The Use of CommerciaTMilk 
Sugar in Infant-Feeding. 
Read in the Section of Diseases of Children at the Forty-first 
Annual Meeting of the American Medical Association, 
Nashville, Tenn., May, 1890. 
BY B. F. BRUSH, M.D., . 
OF MT. VERNON, N. Y. 
Reprinted from " The Journal of the American Medical 
Association," July 5, 1890. 
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 brought 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 disagreea- 
ble. 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 con- 
stituents of the mixture. I then ascertained that 
he had been using the mixture for some weeks, 
and that he had not observed the foregoing 2 
change before. Then I questioned him as to 
what new conditions were existing when this 
change took 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 an- 
other supply and try that, and report to me the 
result. He returned in the afternoon and told 
me that the whole trouble fiad been in the sugar; 
because, when he went home and used the 
second lot, the mixture appeared 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 taking place in the food 
mixture. I have ever since exceedingly re- 
gretted 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 literature 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 customer made 
his complaint. Since then I have found that we 
know very little about this highly recommended 
constituent in mixtures for the artificial feeding 
of infants. Hahnemann discovered 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 recommended it as a 
vehicle for the administration of medicine. Pre- 
vious to this its use was very limited and its manu- 3 
facture was confined to Switzerland. Now, how- 
ever, 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-products and large quan- 
tities are still imported. It is found in the 
wholesale market in large cobs with a stick run- 
ning through the centre resembling 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 18 cents per pound 
for the crystal cobs and 12 cents for the powders. 
No wholesale man of my acquaintance could en- 
lighten me as to this difference. 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 stick on which it is 
crystalized. This is not a scientific point, but it 
is one of the things which I learned during sev- 
eral years of intermittent investigation 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 4 
milk-sugar of commerce when added to baby 
food is eliminated both by the kidneys and 
bowels. This, I have demonstrated by numer- 
ous experiments. I have never found sugar pres- 
ent in the urine or faeces of babies fed at the 
breast, but in three cases of infants 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 test. The faeces I macerate in boil- 
ing water, boil the filtrate and refilter, testing the 
final filtrate. I have never endeavored to ascer- 
tain the exact amount of occuring sugar, but the 
reactions have always been definite and well- 
marked. To-night I received two cubic centi- 
meters of urine from a baby io months old fed 
on Meigg's mixture, and this tested with Squibb's 
standard Fehling'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 produce little if any apprecia- 
ble 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 repeated 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 fermentation changes will also re- 
spond quickly to the digestive ferments. 5 
Relating to the 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 
containing a solution from a different sample. 
Into each tube I dropped two drops of brewer's 
yeast ; in twenty-four hours each sample re- 
sponded to the test for alcohol by chromic acid. 
With these five tubes I placed at the same time a 
sixth containing 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 fermentation in five hours. I allowed the 
six solutions 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 entirely 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 Routh was right, it will undergo " fermenta- 
tion less readily ' ' than almost anything fer- 
mentable. 
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 in- 
quiry 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 6 
of these many samples I selected five and sub- 
mitted them to the tests prescribed by the United 
States Pharmacopoeia. First, solubility. Accord- 
ing to the Pharmaccepia milk-sugar is soluble in 
seven parts water at 590 F. Sample No. 1, 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 ag- 
itating 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 capsule, the 
acid should acquire nothing more than a greenish 
or reddish, but no brown nor brownish black 
color within an hour." The following are the 
results of my application of this test: From por- 
tions of the samples above referred to, No. 1, 
blackish-brown; No. 2, dark brown ; No. 3, 
reddish brown ; No. 4, light red ; No. 5, light 
red. The Pharmacopoeia also states that it is in- 
soluble in alcohol, ether or chloroform. I found 
sample No. 1 lost 5 grains from drachms by 
repeated washing with sulphuric ether and 11 
grains by washing with 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. 1 and 2 of the foregoing for analysis as to 
the quantity of sugar contained in each sample. 
I received from him the following reply: 7 
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 brought in the open 
market 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 above analysis. The milk is collected and 
allowed 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 Flint1 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 ren- 
net are as follows : ' ' Care must be taken not to 
use too much water in cleaning, wiping 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 ren- 
net are steeped in warm water, and the solution 
from it is added to the milk and then the milk is 
raised to a temperature above ioo° and kept at 
that until coagulation takes place. Then the 
whey is drawn off and this whey is evaporated 
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 drains 
off. The sand is again boiled in water to a 
1 Milk Cows and Dairy Farming. 8 
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.