Therapy of Syncope

Abstract

one year. The cost of all materials and labor totaled about $350. The total time spent on the project, includ¬ ing designing, experimenting, constructing, and installing, was about one month. PROCEDURE FOR USE At the time the apparatus was installed, the following regulations for formula production by terminal heating were instituted.Wash, scrub, and thoroughly rinse all bottles, nipples, and glass covers with a suitable detergent. In washing nipples evert them and do a thorough job. The success of this method depends on the thorough washing and rinsing of bottles, caps, and nipples. No method of terminal heating can kill bac¬ teria embedded in a scum or ring of milk in a bottle, bottle cap, nipple cover, or nipple. Pour sterile water from auto¬ clave mixed with formula into bottles. Place nipples on bot¬ tles. Put glass nipple covers on loosely. When using Evenflow caps, apply caps loosely; otherwise bottles will crack when heated. Fill sterilizer with hot water to overflow level. Turn off hot water. Place bottles in racks. Lower filled racks into sterilizer. Turn steam on "full." It will take about 30 minutes for sterilizer to reach the holding temperature of 212 F. When temperature gage on lid of sterilizer reaches 212, begin timing the formula. Formula should remain in sterilizer for 30 minutes at 212 F. After this period, open drain and let out scalding water. Close drain and fill to level of overflow pipe with cold water. After five minutes in cold water, remove formula, tighten nipple covers or caps, and place in icebox at 40 to 45 F. Once a week the unit is taken apart, scrubbed down, and polished. This is to prevent the growth of thermophilic organisms or maintenance of viable spores beneath the mineral deposit that accumulates on the metal surface after a week of operation. EFFECTIVENESS OF NEW UNITThe formulas produced by our terminal heating unit were studied in the same manner as those produced by the aseptic technique. The results were gratifying because 31 consecutive cultures covering a period of about 10 months showed no growth. Because of the interest and cooperation of the Milk Laboratory we were able to conduct a detailed bacteriological study of the nipples.Washed unboiled nipples were attached to the bottles before they were terminally heated. We felt that steriliza¬ tion or near sterilization (less than 25 nonpathogenic organisms per cubic centimeter of wash in the standard nipple test) could probably be achieved during the 30 minute period when the nipple was subjected to the heat of the terminal heating process. Boiling of 120 nipples prior to their utilization not only subjected them to ex¬ cessive wear but was a time-consuming process. Bacteri¬ ological tests substantiated our viewpoint. Tests on the nipples using the standard procedure and an additional procedure where some nipples were inundated in the sterile wash for 24 and 48 hours prior to being plated showed no growth. Of course, the ingredients of the for¬ mula bottle were essentially sterile to begin with. Whether or not boi...