Karitane Nurses

Kai Tiaki : the journal of the nurses of New Zealand, Volume XVI, Issue 2, 1 April 1923, Page 71

Karitane Nurses

The following- is an examination question in a recent paper set for Karitane Nurses and an answer written by Dr. Truby King as an indication of one way in which the main practical essentials could be marshalled. No attempt is made to crowd in everything that might be said, and no candidate is expected to give necessarily as much as Dr. King has set down, or to answer in the same way. Originality and self-expression are of all things desired, Dr. King's aim being to get nurses to marshal the main facts in their own way, in a simple, logical sequence. He wants them to give not what they can cram up but what they can master and can be fairly expected to know, retain, and always keep "on tap" for practical purposes, rather than cover paper with irrelevancies — the bane of examinations and examiners. (Karitane Nurses, who are nursery nurses, must not be confused with Plunket Nurses who receive naturally a fuller and more advanced training) . Give the average composition of human milk and cow's milk respectively. What variations are commonly met with, and how may these need to be allowed for, compensated and counteracted when feeding a baby? 1. Composition Sugar Fat Protein Human milk .. .. 6.75 3.5 1.5 Cow's milk .. .. 4.75 3.5 3.3 The fat of human milk is more oily (lower melting point) and therefore more easily digested by the baby than that of cow's milk, and the human protein is mainly in the form of soluble lactalbumin, whereas in cow's milk the protein takes the form of a relatively indigestible, coarse, insoluble casein. 2. Variations in Composition. (1) Human Milk. In the early part of the first week after childbirth, the "firstmilk" or colostrum may contain 6 per cent, or more of protein. At the end of a month it averages 1.5 per cent. At the end of six months it averages 1.2 per cent.

While the average protein content of "mature milk" is about 1.3 per cent., it may be over 3 per cent, or below 1 per cent, in particular cases. Similar variations occur in the fat-content, which may be over 5 per cent, or below 2 per cent. Such variations are often found on analysing specimens of human milk, but, in most cases the Avide departure from the normal is due to the fact that the samples have been wrongly taken — being "strippings/' on the one hand, or th riist miiK drawn oft' on tue other, or being in any other such way not representative of the 24 hours yield of the breasts. But wide variations do take place, due to individual idiosyncrasy or to wrong habits on the part of the mother, as regards food, drink, feeding, exercise, etc. The remedy in every such case is to regulate the diet and general hygiene of the mother, and if this is not enough to modify what the baby receives, by such measures as giving water before each nursing, besides supplementing the fat or sugar in accordance with the needs of the case, or reducing excess of fat by skimming. There is rarely any wide divergence from the normal in the sugar-content. (2) Cow's Milk. Jersey milk averages from 4| per cent, to 5 per cent, of fat, and a single cow's milk may average above 6 per cent. Holstein milk averages only from 3 per cent, to 3£ per cent, of fat, and may fall much below this, especially when the cows are feeding on young, watery, immature grass in early springtime, or at any time in the case of a particular cow. Similar variations may occur in the protein content. As in the case of human milk, the sugar-content is more constant. The variations in the proportions of fat ami protein are of prime importance — especially the fat variations, which are the main causes of trouble in artificial feeding (so far as the composition of the milk supply is concerned) and are easily detected and remedied. Protein analysis is expensive and difficult.

The main practical measures needed to ensure suitable percentages in humanised milk are as follows: — (a) The use of milk from a herd, rather than from a single cow. (b) Inquiry as to the average composition of the milk of the particular district, city or town. Thus in Wellington the Municipal Milk Supply averages above 4 pei- cent . of fat, while in other places the average is only 3 per cent. (c) It' one cow'vs milk must be used, the breed, and if possible the Eat test, should be ascertained and taken into account. (d) No careful inquiry, as to why a modified milk is disagreeing with a baby, is complete without finding out whether the milk fairly represents the yield of the herd or of the particular cow. Modified skim-milk or modified "strippings" or top-milk arc not ' 'modified-whole-cow's-milk." Carelessness in the household — dipping off "top-milk," or taking as whole milk a remainder which is virtually skim-milk — is accountable for many failures in artificial feeding. (e) Finally, a nurse or mother should never rest content, if a baby persistently does badly on a modified milk, until she has had a specimen of the preparation, as used, tested for 'fat at least — and it is desirable also, in difficult cases, to ascertain at least the proportion of total-solids in the milk. This is easily ascertained by a chemist, and taken in conjunction with a definite knowledge as to the fat percen-

tage, and the known comparative constancy of sugar and salts, enables the protein percentage to be inferred with sufficient accuracy for most practical purposes. The essential basis for modifying normal cow's miik, for baby feeding, is to reduce the percentage of protein, by dilution with more than an equal quantity of water, and to make up the sugar and fat by adding lactose, cream, or emulsion of oils and fats. Where setting for top-milk is used for concentrating the fat, full account must be taken of the variations before referred to. While a quart should be set in the case of average milk, in order to prepare 1-J- pints of humanised milk, 35 oi* oven 30 ounces may suffice in the case of -Jersey milk, and 45 to 50 ounces could he used for very poor Holstein milk. Selling the milk for shorter or longer times than the normal average requirement may be resorted to; but in the case of Jersey milk the most economical and rational alteration is to set loss milk. Xote. — Karitane nurses are young girls who enter the Karitane Hospitals for a year and are trained in the care of normal infants to recognise infantile sickness and to understand and carry out the feeding and general care of babies, either breast fed or artificially fed . They are not trained for Pluriket work, which requires a qualified nurse or midwife but understand, after their course, the Plunket methods so far as possible. — Kditor.