the air; the lactic fermentation first 
 and then the butyric; until these have completed 
 their role, bacteria termo and the other micro- 
 organisms that appear to produce putrefactive 
 changes cannot act. Therefore lactic acid is not 
 a purifier, but a dangerous body in nitrogenized 
 foods. It is simply lactic-acid fermentation that 
 has taken place in certain articles of food, and the 
 putrefactive germs first commencing their life, 
 that produce the violent attacks of choleraic 
 diarrhoea that seize persons who have eaten food 
 that has turned sour. Such a careless statement 
 as this of Professor Taylor should not, I think, 
 be allowed to pass unchallenged. Lactic acid in 
 food must always be looked upon as a dangerous 
 body; it is a far different substance when used 
 medicinally in its free state than it is in combina- 
 tion with nitrogenous bodies undergoing fer- 
 mentative changes that result in the dangerous 
 alkaloids produced by putrefactive ferments. 
 
 Professor Taylor seems to know as little about 
 kumyss as he does about kephir. One might in- 
 fer from his expressions that the only genuine 
 kumyss is that made in skin-bags of the Bash- 
 kirs in their old traditional way, and that all other 
 kumyss, no matter how much intelligence is dis- 
 played in its manufacture, is in disrepute; while, 
 4 
 
so Fermented Milk. 
 
 on the other hand, kephir can be made without 
 any intelligence by any one who possesses the 
 ferment without knowing whence the ferment is 
 derived or what action is set up by this mass. 
 When one prepares kumyss intelligently one 
 knows exactly what fermentative changes are to 
 be produced, and can, therefore, select the proper 
 ferment for the purpose. But this, according to 
 the professor, does not possess the virtues of a 
 genuine article, while a mass of diseased fermen- 
 tative germs with a variety of bacteria and fungi, 
 of which no man knows which will predominate, 
 this makes genuine kephir. 
 
[Read at a Meeting of the American Medical Association at Newport, 
 R, I., June 25, 1889.] 
 
 COW'S MILK FOR INFANT FOOD. 
 
 In India, several years ago, one of the Hindoo 
 Kings, "in order to atone for his cruelties, caused 
 a colossal golden cow to be made, through the 
 body of which he passed with profound reverence 
 and made it the era from which all his edicts were 
 dated/'* This historical fact is significant. We 
 have practiced all manner of cruelties with the 
 luckless infant deprived of its mother's breast; 
 we have presented all manner of unfit substances 
 to this small animal whose only language is a 
 cry, whose only desire is food. In fact, when- 
 ever a commercial enterprise finds itself bur- 
 dened with some waste product that cannot be 
 put to other use, it has been deemed a good sub- 
 stitute for mother's milk, and straightway the 
 market is stocked with another " Baby Food," 
 and physicians ready to recommend it and plenty 
 of babies ready for martyrdom. Now, how can 
 the physicians of the nineteenth century better 
 atone for all their cruelties toward the human 
 
 •India and the Hindoos. F. DeW. Ward, 1850, page 34. 
 SI 
 
52 Cow's Milk for Infant Food. 
 
 young than by causing a better cow to be reared, 
 and from henceforth base all their edicts on the 
 artificial feeding of infants on this better cow 
 with a better milk product? I think that with 
 few exceptions we are all agreed now that 
 nothing excels good pure milk from good 
 healthy cows for the artificial nourishment of 
 infants, and if the great body of physicians put 
 themselves about it with anything like the same 
 energy they have displayed in supporting sub- 
 stitutes they can so reform the breeding of dairy 
 cattle and the handling of their milk that the 
 suffering of the human young will be ameliorated 
 to a far greater degree than was ever hoped for 
 by the astute chemist who started out years ago 
 to make not only a substitute for cow's milk, but ' 
 also for that of the human mother.* It is this 
 idea of a substitute that has led us away from the 
 more important consideration of improving what 
 nature has already presented to us. Just look at 
 the improvement in the commercial line that the 
 middlemen have made in their milk transactions. 
 These men have reduced the purchasing of milk 
 to a nicety hardly surpassed by the purchasers of 
 
 ♦ "Now, I have come to the most important matter of the lecture, and 
 that is the consideration of the proposition at one time sincerely made of 
 substituting^ some other food for human milk as being a better food for 
 infants." Abstract of a lecture before the New York Academy of Sciences, 
 by Prof. Albert R. Leeds, Ph. D., of the Stevens Institute of Technology, 
 " Sanitarium," May 24, 1883, page 3^5. 
 
Cow's Milk for Infant Food. 53 
 
 gold and diamonds; they have worked down the 
 price of milk from the producer to the lowest 
 possible point; they have dropped fluid measure- 
 ment and adopted weight as being more accu- 
 rate; in butter factories they have invented an oil 
 test that will indicate in a very short space of 
 time the exact amount of butter a given quantity 
 of milk will yield, and on this test the price of 
 the milk is regulated; likewise the cheese facto- 
 ries have established a standard of solids in milk 
 which also regulates the price. But all the im- 
 provements these men have made do not help us 
 notwithstanding the fact that our chemists, sani- 
 tarians, health authorities have followed in the 
 wake of these men and endeavored to make us 
 believe that the healthfulness of milk is depend- 
 ent upon the total solids,. fats, etc., that relate 
 solely to its commercial value. A larger per- 
 centage of fat that is easily removed from milk 
 does not improve it for our purpose; it matters 
 very little to us whether a given quantity of milk 
 contains 12 or 14 per cent, of solids. 
 
 In milk for infant feeding we should consider 
 first the variety of fats, the manner in which they 
 are emulsified and combined; second the amount 
 of albuminoids and their condition; third, the 
 amount and variety of salts; fourth, the health of 
 th§ animals from which it is derived, and the 
 
54 Cow's Milk for Infant Food. 
 
 food that has been consumed to produce the 
 milk, and fifth, the changes which the milk has 
 gone through before it reaches the infant's 
 stomach. When we come to understand all these 
 conditions we shall readily perceive just what 
 kind of milk we want, and exactly the kind of 
 cow which, with a given variety of food, will 
 produce the very best substitute for the infant in 
 li'eu of its own maternal breast. 
 
 Let us then first consider the fats. Taking the 
 human milk, which should always be our stand- 
 ai-d, we find these solids according to the best 
 authoritative analysis occur in proportions of 2.11 
 to 6.89.* Now this makes an average of 4.131, 
 for human milk. From several hundred analyses 
 of cow's milk in different parts of France, Eng- 
 land and America, the average of the chemist is 
 3.91. Thus you will see the difference, accord- 
 ing to the chemist, between the two varieties of 
 milk is very slight. I know, however, from the 
 actual experience of practical dairymen that 
 cow's milk contains more fat than is indicated by 
 the above figures. The lowest amount of butter 
 obtained from mixed milks is one pound of but- 
 ter from 25 pounds of milk. This would make 
 the fat percentage 4. In drawing this de- 
 
 * Composition and Methods of Analysis of Human Mills bv Prof. Albert 
 R. Leeds. Transactions of the College of Physicians of Philadelphia. 
 Third series, Vol. VIIl, p. 248 
 
Cow's Milk for Infant Food. 55 
 
 duction I am well aware that a pound of butter is 
 not a pound of fat, but a pound of butter ob- 
 tained from a given quantity of milk represents 
 a pound of fat in that milk, because the quantity 
 of fat in a pound of butter is exactly 84 per cent., 
 and, according to the latest experiments at agri- 
 cultural stations only 84 per cent, of the fat can 
 be obtained from the milk by the process of 
 butter-making. Now, this percentage of 4 is a 
 low practical estimate of the quantity of fat, for 
 among dairymen with special breeding and feed- 
 ing they get as high as one pound of butter from 
 14 pounds of milk, that is 7.13 per cent. This 
 is a higher percentage than has been found by 
 any chemist in human milk. This is a practical 
 fact, not chemical inference. It is very easy 
 to understand where the fault in chemistry has 
 been. The fat in milk is dependent upon the 
 food the animal receives more than are the albu- 
 minoids, and we all know that very many of the 
 varieties of fat contained in cow's feed are vola- 
 tile, and the chemical methods of using heat 
 dissipate these varieties of fat; hence the low 
 percentage obtained by chemists. 
 
 We must all admit that the fats contained in 
 human milk, the product of an omniverous, 
 largely carnivorous animal, consuming fixed and 
 more stable fats, differ from those contained in 
 
56 Cow's Milk for Infant Food. 
 
 the milk of the cow, a herbivorous animal whose 
 food holds more vegetable, volatile and unstable 
 fats. Practically one is a yellow, unctuous, 
 pleasantly odorous fat, as we see in butter, the 
 other is colorless, waxy, decidedly different in 
 odor, and therefore it can be easily understood 
 that the chemist who is obliged to use heat will 
 recover more fat from the human than the cow's 
 milk. Thus we see that the fat is largely depend- 
 ent on the nature of the food, and from the dairy- 
 man we learn that we can regulate the food of 
 the cow so as to materially afifect the proportion 
 of fat secreted. We know very little about the 
 chemistry of fats; as far as I have been able to 
 ascertain there has been but one analysis of 
 cow butter fat made up to the year 1875. 
 Wherever we turn, the analysis of Bromeis con- 
 fronts us, and later English analysts, while finding 
 this analysis all wrong, are unable to give us a 
 correct one. These later analysts,* without as- 
 certaining the proportions, found in butter pal- 
 mitin, palmitic acid, stearin, stearic acid, olein, 
 oleic acid, butyrin, butyric acid, caproic acid, 
 caprylic acid and capric acid. The fat of human 
 milk has also been analyzed by Robin several 
 years ago and also copiously quoted. I think 
 
 * Hahnerand Angell. Butter: Its Analysis and Adulterations, London, 
 1877. 
 
Cow's Milk for Infant Food. 57 
 
 that it is due to us from the chemists that we have 
 some authoritative analysis of these milk fats, that 
 we may know which, if any, of the fatty acids are 
 the mischief makers in milk, for I have no doubt 
 that the glycerides and fatty acids from the de- 
 composition of milk have more to do with the 
 development of poisons than the albuminoids 
 have. The present popular method of analyzing 
 milk by heat undoubtedly decomposes the fats, 
 as is evidenced by the skin that forms on the 
 surface of boiling or evaporating milk. This 
 skin is undoubtedly the oxide of lipyl; it was at 
 one time considered that it was coagulated albu- 
 men, but it does not form in vacuo, and will con- 
 tinually form on the surface of boiling or evap- 
 orating milk as often as you remove it, and re- 
 sembles very much the skin which forms on old 
 paint pots that have contained vegetable oil. 
 Furthermore, the condensation of milk for com- 
 mercial purposes does not preserve the fats; 
 hence condensed milks are more or less skimmed, 
 the better varieties having only the more volatile 
 fats removed, otherwise they would become 
 rancid. I am coming more and more to con- 
 sider that the fats in milk are the bodies most 
 likely to cause the digestive derangements of 
 infancy, and when we know more of the compo- 
 sition and combinations of those bodies occur- 
 
S8 Cow's Milk for Infant Food. 
 
 ring in milk, many of the poisons, notably tyro- 
 toxicon, will be less of a mystery than they are 
 now. 
 
 Our second consideration will be directed to 
 the albuminoids. Some time ago there arose a 
 mild dispute between two chemists as to the 
 amount of the albuminoids occurring in human 
 milk; Professor Meiggs asserting that there was 
 only I per cent., while Professor Leeds makes 
 the variation of from 0.85 to 4.86, an average of 
 1. 195. Koenig, an earlier analyst, makes the 
 variation from 0.57 to 4.25. Some of these re- 
 sults give as high a percentage of albuminoids 
 in woman's milk as we find in cow's milk, and I 
 have no doubt in my own mind that the time 
 and habit of extracting the milk has a deal to do 
 with the amount of occurring albuminoids. In 
 other words, when milk is extracted every two 
 hours or less, it cannot contain as much of the 
 cell material as milk from the same source ex- 
 tracted at intervals of twelve hours. This latter 
 is riper and it is the nonuniformity of the tissue 
 which causes all the difiference in the different 
 occurring albuminoids. We know that during 
 the incubation of eggs caseine is developed from 
 egg albumen. This illustrates the ripening of 
 albumen. Furthermore, take an egg just laid by 
 the hen and boil it and you will find immature 
 
Cow's Milk for Infant Food. 59 
 
 albumen in it, that is, after boiling, instead of 
 being thick and firm, like an older egg, much of 
 it is milky. If boiled a few hours later, all the 
 albumen will coagulate perfectly, because it has 
 had time to ripen. There is no doubt that the 
 albuminoids in milk from healthy animals are all 
 cell transformations, not an exudate, as are un- 
 doubtedly the fats and salts, because these latter 
 we can influence by the food very plainly, but 
 in health the albuminoids are constant without 
 regard to the food, while during menstruation, 
 pregnancy and other conditions, notably febrile 
 disturbances, we find the fats and salts not mate- 
 rially affected, but the albuminoids are decreased, 
 increased or totally changed, as we find in colos- 
 trum. The caseine, besides being riper in cows' 
 milk, by reason of its stronger growth, is in- 
 tended by nature to coagulate into a hard mass, 
 because it is the product of a cud-chewer for the 
 nourishment of a cud-chewer, and the reason 
 why it does not always coagulate in the infant's 
 stomach as it does in that of the calf, is, that the 
 latter animal's stomach secretes a principle called 
 chymosin ; this is the principle that curdles cows' 
 milk, and it operates either in an acid or an alka- 
 line medium. Pepsin will not coagulate milk, 
 and hence the hard coagulum of cows' milk that 
 sometimes forms in the infant's stomach is due 
 
6o Cow's Milk for Infant Food. 
 
 to acidity of that organ, and this acidity is not 
 always the fault of the stomach, but of the milk 
 itself. The variations in the chemistry of the 
 albuminoids found in cows' milk would not be 
 surprising to any one if he would examine into 
 the condition of some of its mammary sources, 
 for often it will be found on dissecting a cow's 
 udder, which I always do when making an au- 
 topsy on a cow, that there are old cicatrices, one 
 or more quarters of the udder intensely inflamed, 
 sometimes a mammiferous duct clogged with a 
 calculus or a clot of fibrin, and besides these 
 pathological conditions, the mammary gland is 
 subject to benign and malign infiltrations, bacil- 
 lary tubercular deposits and eruptive diseases of 
 the skin involving the gland and dugs ; therefore, 
 that fibrin, serum, albumen in various forms, are 
 found in the cow's milk is not surprising, and it 
 can safely be assumed that any variation in the 
 albuminoids from the normal caseine can be as- 
 cribed to sickness on the part of the animal. 
 
 We next come to the salts contained in milk, 
 and it is remarkable how few analyses have been 
 made to determine the salts or minerals that are 
 contained in this fluid. Heidlin's analysis, copied 
 everywhere, seems to be the only exhaustive one 
 of the salines in cows' milk made during the 
 present century. It seems to me in this case, 
 
Cow's Milk for Infant Food. 6i 
 
 too, that it is time for the chemist to teach us 
 something more. There probably never was a 
 time, in our era at least, when milk was attract- 
 ing so much attention as now, and still all our 
 chemists are content with the total solids, fats, 
 albuminoids and sugar — just what the butter 
 and cheese-makers want to know. From this 
 much-quoted analysis of cows' milk salts we 
 learn that milk contains in varying proportions 
 the phosphates of lime, magnesia and iron, the 
 chlorides of potassium, sodium and iron and free 
 soda. Robin gets from human milk, in addition 
 to the foregoing, carbonate of lime and soda, 
 phosphate of soda and the sulphate of soda and 
 potash. We have no means of knowing how 
 constant is the occurrence of any of these salts in 
 milk or under what conditions they are modified; 
 we do know, however, from the experiments of 
 Fehling, that many of the drugs administered to 
 the milking female are excreted in the milk. 
 Therefore, we can safely assume that the saline 
 constituents occurring in milk are influenced 
 both by the health and food of the animal. That 
 the phosphates are craved for by the milking 
 cow is evidenced by the habit of chewing old 
 bones and the like, and that there is a lack of 
 this element of food is not to be wondered at 
 when we see herds of milking cows pastured on 
 
62 Cow's Milk for Infant Food. 
 
 old worn-out lands; the practical farmer knows 
 that exhausted pasture lands need more than 
 anything else for their rejuvenescence the phos- 
 phates, and we know that in our nutrition we 
 need them also. The land on which a cow is 
 pastured will indicate pretty fairly what we may 
 expect to find in her milk as salts. We have all 
 noticed the excessive growth of sorrel on ex- 
 hausted land, and can it then be a subject of 
 wonder that some kind of avegetable acid should 
 be found in the milk of animals that are obliged 
 to include this variety of food in their summer 
 rations and sour ensilage or spoiled' brewery 
 grains in their winter feed. Theodore Hankel's 
 discovery of citric acid in cows' milk to the 
 amount of 0.9 and i.i grammes per litre is just 
 what might be expected. 
 
 Sugar, I think, in milk has always been over- 
 estimated as to its nutritive value, because we 
 know that carnivorous animals do not secrete 
 sugar to any appreciable extent, at least so the 
 chemists tell us, and when we see a small slut* 
 nursing seven or eight puppies and keeping 
 them all fat and in a thriving condition, we can 
 easily imagine that sugar is not one of the neces- 
 sary elements of food; while, on the other hand, 
 we know that the gross result of condensed milk 
 
 •The canines excrete no sugar in their milk. 
 
Cow's Milk for Infant Food. 63 
 
 feeding where the sugar is in excess is not good. 
 In regard to using the commercial sugar of milk 
 as an addition to cows' milk for infant feeding, 
 I think it is a mistake, as there are undoubtedly 
 all the other crystallizable milk salts with the 
 milk sugar, and consequently we can know very 
 imperfectly what we are feeding an infant with 
 when we are giving milk sugar. If the milk from 
 which the sugar was crystallized contained im- 
 proper vegetable salts, those would undoubtedly 
 become crystallized with the sugar, and many 
 of the proper salts would have become changed 
 to the lactates. Therefore, I think if sugar is to 
 be used at all, although I deem it of doubtful 
 necessity, the pure cane sugar is undoubtedly the 
 best because you know just what it is. When we 
 consider the chemistry of milk as we find it in 
 the books, what does it all amount to? The 
 chemist has given us to understand that the 
 needs for bodily nourishment are a certain 
 amount of the albuminoids carbohydrates, fats 
 and salts. We can, therefore, from some of the 
 cheap cereals make this ideal food, and for one 
 cent have as much in nutritive value as we get 
 in milk at a cost twenty or thirty times greater. 
 Then, why do we give milk? Because we have 
 tried the chemist's ideal food with the infants at 
 least, and however admirable the theory may be, 
 
64 Cow's Milk for Infant Food. 
 
 in practice it is a failure. Nature does not make 
 so close an allowance that there is nothing to 
 spare and no margin. She does not measure 
 food by the rule of three, always exactly in the 
 same proportions. Let us examine the work of 
 the chemists themselves, and we find in human 
 milk a standard that we cannot ignore, the al- 
 buminoids varying from 0.85 to 4.86. There- 
 fore, let us not deceive ourselves with the popu- 
 lar error of the day, namely, that milk must con- 
 tain just such a proportion of solids, and solids 
 not fat, and so forth, to a chemical nicety, but 
 let us look into the cow-house and see what goes 
 through the cow to produce the food for infants 
 and what kind of an animal she herself is. Prof. 
 L. B. Arnold, as good an authority as we have in 
 this country on dairy matters, says: " Milk is 
 the scavenger of the cow's body." What would 
 be the sense of taking a sample of v/ater from a 
 sewer and asking a chemist to examine it for 
 sewage, and so when we go into a dairy stable 
 and see dirt and filth, disease and improper food, 
 need we ask the chemist to ascertain the total 
 solids, fats, etc., to find if the milk is fit for infant 
 food? When this fluid will not properly nourish 
 an infant it is not cows' milk, per se, that is at 
 fault, but it is either a pathological condition of 
 the cow or improper food or care or the condi- 
 
Cow's Milk for Infant Food. 65 
 
 tions through which the milk has passed on its 
 way from the cow to the infant. It is safe to say- 
 that if we had directed the same attention to the 
 cow, and if the same amount of money that has 
 been spent on the various substitutes had been 
 devoted to the improving of her condition, the 
 infant at least would be better off. 
 
 Now we can assert that cow's milk is the best 
 food for the artificial feeding of infants, and when 
 this fails the fault lies in one or other of the fol- 
 lowing conditions, or several of them combined: 
 First, a faulty condition of the cow herself, and 
 this will be indicated by the condition of the 
 albuminoids; second, improper food or an im- 
 proper manner of feeding and caring for the 
 animal, and this will be indicated by the fats and 
 salts; third, improper handling of the milk after 
 it is taken from the cow, and this will be indi- 
 cated by the ptomaines and extractives. A 
 proper understanding of these three sources of 
 danger will make the feeding of infants a sim- 
 pler matter than that offered by any of the sub- 
 stitutes, and be at the same time a more rational 
 method. We shall consider the conditions of 
 the animal that render her milk unfit for food. 
 The cow is an unique beast, differing in many 
 respects from any of our other domestic animals. 
 One of her peculiarities that has caused a great 
 5 
 
66 Cow's Milk for Infant Food. 
 
 deal of confusion among veterinary writers is her 
 normal temperature. Several years ago I 
 searched diligently in books devoted to bovine 
 pathology to find the normal bodily heat of the 
 cow, and the confusion was puzzling. It is vari- 
 ously stated at from 98° to 101° Fahr. I, myself, 
 made several hundred thermometrical examina- 
 tions, under varying conditions, and found that 
 the temperature is not constant in apparent 
 health, as it is within very narrow limits in the 
 human subject. Of course we cannot tell to a 
 certainty how near to health a dumb creature is. 
 The standard that has been adopted with these 
 animals is that they are in health when they per- 
 form their functions with profit to their owners. 
 Certainly, there are many slight ailments that do 
 not carry the animal beyond this limit. There- 
 fore, the varying temperature in the cow 
 may be due to slight ailments that do 
 not demand the attention of the veterina- 
 rian. The average temperature of the cow in ap- 
 parent health I have found to be 102^° Fahr., 
 ranging from ioii° to 103°. This you will per- 
 ceive is a peculiarity of the cow, and none of the 
 other large domesticated animals maintain so 
 high a bodily temperature. Another peculiarity 
 of the cow is the constant employment of her 
 generative functions. She is always milking or 
 
Cow's Milk for Infant Food. 67 
 
 pregnant, and both the uterus and the mammary 
 glands are employed almost constantly at the 
 same time. Hence, her nervous functions are 
 exaggerated. Therefore, with an abnormally 
 high temperature, for I have found that bulls 
 and steers have not so high a temperature as the 
 milking cow, and with an unnatural functional 
 activity of the organs of generation, she is used 
 also as a machine to transform food into milk, 
 and it is astonishing to what capacity she has 
 been trained in this direction. With four stom- 
 achs, the first alone with a capacity of sixty gal- 
 lons, she simply eats, and she will eat anything; 
 in health she is always either eating or chewing 
 her cud, and her pedigree sometimes shows the 
 closest consanguinity in her breeding. Now 
 when we consider all these unusual conditions is 
 it at all to be wondered at that the ordinary dairy 
 cow is as a rule an unhealthy animal, more prone 
 to bacillary phthisis and scrofulous affections 
 than other animals? Her nervous system is 
 more subject to severe shocks, and in fact she is 
 a delicate creature, her attendants are not usually 
 either mild or cleanly, nor is her housing always 
 the best. 
 
 Our next consideration is the feeding and care 
 of this nervous and deHcate animal. The ordi- 
 nary dairyman receives for his milk i| to 2^ cents 
 
68 Cow's Milk for Infant Food. 
 
 per quart. At this low price received by the pro- 
 ducer he cannot usually give his cattle the best 
 food. I noticed in a dairy journal this summer 
 an estimate from the New York Dairy Commis- 
 sioner. Taking the milk received at the cream- 
 eries as a basis, the average income from each 
 cow is about $20 a year to the producer. This is 
 almost seven cents a day, from which the dairy- 
 man has to buy food and pay for labor. This 
 sum alone would not begin to pay for proper 
 food for the animal, hence the farmer is driven 
 to every known expedient to keep his cows in 
 milk, and the profits being so small, if there is 
 any profit at all, he must utilize every drop of 
 milk, whether the animal giving it be sick or 
 well. In this state of affairs is it not natural that 
 all the cheap foods, such as brewery grains, dis- 
 tillery slops, the refuse from starch factories en- 
 ter so largely into the food from which our 
 babies' supply of milk is produced? Of course 
 this condition of low price and improper feeding 
 does not apply to every dairy, but after years of 
 experience I have no hesitation in saying that it 
 applies to the great majority of dairy farms, sur- 
 rounding New York city, at least. I have per- 
 sonally inspected small dairies where the sole 
 article of diet was swill, gathered in the city. 
 Good food is to the cows of course the prime 
 
Cow's Milk for Infant Food. 69 
 
 absolute essential for the production of good 
 milk, and unless the public are willing to pay 
 more for their milk than they do at present a 
 reform in this direction cannot be expected. 
 
 The handling of milk after it leaves the cow is 
 the next important consideration. Owing to the 
 cow's natural high temperature, 102° to 103° 
 Fahr., the milk when drawn must cool rapidly, 
 and this first cooling taking place in a cow-house, 
 the milk is, of course, more or less affected by 
 the conditions generating odors. If these odors 
 are not very bad they can be removed more or 
 less perfectly from the milk by a process of aera- 
 tion. This can be accomplished readily by pour- 
 ing the milk from one vessel to another in a thin 
 stream in the presence of a pure atmosphere, or 
 on a larger scale by pumping pure air into it by 
 a suitable machine. One of the most dangerous 
 methods that I know of for killing the odors that 
 milk absorbs from dirty stables or improper food 
 is that recommended by many practical and 
 otherwise sensible men, namely, the addition of 
 nitrate of potash, that is, common saltpetre. It 
 is very easy from this addition of nitre, combined 
 with the glycerides and sulphates already con- 
 tained in milk that is decomposing, to figure out 
 chemically bodies approximating to nitro-gly- 
 cerine. It is suggestively strange that the 
 
yo Cow's Milk for Infant Food. 
 
 toxic effects of nitro-glycerine are similar 
 to those of tyrotoxicon. The often-reported 
 detonation of this latter extractive while 
 undergoing examination in the laboratory is 
 also suggestive of the properties of nitro- 
 glycerine. The addition of chloride of hme 
 which is also recommended for the same pur- 
 pose, although apparently a less dangerous 
 chemical compound, should nevertheless be pro- 
 hibited. Soda is also added to milk sometimes 
 to delay the souring process. The prohibition 
 of this chemical may be viewed in the light of a 
 stultification when we consider the large amount 
 of bicarbonate of soda that is used at the present 
 day in one of the popular methods of feeding 
 infants. I think it is no less reprehensible on the 
 part of the physician than it is on the part of the 
 dairyman. No chemical substance whatever 
 should be added to cow's milk by the dairy- 
 man. Milk that is procurable too far away 
 to reach the child within a few hours should 
 not be used for infant feeding. The differ- 
 ent degrees of temperature through which it 
 must pass in its transit by country wagon, rail- 
 road train, and city express are productive of 
 changes that cannot but deteriorate the quality 
 of the milk. It is well known that light as well 
 as heat is one of the elements that hasten de- 
 
Cow's Milk for Infant Food, 71 
 
 composition in milk, hence the now popular 
 method of serving milk in clear glass bottles is 
 also a popular error. No milk should be served 
 by the milkman for infant feeding after it is 
 twelve hours old, nor should it be served to the 
 infant while it is warm, immediately after leaving 
 the cow, for I have found by actual experiment 
 that cow's milk while still retaining the animal 
 heat, if taken into the stomach, would coagulate 
 into a soHd mass, but this coagulation was not 
 so hard and rubbery as the curd we see some- 
 times formed when milk is too old. In regard 
 to sterilized milk, I am of the opinion that it is 
 far better for us to make an efifort to improve the 
 quality of milk to such an extent that it will be 
 needless to sterilize it, because, of course, steri- 
 lized milk must take its place with condensed 
 milk and other varieties of preserved food. If 
 we cannot improve our milk then, of course, 
 sterilization ought always to be practiced; not- 
 withstanding that it is a preserved food like con- 
 densed milk it is not necessarily skimmed or 
 sweetened as the latter is. 
 
 Having thus outlined the condition of the milk 
 we get and the reasons why it is not always good, 
 let me in the next place suggest remedies for the 
 existing evils. First, in regard to the cow her- 
 self. No cow that is bred for a butter-maker 
 
72 Cow's Milk FOR Infant Food. 
 
 should ever be used to furnish milk for infant 
 feeding. The ideal butter-cow is too closely in- 
 bred, and consequently too nervous; there is too 
 much free fat in her milk. The ideal cow to fur- 
 nish milk for our purpose should not be too 
 finely bred and with little, if any7 consanguinity 
 in her breeding. She should not have had her 
 first calf till she was in her third year; her milk 
 should not be used after she is six years old, 
 unless she has been spayed; she should be of a 
 quiet disposition; her surroundings clean and 
 quiet; she should be stall-fed always while giving 
 milk for infants; her food should be hay without 
 weeds, ground oats, bran, flaxseed meal, roots 
 (beets and carrots), bone-meal and salt, in the 
 winter corn-meal in addition and in summer in 
 lieu of dry hay, green cut clover or grasses free 
 of weeds. She should be curried daily and well 
 bedded, and in the winter the water she drinks 
 should be slightly warmed. The milk should be 
 aerated and cooled as quickly as possible. It 
 should then be put into opaque bottles and 
 securely closed. 
 
 Now, why do we not have this kind of cow 
 and obtain this quality of milk from our milk- 
 man? The very first and prime reason is that 
 milk is sold altogether too cheap. The producer, 
 as I have before mentioned, gets about two cents 
 
Cow's Milk for Infant Food. 73 
 
 a quart. The railroad or the carrier gets one 
 cent a quart for all handled, and the distributor 
 gets five cents a quart for peddling to the cus- 
 tomers. Therefore, the consumer pays eight 
 cents. This variety of milk does not usually 
 agree with the child, and therefore the consumer 
 is advised to buy some of the Baby Foods as an 
 addition to the milk, and this increases the price 
 of the food to something like fifteen to twenty 
 cents a quart. Now, if the producer got this 
 extra amount of money he could buy better food 
 and better cows, exclude the milk of sick animals, 
 and altogether improve the quality of his pro- 
 duce. But would he do it? That is the question. 
 Still it would be more humane to make him do it 
 when he is making a living than under circum- 
 stances as they exist now. So the question of a 
 purer supply rests very largely with the medical 
 adviser. Instead of recommending commercial 
 Baby Foods in addition to doubtful milk, he 
 should advise the parents to purchase milk at 
 twelve or fifteen cents a quart, and when the in- 
 fant gets sick from digestive troubles, then lay 
 the blame where it is justly due, to the milkman, 
 and he will lose his customer. The supply of 
 baby milk in cities should be kept entirely dis- 
 tinct, and should be procured from those farms 
 th^t ar? situated near enough to the customer to 
 
74 Cow's Milk for Infant Food. 
 
 get the morning's milk of the day of delivery. 
 The dairies supplying this variety of milk should 
 be under strict sanitary surveillance, for no mat- 
 ter how good a condition a cow may be in if she 
 is in heat, has sustained an injury or is sick in 
 any manner whatever, her milk should not be 
 used for infant feeding until she has completely 
 recovered. The ideal dairy for supplying infant 
 food should be composed entirely of spayed 
 cows, and thus one constant source of nervous 
 functional disturbance would be eliminated. In 
 my own herd I have several spayed cows whose 
 milk I supply for infant feeding. These animals 
 are much more quiet in disposition, they give a 
 more constant and uniform supply of milk, and 
 seem to enjoy a more even degree of health than 
 the cow who is occasionally bulling and becom- 
 ing pregnant when giving milk. 
 
[Reprinted from " The Journal of the American Medical Association, 
 July 5, iSgo.] 
 
 THE USE OF COMMERCIAL MILK 
 SUGAR IN INFANT-FEEDING.* 
 
 Some time ago a gentleman came to me, who 
 had been sent by his physician for me to discover, 
 if I could, what the trouble was with the milk 
 which he was feeding his baby. He bought a 
 sample with him, it was very slightly gray in 
 color, and the caseine was precipitated in a fine 
 granular deposit, the odor was slightly disagree- 
 able. On inquiry, I found the mixture to be that 
 known as the " Meigg's mixture " as recom- 
 mended by Dr. J. M. Rotch in the article on " In- 
 fant Feeding " in Keating's Cyclopedia. After a 
 thorough investigation as to the milk and cream, 
 I could find nothing wrong with these constitu- 
 ents of the mixture. I then ascertained that he 
 had been using the mixture for some weeks, and 
 that he had not observed the foregoing change 
 before. Then I questioned him as to what new 
 conditions were existing when this change took 
 
 *Read in the Section of Diseases of Children at the Forty-first Annual 
 Meeting of the American Medical Association, Nashville, Tenn., May, 
 i8go. 
 
 75 
 
76 Use of Milk Sugar in Infant-Feeding. 
 
 place and I learned that he had just procured a 
 new supply of milk-sugar. " But," he said, " It 
 cannot be that for I got it where I have always 
 bought it." I told him to go to some other store 
 on his way home and get another supply and try 
 that, and report to me the result. He returned in 
 the afternoon and told me that the whole trouble 
 had been in the sugar; because, when he went 
 home and used the second lot, the mixture ap- 
 peared all right, and to assure himself that this 
 was the case, he again mixed a quantity with the 
 first milk-sugar and found the same change tak- 
 ing place in the food mixture. I have ever since 
 exceedingly regretted my foolish oversight in not 
 securing the troublesome sugar. I thought I 
 could look the matter up in the books and find 
 there what the trouble was, but after diligent 
 search I found that there was practically no liter- 
 ature on this subject. By this time the man had 
 unfortunately thrown away the bad sugar. I 
 have been ever since trying to find out what was 
 in that sugar. It was purchased at a reputable 
 first-class drug-store and the proprietor, I know, 
 deals only with reputable high-class firms. I 
 could not get a sample from him because he had 
 returned it to his wholesale supplier when his cus- 
 tomer made his complaint. Since then I have 
 found that we know very little about this highly 
 
Use of Milk Sugar in Infant-Feeding, "jy 
 
 recommended constituent in mixtures for the 
 artificial feeding of infants. Hahnemann discov- 
 ered years ago that the sugar of milk had the 
 least appreciable effect on the human system of 
 any substance he had tried, and hence, he recom- 
 mended it as a vehicle for the administration of 
 medicine. Previous to this its use was very 
 limited and its manufacture vi?as confined to 
 Switzerland. Now, however, with our pepsine 
 powders, tablet triturates and baby-foods it has 
 become one of the regular articles of commerce, 
 and its consumption is computed by tons; in 
 short every creamery in the country where cheese 
 is manufactured, milk-sugar is one of the by-pro- 
 ducts and large quantities are still imported. It 
 is found in the wholesale market in large cobs 
 with a stick running through the center resem- 
 bling the barley-sugar of our youth and also in 
 coarse irregular crystals resembling somewhat 
 coarse salt, and in the retail stores we find it in 
 the fine powdered condition. The market price 
 last winter at the time of my inquiry was 14 to 1 8 
 cents per pound for the crystal cobs and 12 cents 
 for the powders. No wholesale man of my ac- 
 quaintance could enlighten me as to this differ- 
 ence. It is well known that milk-sugar is one of 
 the difficult articles to powder properly, and there 
 is considerable waste in the crystal owing to the 
 
78 Use of Milk Sugar in Infant-Feeding. 
 
 stick on which it is crystalized. This is not a 
 scientiiic point, but it is one of the things which I 
 learned during several years of intermittent in- 
 vestigation and it may be interesting to some 
 people. 
 
 One of the faults of physiological chemists is, 
 that they make no distinction between a sub- 
 stance existing in a natural condition and that 
 substance eliminated and isolated by chemical 
 means. Thus, the sugar of milk of commerce 
 and the sugar of milk as it exists in that fluid 
 are regarded by the chemist as one and the same 
 thing. Hence, the physician has been led into 
 the error of thinking that as the sugar in milk is 
 that designed by nature as the best saccharine 
 nutrient, therefore the isolated sugar must fulfil 
 the same function. This is not the truth. Sugar 
 of milk in that fluid is all assimilated, and the 
 milk-sugar of commerce when added to baby 
 food is eliminated both by the kidneys and 
 bowels. This, I have demonstrated by numerous 
 experiments. I have never found sugar present 
 in the urine or faeces of babies fed at the breast, 
 but in three cases of infantSi fed with mixtures 
 containing commercial milk-sugar to the amount 
 of three ounces or more in twenty-four hours (as 
 in Meigg's mixture) I have always found sugar 
 in the urine and faeces demonstrated by Fehling's 
 
Use of Milk Sugar in Infant-Feedjng. 79 
 
 test. The faeces I macerate in boiling water, boil 
 the filtrate and refilter, testing the final filtrate. 
 I have never endeavored to ascertain the exact 
 amount of occurring sugar, but the reactions 
 have always been definite and well-marked. To- 
 night I received two cubic centimeters of urine 
 from a baby 10 months old fed on Meigg's mix- 
 ture, and this tested with Squibb's standard Feh- 
 ling's solution indicates .025 per cent, of sugar. 
 Therefore instead of being of value as a nutrient 
 it must be harmful, to what extent, I am not at 
 present prepared to say. A substance that is not 
 broken up in the system but eliminated without 
 change, if it be not an absolute poison will pro- 
 duce little if any appreciable immediate effect. 
 Hence, Hahnemann was right in his observation 
 as to the effect on the system of administered 
 milk-sugar. Routh also in his work on " Infant 
 Feeding " recommends milk-sugar because it 
 undergoes " fermentation less readily than the 
 ordinary sugar." This statement has been re- 
 peated by nearly every one who recommends the 
 sugar of milk as an infant food. I think this 
 statement of Routh would be rather against any 
 article of food because any substance that spoils 
 quickly or responds readily to any of the fermen- 
 tation changes will also respond quickly to the 
 digestive ferments. 
 
8o Use of Milk Sugar in Infant-Feeding. 
 
 Relating to t^e fermentation of milk-sugar, I 
 have made the following experiment. I took five 
 test-tubes, and in each placed two drachms of a 
 saturated solution of milk-sugar, each tube con- 
 taining a solution from a dififerent sample. Into 
 each tube I dropped two drops of brewer's yeast; 
 in twenty-four hours each sample responded to 
 the test for alcohol by chromic acid. With these 
 five tubes I placed at the same time a sixth con- 
 taining a solution of cane sugar of the same 
 strength as that of the milk-sugar solutions; in 
 this solution also I dropped two drops of brewer's 
 yeast. The cane sugar solution set up active fer- 
 mentation in five hours. I allowed the six solu- 
 tions to remain in a living room with the tubes 
 open for three months. When examined after 
 this length of time the water had completely 
 evaporated leaving the tubes dry. The five milk- 
 sugar tubes contained each a large mass of dried 
 mould and some exhibited crystals of sugar on 
 the side of the tube; while the cane sugar tube 
 contained very little residuum. I added to each 
 tube two drachms of water, the original amount 
 of fluid, and I found that the cane sugar had en- 
 tirely disappeared, while the milk-sugar tubes 
 were each rich in sugar. And now after three 
 weeks in the second solution with all its gathered 
 mould and dust, the sugar is still there. So 
 
Use of Milk Sugar in Infant-Feeding. 8i 
 
 Routh was right; it will undergo " fermentation 
 less readily " than almost anything fermentable. 
 
 Another question that has occurred to me in 
 connection with commercial milk-sugar is, how 
 much sugar does a given quantity of the article 
 purchased really contain? In view of this inquiry 
 I made it a point at one time to buy five cents 
 worth of milk-sugar in every drug-store I came 
 to and thus I collected many samples. Out of 
 these many samples I selected five and submitted 
 them to the tests prescribed by the United States 
 Pharmacopoeia. First, solubility. According to 
 the Pharmacopoeia, milk-sugar is soluble in seven 
 parts water at 59° Fahr. Sample No. i, not 
 completely soluble, after twelve hours a white 
 precipitate surrounded by a black ring at the 
 bottom of the tube; No. 2, slight black precipi- 
 tate, enough to cause a decided opacity on agita- 
 ting the solution; No. 4, solution remained 
 slightly opaque and deposits a dark brown pre- 
 cipitate. No. 5, solution perfectly clear with a 
 few grains of undissolved sugar at the bottom of 
 the tube. 
 
 Tests for the presence of cane sugar according 
 to the Pharmacopoeia: " If one part of sugar of 
 milk be sprinkled upon five parts of sulphuric 
 acid contained in a flat-bottomed capsulfe, the 
 acid should acquire nothing more than a green- 
 6 
 
82 Use of Milk Sugar in Infant-Feeding. 
 
 ish or reddish, but no brown nor brownish black 
 color within an hour." The following are the re- 
 sults of my application of this test: From por- 
 tions of the samples above referred to, No. i, 
 blackish-brown; No. 2, dark brown; No. 3, red- 
 dish brown; No. 4, light red; No. 5, hght red. 
 The Pharmacopoeia also states that it is insoluble 
 in alcohol, ether or chloroform. I found sample 
 No. I lost 5 grains from 3f drachms by repeated 
 washing with sulphuric ether and 11 grains by 
 washing in absolute alcohol. No. 3 lost half a 
 grain by washing with sulphuric ether. I did not 
 test the other solutions in this manner, but I sent 
 to James H. Stebbins, Jr., an analytical chemist 
 residing in New York, samples No. i and 2 of 
 the foregoing for analysis as to the quantity of 
 sugar contained in each sample. I received from 
 him the following reply: 
 
 Dear Sir. — The samples of milk-sugar marked 
 as below submitted to me for analysis contain, 
 No. I, 94.38 per cent.; No. 2, 98.49 per cent. 
 
 These are specimens bought in the open mar- 
 ket from reputable druggists, and such as are sold 
 to the consumers for infant feeding. When we 
 come to know the manner in which milk-sugar 
 is procured, the only wonder is that it does not 
 contain much less sugar than is indicated by the 
 
Use of Milk Sugar in Infant-Feeding. 83 
 
 above analysis. The milk is collected and al- 
 lowed to stand for several hours in cooling vats; 
 then, it is conveyed to a large tank to be coagu- 
 lated. Various substances are used to hasten the 
 coagulation. According to Flint* vinegar, 
 cream of tartar, muriatic acid and sour milk can 
 be used to produce coagulation, but of course 
 rennet is the most popular and most commonly 
 used agent. This, as we all know, is the fourth 
 stomach of the calf. The directions given for 
 preparing rennet are as follows: " Care must be 
 taken not to use too much water in cleaning, wip- 
 ing lightly with a moistened cloth until it is clean, 
 is the better way. If then blown up like a bladder 
 and hung up and dried, it will retain its power 
 for coagulating milk for years." Pieces of this 
 rennet are steeped in warm water, and the solu- 
 tion from it is added to the milk and then the 
 milk is raised to a temperature above 100° and 
 kept at that until coagulation takes place. Then 
 the whey is drawn off and this whey is evapor- 
 ated by boiling to one-fifteenth of its original 
 bulk, leaving a brown, viscid, sweetish saline 
 mass. This is dipped out into a tub where the 
 sugar will crystallize in twenty-four to forty-eight 
 hours. These crystals are known as "sand;" 
 this sand is filled into sacks from which the water 
 
 •Milk Cows and Dairy Farming. 
 
84 Use of Milk Sugar in Infant-Feeding. 
 
 drains off. The sand is again boiled in water to a 
 sufficient concentration and the sugar is allowed 
 to crystallize in sticks. It will thus be seen that 
 many of the other crystallizable bodies contained 
 in milk would be included in this crystallization 
 as well as the alkaloids of ptomaines. 
 
 I am exceedingly sorry that I have not had 
 time to follow out all the experiments that have 
 been indicated to me while making the few hur- 
 ried inquiries relating to a subject, which I am 
 positively sure will change the views of many 
 gentlemen who have taken me to task for recom- 
 mending the use of pure cane sugar as an addi- 
 tion to infant food when a sugar addition is 
 needed. I really think that the addition of any 
 sugar to good milk is overestimated. 
 
Use of Milk Sugar in Infant-Feeding. 85 
 
 III East Seventieth street, New York. 
 
 August 25, 1890. 
 Edward F. Brush, M. D., Mt. Vernon, N. Y.: 
 
 Dear Doctor. — I write to you as chairman of 
 the committee on public health of the New York 
 County Homoeopathic Medical Society. 
 
 I am very desirous of having this Bureau be of 
 some great practical importance, and the other 
 members of the committee in conversation with 
 me have agreed that we shall take up matters of 
 the greatest importance at our meetings of re- 
 port, and that one of the most important of all is 
 the subject of disease contaminations through 
 the medium of milk. 
 
 We look upon you as one who understands 
 that subject in its most minute detail, and we all 
 know you, and I voice the sentiment of our whole 
 society, when I say we are anxious for your views 
 on the subject. 
 
 Our next meeting will be on September nth, 
 and if you would grant us the favor of that time 
 we would be greatly pleased, and I think you 
 would not regret the efifort. 
 
 If, however, that date would not suit you and 
 a later one would, we bow to your will, and will 
 patiently await the time when we may be in- 
 structed by your paper. 
 I am very truly yours, 
 
 J. B. GARRISON, M. D., 
 Chairman Committee on Public Health, 
 
[Reprint from The North American Journal of Homoeopathy.] 
 
 SUGGESTIONS FOR IMPROVEMENTS 
 OF THE DAIRY.* 
 
 Without definite knowledge on the subject, 
 the almost universal belief to-day is, that the 
 milk supplied to cities is not right; and without 
 a unanimous agreement as to what diseases or 
 other disturbing elements are spoiling the milk 
 supply, there is an unsettled, perturbed feeling 
 about the dairy products as supplied to large 
 communities. The medical men are convinced 
 that something is radically wrong, as evidenced 
 by their fruitless efiforts to improve the supply as 
 they get it from the dealer, and now the doctors 
 are becoming hopeless from the failure of sterili- 
 zation, pasturzation, peptonizing, modifying 
 with cream, milk-sugar, and the addition of the 
 variously constituted patent foods. The health 
 authorities, with a grim determination to keep at 
 work, right or wrong, have satisfied themselves 
 with total solids and fat percentages, and would 
 have us believe that any milk containing 13 per 
 cent, solids, of which 2.5 are fats, is absolutely 
 
 •Read before the Homceopathic Medical Society of the County of New 
 York. 
 
 87 
 
88 Improvements of the Dairy. 
 
 normal and healthy. With all these men the 
 great trouble is that they have been working at 
 the wrong end of the subject. If all the honest, 
 scientific, painstaking work that has been done 
 by the sanitarian and medical men had been di- 
 rected to the dairy and the dairy cow, we should 
 be far nearer to the solution of the difificulty than 
 we are at present. 
 
 To begin with generation, the dairy cow is 
 bred wrong. The scrofulous and tuberculous 
 form has been the ideal in the mind of the dairy- 
 cow breeder for generations, not because they 
 recognized scrofula and tuberculosis as abnormal 
 conditions, but because in this pathological con- 
 dition the mammiferous animal becomes a larger 
 milk producer, for the reason that scrofula and 
 tuberculosis are eminently glandular diseases, 
 and the mammary gland being the highest type 
 of glandular structure, takes on an excessive ac- 
 tivity under these conditions. During a number 
 of years of close observation of dairy cows, I have 
 found a sudden increase in the secretion of milk 
 a pathognomonic sign of an active tubercular in- 
 vasion, and I am always afraid of a cow that gives 
 an abnormal quantity of milk. I do not intend 
 in this paper to discuss tuberculosis as a disease 
 conveyed to the human from the bovine race, but 
 I mean to affirm that an excessive quantity qI 
 
Improvements of the Dairy. 89 
 
 milk from a tuberculous cow is exceedingly de- 
 ficient in all the nutritive elements except fat. 
 Hence the first reform in the dairy is to breed 
 our dairy cattle for health and not as large, phe- 
 nomenal milkers, for I can say without fear of dis- 
 pute, that the healthy, robust and vigorous ani- 
 mal is never a large yielder of milk. The breeds 
 of animals that enjoy a reputation for immunity 
 from tuberculosis in this day of phenomenal 
 milkers, are not classed at all as dairy cattle. The 
 Aberdeenshire, a large and robust native of the 
 Highlands of Scotland, generally supply only a 
 quantity of milk sufficient for the nourishment of 
 their ofifspring; these animals enjoy a reputation 
 for immunity from tuberculosis. There are, of 
 course, tuberculous cattle that are not bred for 
 the dairy, but the same methods are followed in 
 breeding them as with the tuberculous dairy ani- 
 mal, namely, in-and-in breeding of the closest 
 consanguinity for early maturity and maternity. 
 All consanguineously bred animals fecundate too 
 early and thus add to their inherent delicacy. It 
 should be the rule in all breeding herds that ani- 
 mals shall not have their first calf till after they 
 are three years old, instead of seventeen and 
 twenty months, as is now the prevailing rule in 
 many dairies. 
 
 Hence the first recommendation is to avoid 
 
90 Improvements of the Dairy. 
 
 consanguinity and not allow the heifer to become 
 a mother until she is twenty-seven months old. 
 This method of breeding I would advocate as the 
 rule for cattle breeders, because I deem it abso- 
 lutely essential that cattle-breeding and dairying 
 should be distinct occupations. Years ago the 
 English breeders found that they could not 
 profitably breed an animal that would be fit for 
 the butcher and the dairy; hence there arose the 
 dairy-breeder and the beef-breeder. Now, after 
 many years devoted to the subject of dairy cattle, 
 I am convinced that a man cannot keep his cows 
 breeding and milking at the same time, and sup- 
 ply a healthy food to the community. 
 
 In my opinion, then, the separation of the 
 functions of breeder and dairyman is the first re- 
 form to be recommended. All the cows used to 
 supply milk for food, especially for infant food, 
 should have their ovaries removed. The first 
 suggestion of this proposition seems, to the or- 
 dinary mind, preposterous, unnatural and cruel. 
 It is no more unnatural than the castration of the 
 male animal for the improvement of its meat for 
 human food, and as to its cruelty, having per- 
 formed the operation several times myself, I can 
 conscientiously afifirm that the pain of one par- 
 turition outweighs the suffering of the operation 
 of spaying, if the latter is properly performed. 
 
Improvements of the Dairy. 91 
 
 The operation of spaying is by no means new or 
 novel; it is probably as old a procedure as any 
 surgical practice associated with the domestica- 
 tion of animals. In some regions the spaying of 
 the female pig, for the improvement of her meat, 
 is as common a procedure as the castration of the 
 male pig, and spaying is often practiced in the 
 females of the bovine tribes among the beef 
 herds, for the same reason of improving the meat. 
 Now, in spaying a beef animal only one result is 
 obtained, while in spaying a dairy animal two 
 very desirable improvements are the result. In 
 the first case, improvement of the meat in the 
 beef animal is the only result; in the other case, 
 that of the dairy cow, the quality of the milk is 
 improved and many of the diseases and disturb- 
 ing affections resulting from oestrum, preg- 
 nancy, and parturition are totally eliminated 
 from the dairy. These latter disturbances have 
 as much, if not more, to do with the production 
 of positively bad milk as any single group of dis- 
 turbing conditions in the dairy. 
 
 No one disputes the deleterious effects of col- 
 ostrum from the cow when used as infant food. 
 On dairy farms, as ordinarilv conducted, abor- 
 tions are very common, and often epidemic, and 
 when these abortions occur the entire product of 
 the dairy becomes colostrum. Cases of pelvic 
 
92 Improvements of the Dairy. 
 
 cellulitis occur, septic absorption is common 
 from placental retentions, and an amount of un- 
 healthfulness prevails, while the quantity of milk 
 produced is not very materially lessened. No 
 one can dispute that under these circumstances 
 the quality of the milk is very much lowered. 
 This occurrence is not a very rare one, but com- 
 paratively common according to my experience 
 and the reports of the dairy journals. The elimi- 
 nation of this trouble alone would quite if not 
 more than compensate for the trouble of spaying 
 every dairy animal. 
 
 Milk fever is a common afifection of the dairy, 
 and the phenomenal milkers are more prone to 
 it than the less abundant milkers. This febrile 
 condition must necessarily affect the milk per- 
 niciously, and as it only follows parturition, of 
 course would be eliminated when parturition 
 ceased to be one of the phenomena of the dairy. 
 The occurrence of ovulation in the dairy has a 
 decidedly deteriorating efifect on the milk supply. 
 I have myself, from numerous experiments, as- 
 certained that in this condition a cow secretes 
 milk that is intensely acid and emits a very dis- 
 agreeable odor if heated in a test tube. The high- 
 bred dairy cow is an excessively nervous animal, 
 and during heat becomes frantic, and in the field 
 with a herd, one bulling cow will often produce a 
 
. Improvements of the Dairy. 93 
 
 condition of excitement among her companions 
 which distinctly and palpably affects the whole 
 milk product of the entire dairy. If there were 
 no ovaries in the herd, this disturbing condition 
 would never occur. 
 
 Mammary abscess and mammitis, when not 
 due to traumatism, are, in the great majority of 
 cases, a complication of the parturient state. It 
 often occurs in these conditions that the milk is 
 mixed with blood and pus. Of course, neither 
 of these materials would have much of a deleteri- 
 ous effect on a healthy stomach, but when we 
 take into consideration the febrile state of the 
 animal thus affected, and the excessive nervous 
 disturbance resulting from the pain caused by the 
 milker, this variety of milk is absolutely poison- 
 ous. A case of acute diarrhoea caused by this 
 variety of milk, I reported sp|ne years ago in The 
 Medical Record, under the 'title of "Acute Milk 
 Poisoning." 
 
 Sore tits in various forms are common in the 
 ordinary dairy,, and occur usually in the first five 
 or six weeks following parturition; these cracks 
 and fissures, that become ulcers from the con- 
 stant irritation of the milker, frequently contam- 
 inate the milk with a virus that must necessarily 
 be productive of disturbances injurious to the 
 infant that gets milk from cows thus affected. 
 
94 Improvements of the Dairy. 
 
 Cow-pox, a disease which has attracted the 
 attention of the entire civilized world, almost 
 invariably commences in the cow soon after par- 
 turition, when it breaks out in a dairy due to the 
 fact that there are cracks and fissures resulting 
 from the excessive activity and consequent en- 
 gorgement that takes place in the first few 
 weeks after calving. Cow-pox is an acquired 
 disease from the horse; it is pretty conclusively 
 settled that horse-pox, a mild disease in the 
 equines, is conveyed to the cow by the milker 
 who had handled the horse, and thus inoculated 
 the cow's dugs if these latter are excoriated, by 
 the virus adhering to his hands. Cow-pox in the 
 cow becomes an exceedingly loathsome disease, 
 and is characterized very often by phagedenic 
 ulcers, which are constantly irritated and excori- 
 ated by the milker, whose hands also become the 
 seat of vesico-pustules. The following passage 
 I quote from Crookshanks' book on " Vaccina- 
 tion," in his chapter devoted to cow-pox: " I 
 hope it [vaccination] will be turned by enlight- 
 ened men towards another perhaps of as nearly 
 as great consequence [prevention of small-pox], 
 namely, the prevention of the original malady in 
 the animals themselves. Those who had wit- 
 nessed it and only reflected upon the excessive 
 filth and nastiness which must accordingly mix 
 
Improvements of the Dairy. 95 
 
 with the milk in an infected dairy of cows, and 
 the corrupt and unsalubrious state of their pro- 
 duce in consequence, will surely join me in the 
 sentiment." Of course, other conditions besides 
 mere spaying, which only incidentally makes the 
 cow less susceptible, because the tits are less 
 hkely to be cracked and excoriated — which is 
 necessary to receive the inoculation — are 
 necessary to avoid this disease entirely in the 
 dairy. It should be an inexorable rule that no 
 one who is employed in attending on horses, 
 should be allowed among dairy cattle. It cannot 
 be doubted when one knows the degree of 
 carelessness that prevails in many dairies that 
 some of the simple throat afifections of infancy 
 and childhood are complicated and rendered 
 grave by milk from cows with cow-pox, or other 
 sore or aggravated conditions of the dugs that 
 pollute the milk. We must all remeinber the 
 interesting discussion in England on the so- 
 called "Hendon cow disease," which was alleged 
 by good authorities to have been the cause of an 
 outbreak of scarlet fever. After reading all the 
 literature available on the subject, and from 
 practical experience, I conclude that the milk in 
 question was contaminated either by cow-pox or 
 ulcerated tits, because it is a well-settled fact that 
 other sores besides those of cow-pox will cause 
 
96 Improvements of the Dairy, 
 
 sores to arise on the hands of the milkers, and it 
 requires no stretch of imagination to see that a 
 virus like this, if conveyed to an irritated or mor- 
 bid throat, would increase the existing disturb- 
 ance. This of course seems plausible, but it is 
 only a surmise. 
 
 Thus it can be seen, that by separating from 
 the dairy entirely the breeding, very many of the 
 common and constantly occurring disturbing 
 conditions that perniciously afifect the milk may 
 be entirely eliminated, and the milk otherwise 
 vastly impi'oved. This is not surmise, but is in 
 fact a demonstrated truth. I have in my own 
 dairy several spayed cows, whose milk is used 
 for infant food, and I have been obliged during 
 the past summer to send milk directly into dairy 
 communities so far from me that the milk cost 
 the receiver seventy-five cents a quart. Commu- 
 nications from these people express surprise at 
 the beneficial results of the milk I send them, 
 being themselves right in the midst of dairy 
 cattle and everything, to their observation, be- 
 tokening health. Many of them imagine that I 
 prepare the milk in some way. I only introduce 
 this bit of personal experience, in order to reiter- 
 ate that the milk is only pure normal secretion 
 from animals that are removed from the danger 
 accompanying these conditions. 
 
Improvements of the Dairy. 97 
 
 The operation of spaying is a very simple one. 
 I cast the cow on her right side, administer chlo- 
 roform, produce complete anaesthesia; observ- 
 ing all the recent antiseptic precautions, I make 
 an opening on the left flank, sufficiently large to 
 admit my arm, which I introduce, reaching up 
 into the pelvis till I find one of the ovaries. This 
 I grasp with the hand and having previously ser- 
 rated my thumb-nail with a file, I saw and 
 scratch the attached end of the ovary till I sepa- 
 rate it thus from its attachments. I drop this 
 out of the abdominal cavity without entirely re- 
 moving my arm and search for the other one, 
 with which I proceed in the same manner. I with- 
 draw my arm, and with a very fine catgut ligature 
 I bring together the peritoneum; with a coarser 
 catgut I unite the muscular structure; with a still 
 coarser ligature I unite the hide, leaving between 
 the hide and the muscular substance in the lower 
 part of the wound a pledget of oakum for drain- 
 age; then I cover the entire wound with a large 
 quantity of oakum, which is kept in position by 
 means of adhesive plaster passed several times 
 round the abdomen, and all left in position for 
 ten days, when the plaster, oakum and drain are 
 all removed and a little iodoform sprinkled on 
 the drainage outlet. There is usually a rise of 
 temperature of one or two degrees, that subsides 
 7 
 
98 Improvements of the Dairy. 
 
 after the first twenty-four hours. The secretion 
 of milk is noticeably decreased for the first two 
 or three days, when it gradually increases, and 
 at the end of ten days has reached its normal 
 flow. We make no use whatever of the milk for 
 two weeks following the operation, and not then 
 if the site of the drainage is still discharging. 
 I have in my herd one cow spayed four years 
 ago, the first one on which I operated; she is 
 giving as much milk to-day, if not a little more 
 (about ten quarts) than she was before the oper- 
 ation. She never has been sick a day and is very 
 quiet, never excited from any cause, in good 
 condition of nourishment and promises to re- 
 main a useful animal for years to come. This 
 same description applies to all my spayed ani- 
 mals. There is hardly a cow in my herd among 
 the animals not yet spayed that I have not been 
 obliged to throw away the milk of for days at a 
 time, owing to injuries, indisposition or like 
 causes; but among the spayed animals, I have 
 not known of one being injured by the horns of 
 their fellows, the most common source of injury 
 among dairy cattle, because they are so quiet 
 and keep by themselves that they are not sub- 
 jected to the ferocity of their companions; they 
 are never excited during the heat of other mem- 
 bers of the herd. I am thoroughly convinced 
 
Improvements of the Dairy. 99 
 
 that the coming dairy cow will be a spayed ani- 
 mal, and when she gains popular favor, then, un- 
 doubtedly, one of the most common and con- 
 stant sources of disturbance in the milk supply 
 will be removed. 
 
 Thus, then, it can be seen that by a careful and 
 judicious system of breeding outside the dairy, 
 and by surgical interference within, the proper 
 type of dairy animal can be established. But un- 
 less this animal receive proper food and rational 
 care, the improvements in her breeding and 
 other conditions will count for less than they 
 otherwise would. It is apparently one of the 
 strange phases of human perversity that the ani- 
 mal that supplies the human race with the high- 
 est type of food — milk — should receive the least 
 care and attention in regard to her food. Visit 
 any dairy farm and you will find the horse-stable 
 clean, the animals well and dryly bedded, curried 
 daily, and fed with the best hay and oats. No 
 refuse for these animals. But the cow you will 
 usually find in a dirty stable, scant bedding, re- 
 ceiving no attention by the way of currying, and 
 if there is any kind of refuse to be bought in the 
 neighborhood, this is deemed good cow feed, 
 whether it comes from the breweries, distillery, 
 glucose or starch factory; and, in fact, all the re- 
 fuse from the preparations of grain is classed as 
 
loo Improvements of the Dairy. 
 
 good cow food. She is pastured usually on land 
 that cannot be tilled, and the exception is when 
 the cow receives any sort of rational care. The 
 cow is entitled to the best food that is procura- 
 ble, and unless she gets it we have no right to 
 expect good milk from her, no matter what her 
 other conditions may be. She deserves the 
 whole grain; in corn she should not receive only 
 the refuse that is left in starch and meal mills, but 
 the entire result of the grist; and the same with 
 oats, hulls and screenings are not good enough 
 to produce good milk. About the common sorts 
 of refuse used I will say nothing, because we all 
 know that they are improper. For the life of 
 me I cannot understand why some judicial legis- 
 lative action is not directed against their use. I 
 have in my possession a series of remonstrances 
 stringing along for forty years, urging the neces- 
 sity of stopping the use of brewery grains and 
 distillery slops, but all in vain. I can understand, 
 of course, why a good deal of this system pre- 
 vails; the dairyman has been ground down too 
 low in the price he receives for his product. He 
 cannot possibly buy prime food for his cows, 
 and he is compelled to pasture them and bestow 
 as little attention as possible to their care. It 
 would require more than double the price he 
 gets now to feed his cows in the stable always. 
 
Improvements of the Dairy. ioi 
 
 when they are milking, summer and winter; it is 
 only by this method that a cow can have her 
 food judiciously selected. The cow is a strange 
 animal; I do not know whether it is natural or 
 comes from her breeding, but she will always 
 drink the dirtiest water she can find; if there 
 happens to be a ptitrefying carcass or dirty bones 
 about the pasture she will sniff about them and 
 chew the bones, and when the pastures are dry 
 there is no poisonous or noxious weed that she 
 will not eat. I repeat that I hold it as one of the 
 prime requisites for good milk that the cow 
 should always be fed in the stable with proper 
 food. Of course this does not necessitate the 
 cow being locked up all the time; she can be 
 turned out the greater part of the day, and. in 
 the hot weather, at night, if necessary, ^f? i-)t 
 where she can get dirty water or be in the pres- 
 ence of filth of any kind, or browse on noxious 
 weeds. 
 
 Thus, avoiding the oft-repeated tales of the 
 calamitous diseases that are communicated or 
 supposed to be communicated from the cow to 
 the human race, I have confined my argument 
 to the simple elementary necessities for a better 
 dairy. But I am pretty well convinced from my 
 experience that there is little to be hoped for 
 from legislative action or public opinion, because 
 
102 Improvements of the Dairy. 
 
 it seems to be regarded as a dangerous thing for 
 legislative bodies to interfere with established 
 commercial institutions, and the public trust in 
 their lawmakers and sanitary authorities. If New 
 York, with her wealthy, liberal and intelligent 
 population, would organize a dairy scheme es- 
 tablishing the reforms I have indicated, the 
 problem would soon settle itself, because it makes 
 little difference what the price of good milk is if 
 anywhere within reason. A supply of good 
 healthy milk will surely crowd out the floods of 
 bad milk that are now being poured into the city 
 for the nourishment alike of infant and adult. 
 
[Reprint from " The New York Medical Journal," June 20, 1891.] 
 
 STERILIZED MILK.* 
 
 Up to this, the bacterial age, the application of 
 heat in the preparation of food was simply to 
 improve its digestibility, or to meet the require- 
 ments of advanced civilization by improving its 
 appearance, odor, or taste. Before man reached 
 the age when fire was in use, putrefaction was 
 the agent allowed to improve the digestibility of 
 his meat-food. After the discovery and use of 
 fire, it was found that it was not necessary to 
 await the process of putrefaction to make food 
 palatable and easy of digestion, but that fire 
 would also improve its digestibility and increase 
 its palatability, and that, too, in a more rapid man- 
 ner. Now, with the prevailing idea that all dis- 
 eases are due to a germ, another function of heat 
 is to apply it to food in order to kill the germs 
 that exist everywhere, and thus to avoid the im- 
 aginary or real pathogenic influences of bacteria. 
 Enthusiasm in science is dangerous, and the pres- 
 ent devotion to the germ phase of disease can 
 
 •Read before the New York County Medical Association, March 16, 1891. 
 
 103 
 
104 Sterilized Milk. 
 
 not be classified as other than enthusiasm, and 
 the prevailing^ enthusiastic warfare against all 
 germs, leading as it does to sterilization of food, 
 may be dangerous. Perfect sterilization as ap- 
 plied to food means complete death, and whether 
 absolutely dead food is the best for infant nutri- 
 tion may well be questioned. 
 
 The adult civilized human being has no natural 
 food. All his nutritive material has been im- 
 proved, and some of it almost generated de novo, 
 by cultivation, selection, combination, etc. All 
 wild animals have their natural food, and the 
 young of all mammiferous creation are provided 
 by Nature with a natural food. Among the ani- 
 mals where the female can not supply the natural 
 nutriment the duty devolves on the male. But 
 man, with his inherited idea of artificial food, 
 imagines that the human young can be nourished 
 by artificial preparations ; the statistics, however, 
 relating to artificially fed infants show how poorly 
 the plan works. The natural food for the human 
 young comes from the female breasts; this is a 
 living, vitalized food; certainly we know that this 
 food can be procured from the breasts of females 
 who have not recently or at any time passed 
 through the parturient state. We likewise know 
 that the male is provided with mammary glands 
 which will secrete this natural food for the young. 
 
Sterilized Milk. 105 
 
 Thus it will be seen that Nature has abundant re- 
 sources to supply vitalized food for the young, 
 and it would seem, from all the plain teaching of 
 Dame Nature, that the prime, necessary quality 
 of food for the young is vitality. Contrary to this 
 is the enthusiastic endeavor of the antibacteriolo- 
 gist to thoroughly devitalize all the food pre- 
 pared for the baby. In the present state of so- 
 ciety it seems inevitably necessary to endeavor to 
 pass some of the young through babyhood by 
 the use of artificial foods. Of all the artificial 
 foods easily procured and abundantly supplied, 
 the milk of the dairy cow is universally admitted 
 to be the best. Unfortunately, however, the cow 
 is a delicate animal, subject to many diseases that 
 afifect the milk perniciously, and her keeper is 
 careless, often allowing the milk to become con- 
 taminated from many sources. The proper steri- 
 lization of cows' milk, when used for infant food, 
 without doubt eliminates or neutralizes many of 
 these disturbing influences, and the work of Dr. 
 Soxhlet, Dr. Caille, and others, has been, without 
 doubt, of great value during the present condi- 
 tion of the dairies and the milk supplied to large 
 cities. 
 
 But the apparent satisfaction that has taken 
 possession of many at the idea of sterilization as 
 having solved the problem of infant feeding, may 
 
io6 Sterilized Milk. 
 
 possibly delay the absolutely necessary reform 
 that is required in the dairy itself. Cows that are 
 perfectly healthy, receiving proper food and care, 
 supply a milk, which, if properly guarded, retains 
 much of its vitality for several hours, and is abso- 
 lutely the best artificial nourishment for the hu- 
 man young. Sterilizing milk obtained under 
 these conditions robs it undoubtedly of much of 
 its nutritive value. Dr. Randnitz, of Prague, in 
 Hoppe-Seyler's Journal for Physiological Chemis- 
 try, shows that much less nitrogenous material is 
 absorbed from milk that has been boiled than 
 from the same milk when fresh. He shows that 
 9.4 per cent, of nitrogenous material was re- 
 tained in store by growing animals fed on fresh 
 milk, and only 5 . 7 per cent, was assimilated by 
 the same class of animals fed on boiled milk. It 
 is a common observation that calves fed on fresh 
 milk have what is apparently a normal yellow 
 liver, which makes a very tasty human food, while 
 those fed on the artificial foods of the dairy — 
 boiled skimmed milk, hay-tea, and so forth — 
 have a liver very dark in color, tough, and not at 
 all tasty like the normal tender liver of young 
 life. How much the vitality of the food has to do 
 with this condition of the liver can only be in- 
 ferred, but it does seem that one of the absolute 
 requirements of perfect nutrition is that some ar- 
 
Sterilized Milk. 107 
 
 tide of diet must be fresh — that is, must retain 
 its vitality — or, in other words, be not absolutely 
 dead. Scurvy is one of the diseases which results 
 from a devitalized diet — that is, one which ex- 
 cludes fresh living vegetable or animal matter. 
 Now, what vitality is, it is almost impossible in 
 the present state of our knowledge to define. 
 With the animals we regard consciousness as one 
 of the phenomena of vitality; but the absence of 
 consciousness does not indicate death of the tis- 
 sues. Vitality in vegetables is the principle that 
 allows them to grow and reproduce; a vegetable 
 would be absolutely dead when it will not grow 
 under proper and favorable conditions. The egg 
 of the hen, which is by common consent classified 
 as a perfect food, because under proper condi- 
 tions it builds up a perfect organized, and 
 living body, if sterilized can by no possibility re- 
 produce a living chick. Many articles of food, 
 undergoing decomposition by reason of the liv- 
 ing germs they contain, possess more or less of 
 the vital principle which, in this case, of course, 
 belongs to the germ. All around us vital pro- 
 cesses are taking place in bodies which we call 
 dead, and when human beings are placed in a 
 position that precludes them from the possibility 
 of obtaining some articles of diet not dead, they 
 suffer from scorbutus, and when suffering from 
 
io8 Sterilized Milk. 
 
 this disease the ingestion of food, whether it be 
 animal or vegetable, that still retains some vital- 
 ity, causes the morbid conditions to subside. In 
 artic regions, when men are deprived of fresh 
 vegetables, they eat their meat raw. The general 
 impression derived from medical text-books is 
 that fresh vegetables are necessary for the cure of 
 scurvy, but both Hall and Kane aver that the fresh 
 raw meat is just as efficacious. Fresh cooked 
 meat is not in any sense an antiscorbutic. We 
 have many accounts of soldiers suffering from 
 scurvy where fresh cooked meat has been a regu- 
 lar article of diet, and all the antiscorbutics (with 
 one exception — lime juice) are nutritive mater- 
 ials that are not sterilized — or, in other words, 
 that retain some degree of vitality. It is not 
 necessary that a child should absolutely suffer 
 from scurvy to indicate that its food is improper. 
 There are undoubtedly a certain number of pa- 
 thological conditions that are compatible with 
 Hfe, but the ability to resist disease and enjoy life 
 is, beyond doubt, lessened by some conditions of 
 nutrition, and, as the proper and natural nourish- 
 ment of the yo.ung is a product from living tis- 
 sues, itself undoubtedly containing some vital 
 principle, it follows that children, as well as 
 adults, require some form of food not devitalized 
 by heat, or preservatives. The heat necessary for 
 
Sterilized Milk. 109 
 
 the sterilization of milk, as practiced at present, 
 undoubtedly lowers its nutritive value in other 
 ways than by depriving it of whatever vitality it 
 may have been possessed of. The soluble albu- 
 men is made insoluble, and many of the salts held 
 in solution are precipitated, and thus become also 
 insoluble; but of course, the lowering of the nu- 
 tritive value of a food is far preferable when the 
 sterilizing process eliminates or neutralizes abso- 
 lutely poisonous principles or materials, and if it 
 were beyond the reach of the powers that be, to 
 improve the milk suppHed for infant feeding, we 
 would all favor the present mode of sterilization, 
 even while fully aware that the food is not per- 
 fect. 
 
 But it is within the lines of human possibility 
 to improve the dairy and thereby render the milk 
 more nutritious and free from those disturbiag 
 elements which render sterilization necessary. 
 
SCORBUTUS IN CHILDREN.* 
 
 The question of scurvy in infancy is, I think, 
 one of the phases of children's diseases that has 
 been lost sight of veiy largely in the study of 
 Pediatrics. There is no doubt but that the dis- 
 ease exists in infancy to a greater extent than we 
 are aware, or would infer from medical literature. 
 There can be little doubt, when your attention 
 is called to the fact, but that you will agree that 
 many of the cases reported as rickets and maras- 
 mus, should be classified as scorbutus. Dr. Nor- 
 thup, of New York, read a paper on scorbutus, 
 last September, in Washington, before the Pedia- 
 trics Society, and I think much good will come 
 from this paper, which was a very interesting and 
 instructive one. By simply calling the attention 
 of pediatricians to the fact that such a disease 
 does occur in infancy, and that it is characterized 
 by very near the same pathological phenomena 
 as is the disease in adult life. Now as this affec- 
 tion in the adult is well recognized, and the cause 
 pretty well understood, I think it would not be 
 
 ♦Delivered before the American Medical Association, Detroit, Mich., 
 June 7, 1892, Section of the Diseases of Children. 
 
112 Scorbutus in Children. 
 
 amiss for me to call your attention to some of 
 the conditions in adult life that stand in a causa- 
 tive relation to the development of scurvy, and 
 then we can see how prone to the affection, the 
 artificially fed infant of to-day must be. Every 
 living creature on the earth or in the water 
 thereof subsists on matter that was once alive, 
 and all food with the exception of a few 
 condiments, has been living, growing matter at 
 one time. I think it can be safely affirmed that 
 man is the only animal who not only kills his 
 food, but makes it absolutely dead and sterile 
 before he consumes it for his nourishment. 
 
 The old adage, " That God sends the food, but 
 the Devil sends the cook," means more than has 
 been credited to the saying. It has always been 
 supposed that the unpalatable preparation of 
 food was the devihsh cook's work, but I believe 
 the cook whom the Devil had sent to mislead us 
 is the chemist with his retort and his balances, 
 with his reagents and his surmises; he has led us 
 to beheve that God has failed to do His work 
 properly by uniting the nutritive materials in a 
 living form, and possessed with a vitality that 
 the chemist knows nothing about. He has taken 
 up a deal too much room, and made things alto- 
 gether too complicated. The chemist would 
 have us believe that man needs for his nourish- 
 
Scorbutus in Children. 113 
 
 ment only so much nitrogenized and so much 
 non-nitrogenized matter, and that the material 
 with which the Creator has united these, and the 
 vitality with which He has endowed it, is totally 
 unnecessary. According to the advanced idea 
 of the chemist, a little jar of Liebig's extract of 
 beef is far better than ten pounds of meat in the 
 form we find it in nature. Milk that has been 
 skimmed, dried and powdered, and mixed with 
 a little cocoa butter, is far better than fresh milk 
 from the laboratory of nature as the Great Giver 
 has allowed us to procure it. I remember seeing 
 it stated in some standard work, that when the 
 chemist had reached his goal, armies would be 
 able to carry in a small vial all the material that 
 was needed for their support for several days, 
 instead of the weighty load of bread and meat 
 which they are now obliged to lug. 
 
 I tell you, gentlemen, the chemist has tried to 
 be too smart, and we have been duped by him in 
 many instances. Every living creature requires 
 for his proper nourishment some rawliving food. 
 Every young living creature needs living food. 
 The mammalia all take it direct from the living 
 fountain, and young feathered tribes are supplied 
 by their parents with living creatures for food. 
 Even the embryonic fishes consume the living 
 animalcule, and man seems to be the only one of 
 8 
 
114 Scorbutus in Children. 
 
 God's creatures who thinks he knows better. 
 The artificially fed infant gets his food from the 
 knowing chemist, or must, according to the pre- 
 vailing fashion, have all the life sterilized out of 
 it, if he gets any, as nature supplies it, without 
 the intervention of the chemist. I am positive 
 that there is more in organism, and the vitality 
 that holds it together, than is dreamed of in our 
 advanced chemical knowledge. 
 
 We know that the sea-faring man, the soldier, 
 the peasant of a famine-stricken district, are all 
 subject to scurvy when they are deprived of 
 fresh living food and any growing vegetable, 
 animal matter or other material not dead, will 
 cure the disease. Milk retains its anti-scorbutic 
 qualities for a few hours, so does meat after the 
 animal is subjected to what we call killing. I 
 suppose the muscular response to electric excita- 
 bility will indicate the point at which meat re- 
 tains its vitality after the animal has been butch- 
 ered, and I think it is a well-known fact that 
 vitality is the anti-scorbutic quality of a food. 
 Now, if the absence of this quality for any given 
 time from the nutritive material of an individual, 
 produces such dire results as scurvy, it must fol- 
 low that this principle is a necessary condition 
 for the proper nourishment, and the chemists' 
 idea that proximate principles being the only 
 
Scorbutus in Children. 115 
 
 necessity for nutriment, must be fallacy. Of 
 course, neither the medical man nor the chemist 
 knows what vitality is; we cannot weigh it, 
 neither can we measure it, but it is with us every- 
 where, and by reason of its possession, we our- 
 selves live and move and have our being, and 
 every article of food we consume was gathered 
 together, and formed into nutritive food for us 
 by the living and growing quality of vitality. Is 
 it unreasonable to suppose, then, that we can get 
 from this quality some sort of force that is neces- 
 sary for our well-being, and are we not depriving 
 ourselves of some absolute necessity when wc 
 eliminate every vestige of vitality from our daily 
 bread? Since I have been possessed with this 
 idea, I have observed several cases of simple 
 dyspepsia recover completely by the use of live 
 raw food. A few months ago a patient came to 
 me complaining of violent attacks of vertigo, and 
 temporary blindness. He had been losing flesh 
 and strength for several months. I examined 
 his urine and found it to contain 15 per cent, of 
 albumen. He was directed to take nothing but 
 living raw food. That is, milk not over four 
 hours' old, eggs laid but a few hours, raw oys- 
 ters, raw clams, lettuce and other greens with no 
 dressing, meat within a few hours after it was 
 killed, eaten raw; apples, oranges and other raw 
 
ii6 Scorbutus in Children. 
 
 fruits. No medicine, except three drops of the 
 tincture of ntix vomica in water before meals as 
 a mild tonic. At the end of fifty days the albu- 
 men had entirely disappeared. He had but few 
 attacks of vertigo after he had the exclusive diet, 
 and the attacks of temporary blindness never re- 
 turned, and now, after five months, he is in a 
 better state of physical health than he had been 
 before for years. 
 
 Now this one case proves very little, but it at 
 least indicates that the diet must have had some 
 influence in the man's recovery. I do not affirm 
 that albuminaria always arises from the same 
 cause, neither do I think any will affirm that de- 
 fective nutrition is not one of the prominent etio- 
 logical factors in Bright's disease, and if I am 
 right in my deductions, one of the defects in our 
 materia alimenteria is the absence of vitality, and 
 if this is true regarding the adult, how much 
 more must it be so with the luckless infant de- 
 prived of the normal living fountain which nature 
 designed for its proper nutrition. I am firmly 
 convinced that not only scorbutus, and other 
 serious affections, arises from the absence of liv- 
 ing food in the infant, but many of the weakly 
 non-resisting babes succumb to disease, or live 
 with more or less suffering, because of the ab- 
 sence of vitalized food. 
 
Scorbutus in Children. 117 
 
 One of the defects with the finite mind is its 
 limit to be able only to harbor one idea at a time, 
 and so when one man discovers a truth he 
 straightway imagines that he has solved all the 
 mysteries of the science relating to the subject 
 to which the discovered truth relates. I am will- 
 ing to acknowledge that the vitality of a food is 
 not its only requirement, but I am thoroughly 
 convinced that it is one of the very important 
 necessities to perfect nutrition. There can be 
 little doubt that many children live who have 
 been so improperly nourished (although fat) that 
 life is more or less of a burden. A great deal of 
 this may be due to their progenitors, their sur- 
 roundings, and many other conditions, but some 
 suffer by reason of improper food, and the 
 method of its administration. 
 
 The French nation have as an executive officer 
 in their scheme of government a medical health 
 officer. He has lately discovered that the death 
 rate in infants is so alarmingly large that there is 
 great danger of depeopling the nation; therefore, 
 he has issued an edict forbidding the use of the 
 long-tube nursing bottle in feeding infants, and 
 I suppose he imagines that by this wise (?) law- 
 he will repeople France. If the death rate could 
 only be lowered by so simple an edict, our occu- 
 pation would be gone, but we know that there 
 
ii8 Scorbutus in Children. 
 
 are many other conditions, graver, more import- 
 ant and serious than simply the form of a nurs- 
 ing bottle. There are very many things for us 
 to find out before we know it all, but one fact I 
 feel sure of, that the constant use of dead food 
 with an infant is wrong. There is no greater 
 field, too, for the pediatrician, than the study of 
 infant feeding. We must exclude from our 
 counsels, absolutely, the patent baby food manu- 
 facturer, and study how we can get a full supply 
 of fresh, raw, living food to the unlucky infant 
 who has to submit to an artificial diet, and then, 
 from the knowledge we are now in possession of, 
 we will know that we are guarding the young, 
 at least, from the danger of scurvy and, perhaps, 
 greater evils. 
 
[Reprinted from the Medical News, Feb. 12, 1898.] 
 
 SOME OF THE DANGERS SURROUND- 
 ING THE DAIRY.* 
 
 If the dairy is suggested to the every-day urban 
 citizen, his imagination immediately conjures 
 up the fair and buxom milkmaid, the foaming 
 pail, the breath of the sweet-smelling kine, 
 luscious cream for his oatmeal and strawberries, 
 golden pats of butter, and bountiful, innocent 
 sweetness, milk and honey. It may be owing to 
 this sentimental idea of the dairy that so many 
 take kindly to raw milk, while having at the same 
 time an abhorrence at even the thought of eating 
 raw meat from the same animal; when, actually, 
 the danger of contagion, disease, and the inges- 
 tion of impurities are far greater from the milk 
 than the meat. Few people, I believe, realize the 
 menace which lies in the milk-supply of cities. 
 Milk which is dangerous, and perhaps deadly 
 poisonous, appears just as innocent, innocuous, 
 and deliciously nourishing as the fluid that is so 
 in truth. 
 
 In many of the dairies supplying milk for food 
 
 *Read at the Ninety-second Annual Meetings of the Medical Society of 
 the State of New York, held at Albany, N. Y., January 25, 26^and 27, i8g8. 
 
 119 
 
I20 Dangers Surrounding the Dairy. 
 
 nearly everything is either totally wrong or not 
 quite right enough to produce a wholesome pro- 
 duct. It is well known that the dairy cow is sub- 
 ject to numerous grave diseases, and many of her 
 maladies are, we know, the same as those which 
 afflict the human race, and it is also an established 
 fact that any disease in the cow affects her milk 
 perniciously. Every one who observes current 
 literature on the subject knows that there are sev- 
 eral articles of absolutely refuse material which 
 are used as food for the dairy cow, while she is 
 expected to give in return one of the highest 
 types of food for human use. The cow is neces- 
 sarily a delicate creature. What condition may 
 be imagined, except actual disease, that is more 
 opposed to robustness, vigor, and hardihood to 
 withstand the shock of cruelty, bad food, and 
 dirty surrotm dings than maternity and lactation? 
 The cow, while giving us milk almost constantly, 
 at the same time sustains a fetus; and so it is only 
 reasonable to affirm that the dairy cow must re- 
 ceive solicitous attention, gentle treatment, and 
 absolute cleanliness in her surroundings and 
 feeding, if it is expected that she will supply milk 
 fit for human food. It was long ago discovered 
 that what affects the mother affects the nursling, 
 sometimes even so far as to cause the death of the 
 latter. 
 
Dangers Surrounding the Dairy. 121 
 
 Unfortunately, it is the exception to find a 
 dairy in which the cows are treated kindly and fed 
 or housed in a cleanly manner. At the present 
 time health authorities appear to recognize noth- 
 ing but tuberculosis as the sum total of all the 
 disease and danger contained in the improperly 
 managed dairy. The sources of possible contam- 
 ination which surround the milk after it is drawn 
 from the cow are many and serious on the ma- 
 jority of dairy-farms as they are conducted at the 
 present time, and it is this part of the hygiene of 
 the dairy to which I particularly wish to call at- 
 tention now, because this branch of the subject 
 receives everywhere less attention than it de- 
 serves, and I believe that when we are able to 
 exclude the diseases which arise from milk-con- 
 tamination in the dairy, outside the cow, we will 
 be better able to trace some of the epidemics 
 which find origin in the animal herself. Until all 
 the dangers of the dairy are recognized many of 
 the more grave and menacing ills cannot be 
 remedied. 
 
 It must be remembered, in considering milk, 
 that there is no other article of food just like it. 
 There is no food, fluid or solid, which presents so 
 many favorable conditions for the absorption of the 
 tangible material of disease and for its preserva- 
 tion and multipHcation, and in no other instance 
 
122 Dangers Surrounding the Dairy. 
 
 is a medium found for the conveyance of infec- 
 tion by which so much harm can be accom- 
 plished in such a very short time. Of course, a 
 certain degree of heat will disinfect milk, but 
 even a high temperature will not eliminate the 
 toxins already contained therein. 
 
 We are constantly searching for a specific 
 remedy for scarlet fever and other often fatal dis- 
 eases of childhood, while frequently permitting 
 the bacterial cause of these diseases to be fed to 
 our children in their milk. Many of the diseases 
 of infancy may be rendered much less frequent or 
 even altogether eradicated by proper attention to 
 the hygiene of the dairy, and I believe that the 
 achievement of success in this line is being de- 
 layed by the futile efforts of well-meaning physi- 
 cians, who imagine that they are correcting the 
 evils of a bad milk-supply by modifying, pasteur- 
 izing, steriHzing, adding animal and chemical 
 compounds, and by otherwise changing the 
 character of the milk. 
 
 Around every dairy is a multitude of dangers 
 — dangers, unfortunately, which are not always 
 appreciated or avoided, and hence culminate in 
 disaster. There are many other animals about 
 the dairy besides the cow which menace the dairy 
 product, often as seriously as a diseased cow her- 
 self. Horses, dogs, cats, rats, mice, and fowls 
 
Dangers Surrounding the Dairy. 123 
 
 undoubtedly are often the direct means of infect- 
 ing milk, and of thus passing contagion along to 
 the human race. 
 
 Cats loll and purr around many dairies all day, 
 and it is a very common thing to see a wheezy 
 old cat lapping warm milk from a pail or other 
 milk container. These animals are known to 
 succumb to a throat trouble which appears iden- 
 tical with human diphtheria, and it is also known 
 that they die from many tuberculous forms of dis- 
 ease. So it is not unreasonable to ascribe con- 
 tagion to these animals when they are allowed 
 the freedom of the dairy. Dogs prowl about the 
 farm day and night, and very often depend upon 
 the carcasses of dead animals for their living. 
 Cows, horses, and pigs often die of septic and 
 contagious diseases; the carcasses are hauled into 
 the woods or fields, away from the house, and 
 there left exposed as meat for the farmer's dogs. 
 These dogs come back and lap the milk from the 
 pail, lick the empty milk vessels which are never 
 properly cleaned ; and can there be doubt that the 
 milk is thus infected? Where this danger exists 
 in a dairy it is practically unlimited. Rats and 
 mice infest the ordinary dairy; they get into the 
 milk and the milk-vessels. These animals also 
 have their diseases, and, therefore, the element of 
 danger and disease from these pests must be ac- 
 
124 Dangers Surrounding the Dairy. 
 
 knowledged. The poultry around the farm are 
 sometimes very numerous, and not always 
 healthy. The diseases to which they are subject 
 are many, and, owing to their high, normal body 
 temperature (io8° Fahr.), there is no other ani- 
 mal which so readily becomes tuberculous or 
 which dies so quickly from this disease. On some 
 dairy farms the hens are everywhere, in the cow 
 stable, in the milk-house, in the dwelling- 
 house, and even in the milk-pails. The 
 dairyman, as a rule, has a family of chil- 
 dren who are often attacked with the grave 
 diseases of childhood. The milking vessels are 
 frequently washed in the house, and not unusu- 
 ally there is a close connection between the house 
 and the dairy, and sometimes the living-house is, 
 itself, used as a dairy-house. It requires no argu- 
 ment to point out the dangers here; in fact, nu- 
 merous epidemics have been traced to such a 
 source. 
 
 Those who milk the cows are not always free 
 from disease; often we see the milker with hands 
 that are cracked or sore. One of the dirtiest 
 habits which exist in many dairies is that of wet- 
 ting the cow's teats to lubricate them, to make 
 the milking process easier to the milker. This 
 custom, not rare, unfortunately, is the most com- 
 mon nasty habit permitted in many dairies. If it 
 
Dangers Surrounding the Dairy. 125 
 
 were not for the good that is sure to follow the 
 agitation of these matters I should hesitate to 
 record that I have myself seen milkers spit upon 
 their hands to wet the teats before they began 
 milking, and then, when there was a certain 
 quantity of milk in the pail, dip their dirty hands 
 into it, and keep the teats dripping wet during 
 the whole process of milking. Cow's teats should 
 not be wetted in any manner, especially in winter, 
 even to wash off dirt if it is already there. This 
 should be removed with a brush or a dry towel. 
 Wetting of the teats very often leads to chap- 
 ping, and chapping to cracks, and these cracks 
 often become running sores from the constant 
 irritation of the milking process. 
 
 In these days of bottled milk the danger of 
 spreading contagion is vastly increased. Bottles 
 which go into rooms where children are suffering 
 from any of the contagious diseases must be a 
 source of danger if they are not subsequently 
 sterilized. Quite Recently I had occasion to visit 
 a man who did a large bottled-milk business in 
 New York city. The milk came in wagons from 
 the upper part of Westchester county, and he had 
 a horse-stable half way between his source of sup- 
 ply and New York. Here his horses were 
 changed. All the milk came to this stable in 
 cans, and the empty bottles came back here from 
 
126 Dangers Surrounding the Dairy. 
 
 New York to be washed. He had two wooden 
 troughs in this stable, and a stove with a large 
 kettle to heat water, and the bottles were washed 
 here in luke-warm water with sal soda, rinsed 
 with cold water, and then filled from the cans. 
 
 I think, if some of us followed these bottles 
 around and had seen where some had been, we 
 would want them pretty well steamed and steril- 
 ized before we drank milk from them. It is often 
 a source of wonderment to me why we do not 
 have more direct and palpable evidence of trouble 
 arising from just this state of affairs. Of course, 
 there are unfortunate results from this sort of 
 carelessness; but how much or how little we are 
 not always able to say. We ought to be able to 
 prevent it by insisting that all milk containers be 
 sterilized with steam under pressure after each 
 usage. 
 
 When the dangerous elements are recognized 
 and eliminated from the dairy, then it only re- 
 quires that the cows be healthy, properly fed and 
 cared for, in order that we may have milk fit to 
 drink and to feed to the baby, without the inter- 
 vention of the chemist or any of the prevailing 
 laboratory methods, which at the best are only 
 questionable makeshifts.