The Prevention of Infantile Diarrheas
ABOUT one fourth of all children born in the civilized world die before they reach five years of age. About one half of all deaths among infants are due to diarrheal diseases. These diseases prevail almost exclusively during the hot months of summer, consequently they are known as the summer diarrheas. They are confined to children that are fed wholly or in part on cow’s milk. Failure of the mother to nurse her child during the first year of life greatly increases the danger of illness from the summer diarrheas. The summer diarrheas of infancy are cases of milk poisoning. Cow’s milk becomes poisonous on account of germs which get in it and multiply, producing highly poisonous substances. The prevention of the summer diarrheas and of the fearful mortality due to them consists in giving attention to the milk with which children are fed. If the cow giving the milk be healthy, and germs be kept out of the milk after it is drawn, it will not cause diarrhea. The following rules should be observed:— 1. The cows should be healthy, and the milk of any animal which seems indisposed should not be mixed with that from the perfectly healthy animals. 2. Cows must not be fed swill, or the refuse of breweries or glucose factories, or any other fermented food. 3. Cows must not be allowed to drink stagnant water; but must have free access to pure, fresh water. 4. Cows must not be heated nor worried before being milked. 5. The pasture must be free from noxious weeds, and the barn and yard must be kept clean. 6. The udder should always be washed before the milking. 7. The hands of the milker should be clean. 8. The milk should be received in a clean, scalded pail. 9. The milk must be at once thoroughly cooled. This is best done by placing the milk can in a tank of cold spring water or ice water, the water being of the same depth as the milk in the can. It would be well if the water in the tank could be kept flowing; indeed, this will be necessary unless ice water is used. The tank should be thoroughly cleaned every day to prevent bad odors. The can should remain uncovered during the cooling, and the milk should be gently stirred. The temperature should be reduced to 60° F. within an hour. The can should remain in the cool water until ready for delivery. 10. In summer, when ready for delivery, the top should be placed on the can, and a cloth wet in cold water should be spread over the can, or refrigerator cans may be used; at no season should the milk be frozen, but no buyer should receive milk which has a temperature higher than 65° F. 11. After the milk has been received by the consumer, it should be kept in a perfectly clean place, free from dust, at a temperature not above 50° F. Milk should not be allowed to stand uncovered, even for a short time, in sleeping or living rooms. In many houses in the country and villages and occasionally in the cities the drain from the refrigerator leads into a cesspool or kitchen drain. This is highly dangerous; there should be no connection between the refrigerator and any receptacle of filth. The refrigerator waste should discharge in the open air. 12. The only vessels in which milk should be kept are tin, glass, or porcelain. After using the vessel, it should be scalded, and then, if possible, exposed to the air. 13. When ordinary market milk is used in feeding infants, it should be sterilized. 14. The details of sterilization can be learned only by practical demonstration, and the family physician should be asked for instruction. Unless sterilization is scientifically carried out, it is worthless. 15. A milk which has already an abundant germ growth in it cannot be made a safe food for infants by sterilization; because, while the heat employed in sterilization kills the germs, it does not destroy the poisons already generated by the germs. 16. After sterilization, the bottles of milk should be kept at a temperature below 50° F. When one is needed for the child, the bottle with its contents should be warmed by being held for a few minutes in water until it is brought near the temperature of the body. 17. Should an infant develop a diarrhea, discontinue the administration of milk in any form, and immediately seek the advice of a competent physician. 18. The family physician alone is competent to decide what modification should be made in cow’s milk to render it a suitable food for a given child. The Sterilization of Milk for Infants
For those who cannot conveniently consult a physician, the following details for the sterilization of milk are given: it should be understood that only fresh milk, obtained according to the rules already given, is fit food for infants, even after sterilization. Obtain one-half dozen or more nursing bottles with suitable wire holder, kept by druggists. Place the bottles in a kettle of soft water, in which a heaping teaspoonful of the bicarbonate of soda has been dissolved in order to render it fully alkaline, and then boil the bottles for half an hour. After cooling the bottles, fill with the milk, close the mouths with clean, absorbent cotton, and place the bottles in the wire holder, and set them in a kettle of water, so filled that the water in the kettle is but little below the level of the milk in the bottles; then bring the water in the kettle to the boiling point, and keep at this temperature for fifteen minutes; then keep the wire holder with the bottles in an ice chest, removing the bottles one at a time as needed to feed the child. Warm this bottle by holding it a few minutes in lukewarm water, then remove the cotton, and draw a rubber nipple over the mouth of the bottle. Nipples with long rubber tubes attached should never be used. It is impossible to cleanse them, and they have undoubtedly caused the death of many children. The nipples when not in use should be kept in a clean glass jar containing lime water, and each nipple should be dipped in boiling water just before it is attached to the nursing bottle. When the child has taken its food from a bottle, any milk remaining in the bottle should be thrown away, and the bottle boiled before it is again filled with milk. Enough bottles should be prepared each morning to last the child for twenty-four hours, one bottle for each feeding; any milk left over at the end of the twenty-four hours should be thrown away. Remember (1) that milk which has already become bad cannot by any means be rendered a fit food for infants: (2) that after sterilization, the milk must be kept on ice, at a temperature not above 50° F. until needed by the child; (3) that tube nipples must not be used under any circumstances, and that the nipples must be kept clean, and each one dipped in boiling water before it is used. The fingers with which the nipple is handled must be clean.—Document Issued by Michigan State Board of Health, July, 1902.