Milk Mixtures

Milk Mixtures include a range of food modifications prepared from milk, starting with simple dilutions with water and added sugar and ending with very complex mixtures in which not only individual ingredients are added but the proteins themselves are enzymatically changed. The application of milk mixtures is closely connected with artificial feeding (see Feeding of Young Children) and dates back to ancient times. The failure of artificial feeding for infants in orphanages and shelters in all countries prompted physicians in the 1880s to seek methods for preparing milk mixtures that approximated the composition and correlation of nutrients in breast milk. The first scientifically based milk mixture was introduced by Biedert. Being the founder of the doctrine on the harmful effects of cow's milk proteins due to their difficult digestibility, he proposed diluting milk with water while enriching it with fat. Since then, in connection with the study of metabolism, changing views regarding the greater tolerance of the infant to various components of milk have been reflected in the preparation of increasingly new mixtures. The theory opposite to Biedert's regarding the value of protein led to the use of protein milk by Finkelstein and Mayer in 1910 for diarrhea, and at a later time to the enrichment of milk mixtures with protein preparations: larosan, plasmon, and cottage cheese. The good digestibility of fat and its importance in the diet of the infant laid the foundation for the use of flour-fat mixtures, recommended by Cherny-Kleinshmidt in 1918. The high tolerance for sugar was reflected in the preparation of mixtures: Dybo mixture (see), 'sesk-vibo', whole milk with 5% sugar. The study of salt metabolism and its effect on cell colloids led to the use of whey. In 1919, American authors (Marriott and Davidson), based on research on gastric digestion and the concept of the buffer capacity of milk, proposed milk mixtures acidified with lactic acid. The desire to find a mixture that included the advantages of several led to the creation of extremely complex mixtures, for example, the combination of proteins and buttermilk with flour-fat (Pogorselsky, Nieman-Klein-schmidt and others). However, even these mixtures did not give the brilliant results that their authors expected. The success of the mixtures used depends less on their merits than on the general socio-domestic conditions in which the child is located. The experience of recent years, especially in the USSR, clearly shows that even the simplest mixtures give good results when feeding where the child's entire life is properly organized (rational regimen with alternation of sleep and wakefulness, walks, care, cleanliness of the room, etc.). As a result of all these scientific inquiries, despite the great variety of mixtures, pediatrics has developed a tendency toward simplification. There are many institutions for young children abroad and in the USSR where the use of mixtures is limited to a narrow circle. In general, when prescribing mixtures, it is necessary to take into account various factors: age, nutritional status, constitutional characteristics of the child, season, and cultural-domestic conditions, etc. The division of milk mixtures into therapeutic mixtures used for therapeutic purposes and simple mixtures used for feeding healthy infants is artificial, since it is difficult to draw a line between them: the same mixture, for example, acidified diluted milk with rice broth 2:1, can serve for feeding a healthy child at the appropriate age and be a therapeutic mixture for nutritional disorders. It is more convenient and simpler to divide mixtures into 2 main basic groups: sweet mixtures and acid mixtures. In the first group, with the addition of various food ingredients, the milk casein remains unchanged, in the second group it undergoes curdling. Sweet mixtures. 1. Dilutions of milk with water with added sugar. The purpose of dilutions is to approximate cow's milk in composition to human milk in relation to the main ingredients - protein and sugar. The following mixtures are most commonly used: No. 1 - dilution of milk 1:2, sugar 5%; No. 2 - 1:1, sugar 4%; No. 3 - 2:1, sugar 3%. No. 1 is used in the first weeks of life, No. 2 - from 2-4 months, No. 3 - from 3-5 months. These mixtures, which gave good development to full-term children in family conditions, proved unsuitable for feeding in institutions. The diarrhea observed in children in the first days after admission to the institution (initial diarrhea) was explained by starvation from the use of these low-calorie mixtures (Davidson). At present, mixture No. 1 has been completely abandoned, mixtures No. 2 and No. 3 are used as supplementary food in mixed feeding for healthy infants (milk with the addition of 5%, 7.5% and 17% sugar - see Concentrated mixtures). 2. Dilutions of milk with broths with added sugar. To prepare broths, rice, barley, oat groats and wheat flour (40 g per 1 liter of cold water) are taken and boiled for 1½-2 hours, adding water during strong boiling, strained through a sieve, measured and water is added again if the amount is less than 1000 ml. To milk, broth and sugar are added in the same amounts as in Nos. 2 and 3. These mixtures, known as B and B or B and C_u, have found extremely widespread application everywhere and have gradually replaced dilutions with water, since the use of a second carbohydrate gives better results in feeding. The reason for the beneficial effect of broths can be attributed to the formation of more tender and loose clots in the stomach, the secretion of more active digestive juices and better absorption (Rudnev, Catel). The views of previous authors on the impossibility of using broths before 3 months of age are refuted. The amount of amylase in the gastrointestinal tract increases with the introduction of broths into the diet, and children under three months also tolerate polysaccharides as well as older ones. 3. Milk mixtures with added fat. In simple dilutions of milk with water or broth, the ratio of individual ingredients, especially fat, is disrupted. And yet, the supply of fats is necessary not only from the point of view of increasing caloric value, but mainly for a more perfect construction of tissues, since fats, by inhibiting excessive water retention, create a steady increase in weight and contribute to the appearance of higher immunity. It is possible that the latter increase is due to the presence of additional substances in fats - lipoids. The most rational food is one where proteins, fats and carbohydrates are in the ratio 1:3:6-7 (human milk). The following dilutions according to Nassau satisfy this requirement: ½ milk + 5% sugar + 2% fat: ²/₃ milk + 8% sugar + 2% fat. These mixtures have not found wide practical application, but still in those cases where simple mixtures with broths do not give a good weight gain and the preparation of more complex fatty mixtures is difficult, this simple addition of fat can be used successfully. The enrichment of milk mixtures with fats in practice is achieved by adding butter and cream (see Biedert's cream mixtures).-The flour-fat mixture by Cherny-Kleinshmidt (see) has found wide application. 4. Mixtures with the addition of ready-made protein preparations as a replacement for milk proteins (see Protein milk). Protein-cream milk, according to Feer, is used in 2 dilutions (in g): with a spoon remove 25 cm³ of cream. The ready-made mixture contains (in percentages): Components I mixture II mixture 20-50 10-50 15 600 Milk ........... Nutritive sugar .... Plasmon (sodium caseinate) Water............ To obtain 20% cream at home, Feer recommends the following method: ^g and raw milk leave in a cup for 4-6 hours, and then with a teaspoon Components Protein Fat Sugar Salts I mixture II mixture 2.6 2.3 6.2 0.44 2.5 2.5 6.6 0.27 With simultaneous enrichment with fat, protein and slowly fermentable carbohydrate, the mixture is poor in whey, salts and milk sugar. The indications for the use of protein-cream mixture according to Feer are the same as for the use of protein milk according to Finkelstein-Mayer (see Protein milk). This mixture has more historical significance, since its advantage over protein milk - ease of preparation at home - lost its meaning with the introduction of public feeding. Larosan milk (Stoltzner). 20 g of larosan (easily soluble calcium caseinate) are well triturated with 50-75 cm³ of raw milk and then more cold milk is added to 500 cm³; with constant thorough stirring, the milk is boiled for 3-5 minutes, strained through a hair sieve and then ^½ liter of boiled water, mucilage or flour broth is added to it. Sugar depending on the peculiarities of the case is added in the amount of 50-100 g per 1 liter. Composition: protein 3.4%, fat 1.7%, sugar 2.2%, CaO 1.36%. Caloric value without added sugar is 400 per 1 liter. Despite its chemical composition, very similar to protein milk (in the latter there is only slightly more fat), pleasant taste, ease of preparation and favorable effect in diarrhea, L. m. did not find such wide application as protein milk.

The addition of larozone to breast milk is of great importance in cases of persistent dyspepsia with sharply acidic stools in very young infants (first 3 months of life) (see Concentrated mixtures). Acid food. The main characteristic of this food is the clotting of casein into small flakes. This can be achieved either by the enzymatic method (lactic acid fermentation with the addition of ready enzymes) or by acidification with a certain amount of acid (acidified mixtures). The group of enzymatic mixtures includes buttermilk (see), kefir, protein milk, kumys and their derivatives: whey, Klein Schmidt-Niman mixture (see), Adam's mixture, protein-fat-flour mixture, Peiser's kefir, kefir soup, pegnin milk, acid mixture by Krasnogorsky.-Adam's mixture. Mix ½ part of whole milk and ½ part of skimmed milk, boil, cool to 20-25°, add two tablespoons of sour milk and leave for 24 hours at room temperature, then add 2.5 g of chalk, mix well, leave the mixture to stand for 4 hours, then carefully heat with constant vigorous stirring, add sugar, sometimes flour, and bring to a boil once. Recommending his mixture, which differs from protein milk by a smaller amount of fat and milk sugar, Adam proceeded from the premise that the basis of dyspepsias lies in the invasion of the upper sections of the intestine by a special strain of Bact. coli. The study of the metabolism of this type of Bact. coli in the test tube showed that the growth of bacteria is delayed under the influence of a decrease in fat, milk sugar and calcium caseinate. This mixture has no particular advantage over protein milk in the treatment of dyspepsias and has not found widespread use. Protein-fat-flour mixture by Pogorelsky (1925). To 1 liter of protein milk prepared according to Finkelstein-Meyer, but not enriched with sugar, add 40 g of flour and 30 g of butter. Butter and flour are prepared in the usual way, as in the preparation of Cherny's mixture (see Cherny-Klein Schmidt mixture). To the resulting brown mass add protein milk and 40 g of sugar. The entire mixture is brought to a boil, passed through a fine sieve and kept cold until use. The mixture contains 2.7% protein, 5.2% fat, 9.4% carbohydrates with a total caloric value in 1 liter of 990. The protein-fat-flour mixture, along with the anti-fermentative components of milk protein, contains a sufficient amount of fats and carbohydrates in an easily digestible form and is a complete food. The replacement of protein milk with this mixture eliminates the harmful effect of the latter with its prolonged use: sharply expressed pallor of the skin, retardation of the weight curve and putrefactive stool. Pogorelsky's mixture gives good results in the recovery stage from diarrheal diseases in dystrophic children with poor appetite as a transitional food to normal. The extreme difficulty of preparation limits its use to the narrow framework of individual clinics and hospitals.-Kefir by Peiser. Daily kefir is diluted 1:1 with water and enriched with 20% sodium bicarbonate (5 g per 1 liter of ready mixture); has not found practical application.-Kefir soup by Sveli. 3-5 day kefir, prepared from skimmed milk, is mixed with mucilaginous decoction, sugar or saccharin. To 150-200 cm³ of this mixture add a raw egg yolk and a teaspoon of fruit juice. The mixture has little application.-Pegnin milk by Dungern. Fine-grained precipitation of casein is achieved by adding pegnin powder containing lab enzyme to milk. Pegnin milk has only historical interest.-Acid mixture by Krasnogorsky. To 500 g of whole or skimmed milk, mixed with 350 g of boiled and ground rice and 50 g of sugar, 150 g of natural gastric juice is added. Testing of this mixture by Dr. Shastin on a large and varied material gave good results. Theoretically correctly justified, this mixture is unlikely to find wide practical application due to the difficulty of obtaining normal gastric juice. Acidified mixtures include lactic acid, hydrochloric acid and citric acid milk, depending on the nature of the added acid. There is no uniform point of view explaining the beneficial effect of acidified milk on the digestive processes, and the arguments put forward by some authors to explain this effect are disputed by others. Nevertheless, the beneficial effect of these mixtures is basically as follows: with the addition of acid, gastric digestion improves due to an increase in the acidity of its contents. The acidity of the stomach contents at the height of digestion in a healthy child fed breast milk ranges from pH=3 to pH=4 (Davidson); the acidity of the stomach contents of a child receiving cow's milk is significantly lower: pH=5.35. This decrease in acidity occurs due to the higher content of buffer substances (proteins and phosphates) that bind hydrochloric acid. With the addition of acid, this buffer capacity of milk decreases, and the pH of the stomach contents with acid mixtures=3.7, approaching that of children fed breast milk (3.75). The higher acidity of the gastric chyme has a stimulating effect on the secretion of bile and pancreatic juice, improving the digestive process, and also has an exciting effect on the intestinal musculature. The formation of fine-flake casein clots in acid milk, along with the physicochemical change in the protein molecule, significantly facilitates its digestion and absorption. Finally, according to a number of authors, the acidic reaction of these mixtures delays bacterial decomposition processes in the intestine and prevents the multiplication of bacteria in the milk itself, being a good preventive measure against exogenous infection. Lactic acid milk was described by Marriott in 1919. To prepare it, to 1 liter of sterilized whole milk or its dilutions, in addition to 50 g of sugar, lactic acid is added drop by drop, stirring well, at the rate of 1 teaspoon of 10% commercial acid per 100 g of mixture or 0.5 g of pure lactic acid or 8 g of 75-80% acid per 1 liter of mixture. The advantages of this acid, in the author's opinion, are as follows: lactic acid can be considered physiological, as it is formed in the body during fermentation; its beneficial effect was found in the action of buttermilk; as an organic acid, it burns completely in the body and does not affect diuresis, and is pleasant to the taste. Under the influence of lactic acid, calcium caseinate turns into casein lactate. The released calcium forms easily absorbable soaps with fatty acids obtained from the decomposition of milk fats, contributing to the absorption of fat. Lactic acid milk is used in two modifications: whole acidified and in dilutions with rice broth 2:1. Combining the advantages of an acidified mixture along with enrichment with two carbohydrates, lactic acid milk with rice broth has found particularly widespread use. It is used with excellent results for long-term feeding of healthy and dystrophic children in institutions, starting from the first days of life, according to the general principles of feeding; in colitis and in the reparative stage of severe acute dyspepsias in artificially fed children. In the acute stage of the latter, it is rational to use defatted acidified mixtures, proposed in 1927 by Luntz under the name "lean lactic acid milk" or "artificial buttermilk". Lean lactic acid mixtures are prepared as follows: milk is separated or, in the absence of a separator, allowed to stand cold and the cream is skimmed off, then 1.5% cream and 5% sugar are added to it. The mixture is sterilized and then slowly drop by drop with constant stirring, lactic acid (30-35 cm³ of a 10% solution per 1 liter) and then 2 g of calcium carbonate per 1 liter are added. This mixture in protein and salt content exactly corresponds to buttermilk, possessing all the other features that give it therapeutic properties: certain acidity, a small but sufficient fat content, fine-flake precipitation of casein. The increased calcium content further enhances the therapeutic effect of this mixture, preventing the undesirable and not particularly rare occurrence or intensification of fermentation processes with the use of ordinary buttermilk. There are two modifications: 1) in the form of whole acidified defatted milk and 2) in diluted form (2 parts mixture, 1 part rice broth). The diluted mixture is prescribed for severe acute nutritional disorders and for children under 3 months, the whole one for older children with milder dyspepsias and for the smallest-as an addition in mixed feeding in cases where buttermilk is prescribed.-Hydrochloric acid milk, recommended by Faber, Scheer, Demuth and others, is prepared in the same way as lactic acid milk, with the only difference that instead of lactic acid, for every 100 cm³ of milk or milk dilution, 8 drops of the official solution (12.5%) HCl (according to Demuth), 25 cm³ of decinormal HCl (according to Faber) or 4 cm³ of normal HCl (according to Scheer) are added.

Possessing the advantages of acidified mixtures, hydrochloric acid milk also has a specific effect of changing the direction of metabolism toward acidosis; HCl, as an inorganic acid, does not burn in the body and is excreted by the kidneys in combination with bases. The use of hydrochloric acid milk is mainly indicated in diseases associated with alkalosis; in tetany (Scheer and Solomon), under the influence of hydrochloric acid milk, convulsions cease and electrical and mechanical excitability decrease; in eczema (Scheer), improvement in skin conditions and reduction of itching are observed. In everyday feeding practice, this mixture has not found such widespread use as lactic acid milk, especially since there is an indication (Flood) that HCl significantly increases diuresis and increases the acidity of the urine sometimes to such an extent that the sharp urine causes skin irritation. Whole citric acid milk was proposed by Weissenberg in 1926. The milk is subjected to brief boiling (5-10 seconds from the moment of boiling) and subsequent long cooling. To 1 liter of milk prepared in this way, 4.64 g of chemically pure citric acid, previously mixed with dextrin-maltose (or if unavailable, replaced with 100% sugar syrup) in an amount of 5% or more, is gradually added. While insisting on the use of whole undiluted citric acid milk for the smallest children, the author pointed to successful feeding due to the extremely fine granular clotting of casein. However, clinical observations did not give the brilliant results that the author indicated—whole citric acid milk is poorly tolerated by children in the first months of life and its use cannot be recommended. Replacing it with dilution with ¹/₈ water or rice broth gives better results than whole milk. However, even when fed with it, children do not have the flourishing appearance that they have when fed with lactic acid milk. - Milk acidified with lemon juice was proposed by Hess and Matzner in 1924. To boiled and cooled milk, lemon juice is added in the amount of 3.5% (usually from one lemon). American authors, in addition to sugar, also recommend adding yolk per 1 liter of milk. In this case, one yolk is rubbed in a small amount of milk, passed through a sieve, and added to 1 liter of warm milk. To well-cooled milk, lemon juice is added drop by drop, stirring constantly all the time. Sugar as desired. In addition to the valuable properties of acidified mixtures, this mixture is rich in vitamins and can be recommended for hypotrophy in combination with rickets (Mochan, Maslov). Unfortunately, this mixture is expensive and not always available under our conditions. Substitutes for M. s. Milk-free food is an achievement of recent times. It is indicated in milk idiosyncrasy, exudative diathesis, tetany, rickets, alimentary anemia, and poor tolerance to fats.-1. Almond milk according to Moll. To almond milk (see Vegetable milk) 3% rice flour and 10% sugar are added; 1 liter of almond milk gives 21 cal.-2. Biscuit pudding according to Moll. To 80 g of cake flour, 1 g of table salt, ¹/₂ g of soda are added, poured with 200 g of hot water and thoroughly rubbed (it is better to also rub through a sieve). To the resulting mixture, 1 yolk, rubbed with 40 g of sugar, and beaten egg white (from one egg) are added. The resulting dough is placed in a form greased with oil and sprinkled with flour, and cooked for 30 min. in a water bath. The finished pudding can be rubbed through a sieve and diluted with various liquids (whey, tea, broth, etc.). Cake flour is prepared as follows: from 1 kg of flour, 2 tablespoons of sugar, 1 teaspoon of soda, 1 teaspoon of salt and 400 g of water, dough is made 69, divided into 4 loaves and placed in the oven. The finished biscuit is cut into pieces, dried, and ground into flour.-3. Flour of various varieties for feeding children—see Baby flour.