Climate and Health in Hot Countries and the Outlines of Tropical Climatology / A Popular Treatise on Personal Hygiene in the Hotter Parts of the World, and on the Climates That Will Be Met Within Them.

by George Michael James Giles

The germs that produce this intensely poisonous matter are quite different from those whereby milk “turns sour,” and the fermentation which produces it may go on some time without giving rise to changes obvious to the nose or eye. Hence, though it is no doubt possible for the germs to reach the stomach in other ways, as a rule the changes have commenced before the food is swallowed.

Diarrhœa is naturally rare in infants fed entirely at the breast, and from what has been said it will be clear that the surest protection against this terribly fatal malady lies in the avoidance of bottle feeding; for to carry out the latter safely in a tropical climate, would tax the resources of a skilled bacteriologist. It is, however, unfortunately the fact that European women residing in such climates are very often really unable to suckle their children, in spite of all the good will to do so; and when the supply is inadequate and has to be supplemented by artificial feeding there is little real gain, as the bottle, with all its dangers, must needs be used several times in the day. On this account, whenever the mother is unable to fully nourish her infant, by far the safest course is resort to wet nursing. I have met with people who have a sentimental objection to entrusting their child to a woman of another race; and are even capable of believing that the mental and moral qualities of their offspring may be affected by such a diet; but it should be needless to say that there is no foundation whatever for any such idea. Great care is of course necessary in the selection of the foster-mother, who should be young, healthy, and vigorous. Her own baby ought not to be much older than the one she is to nurse, while it is needless to say that she should never be permitted to nourish both infants together. It is also most important that she should be examined, and, if possible, selected, by a medical man.

When, however, artificial feeding is unavoidable, the most elaborate care as to the purity and cleanliness of the milk and all utensils that come in contact with it are required. In hot climates it is not enough to merely wash the bottles and jugs which are used. They should be boiled at least once a day, and in very hot weather, even each time after using. The simpler the bottle is in its construction the better, those with long tubes and elaborate screw stoppers being so dangerous that it is far better to resort to spoon feeding than be tempted to use one, even as a temporary expedient. The form of bottle which presents least dangers, because the most easily cleaned, is that in which the nipple is in one piece, with an elastic cap that is made to fit the mouth of the bottle, thus doing away with the necessity of any stopper or cork. Moreover, if the special bottle chance to get broken, it is generally easy to find some medicine phial, or other small bottle, over which the cap can be stretched and which serves equally well. Rubber will not stand repeated boiling, hence, when not in use the nipple should be always kept immersed in a strongish solution of boracic acid (10-15 grs. to the ounce) and rinsed before and after using in ordinary drinking water. In making the boracic solution, a sufficient approach to chemical accuracy may be made by placing an eggspoonful of boracic acid in a breakfast cup and filling up with boiling water.

Asses’ milk is probably the best substitute for an infant’s natural food; and failing this, goats’ milk is to be preferred to that from the cow. Whichever is employed, it is best to buy the animals and have them kept in one’s own compound, so that one can ensure, by personal supervision, their being cleanly kept and carefully fed. Before milking, the animal’s teats and the hands of the milker should be washed in boracic solution, which should be kept ready made up in a large earthen vessel (an Indian gurrah, for example).

A great drawback of cows’ milk as a food for infants in India lies in the fact that, whereas human milk has a distinct alkalinity, that of the breeds of kine indigenous to that country is often (in my own experience, always) rather strongly acid, even when freshly milked from perfectly sound and well-cared for animals.

Generally speaking, indeed, the acidity is so considerable that the amount of alkali contained in even twice its bulk of lime water, is quite insufficient to neutralise it. In place, therefore, of the conventional lime water, it is better to add about as much as will stand on a sixpence, of a mixture of equal parts bicarbonate of soda and citrate of potash, to each bottle. Of course, if you wish to be exact, you can get from your chemists some books of litmus paper which change to a redder tint when dipped into an acid fluid and become bluer when moistened with an alkali; and it is a good plan to test in this way, at any rate to commence with, in order to ascertain roughly the amount required for the milk of the particular cow that yields the milk. The citrate of potash, besides being for practical dietetic purposes an alkali, has the additional valuable property of preventing the milk, after it has reached the infant’s stomach, from curdling in large masses, as cows’ milk is apt to do unless treated in this way. Human milk, when curdled in the process of digestion, does so in small flocculi; and the tendency of cows’ milk to curdle in large masses makes it a frequent cause of dyspepsia as well as of diarrhœa. Whether or no the peculiarity of possessing a so strongly acid reaction is shared with the milk yielded by cows in other hot climates I cannot say. Whatever may be the source of the artificial food, it is needless to remark that it should be sterilised by means of one of the numerous appliances now sold everywhere for the purpose, and that care should be exercised to guard against chill to the abdomen.

The prevention of infantile diarrhœa is in fact purely a question of guarding against impure and unsuitable food, and though the same is no doubt also true for more temperate climates, precautions which may be sufficient in an English summer, break down at once in a moist heat of 90° in the shade.

Should, however, in spite of all precaution, the disease appear, steps should at once be taken to get rid of the food that is fermenting within the stomach by administering a teaspoonful of castor oil, and if any obviously large proportion of the oil be thrown up within half an hour of taking the oil, give another half teaspoonful. The milk given should be much more diluted than usual, and if it obviously continues to disagree, as evidenced by continued sickness after the bottle, it should be pancreated by means of Benger’s food, which will often be kept down where the simply sterilised milk is rejected. If, however, milk in any form prove unsuitable, meat juice may be substituted for a few hours.

Meat juice is made by mincing raw lean meat, sprinkling lightly with salt, and adding just enough blood-warm water to cover it. Place the mixture aside in a covered jug in the sun for two hours and then place the pulpy mixture in a clean cloth and squeeze out the juice into a basin by wringing the cloth. Before administration, a sufficiency of sugar to make the mixture palatable should be added.

Another very useful food, as a temporary substitute for milk, when the latter disagrees, is egg albumen. To prepare this, beat up the white of a small egg with enough cold water to make a bottle, add just enough sugar to perceptibly sweeten, and let it stand till the froth produced in the beating has settled. Should these novel delicacies be refused by the infant, the addition of even a teaspoonful of milk will often lend sufficient of the desired flavour to induce the child to take it. The egg albumen should always be given cold, as even warming the bottle by placing it in hot water might easily coagulate a little of the albumen and so convert an exceptionally bland food into a very dangerous and indigestible material. After the oil has acted, about 5 grains of Gregory’s powder may be given once or twice a day, and if the natural yellow of the child’s napkins be not rapidly recovered a grain of grey powder should be added.