should be re-iced before reaching the dealers. Milk not coming up to this standard and cheap milk purchased in grocery stores in large cities are absolutely unfit for infant use, and raw milk should not be fed to infants unless it is guaranteed at the above described standard of cleanliness.

Modified Milk; Adapted Milk.-These terms are used in connection with cow's milk which has been modified or adapted by dilution to the needs of the infant. Milk may be modified in the household or may be purchased already modified from the various milk laboratories long since established in all large cities. The laboratory modifications are naturally higher in price than household modifications.

Sterilized and Pasteurized Milk.-During hot weather the infant's food should be Pasteurized-heated to 167° F.-or sterilized-heated to

PASTEURIZER.

212° F. The bottles of food may be set in

a kettle of water with a thermometer. Heat rapidly to 167° F. and keep the water at this temperature for twenty minutes; then cool the food rapidly and keep it cool.

Combined Pasteurizers and sterilizers can now be bought with full directions for using. Pasteurizing or sterilizing does not increase the digestibility of the food, but prevents the growth of germs that spoil the food and cause sickness.

Rationale of Milk Sterilization

A few words as to the rationale of milk sterilization. All of our food, liquid or solid, is perishable, and we associate with this process of organic decay the terms fermentation and putrefaction as representing those processes in nature by which organic substances are split up into their elementary constituents, such change being usually accompanied by the formation of poisonous by-products-ptomaines and toxalbumins. In order to hinder a rapid decomposition of our food, we make use of methods of preservation, and employ for that purpose in the laboratory, as well as in the household, the high and low temperature respectively known as the freezing and boiling point of water. Now, one of the most important, and at the same time one of the most unstable, articles of food which enter the household of the rich and poor is cow's milk; and as we know at the present time that spoilt milk is the chief factor in the causation of summer diarrhoea, we have naturally come to the conclusion that the ordinary methods of preserving milk in the household are faulty, especially as regards the manipulation of milk intended for infants' use, and the suggestions of the German chemist, Soxhlet (whose method of sterilizing milk in the household is well known in all civilized countries), have been most enthusiastically accepted and mark a distinct advance in the rational

prophylaxis of acute gastrointestinal disease. Since the introduction of Soxhlet's method to the American profession by the writer, in 1887, numerous milk sterilizers have been launched upon the public. The different forms of apparatus now obtainable in this country are all constructed on correct scientific principles, and no special designation need be made in favor of one or the other. The Arnold sterilizers can be used both for Pasteurizing and sterilizing.

One point must be borne in mind, however: there is no apparatus on the market which will make innocuous such milk as already contains the chemical products of decomposition-the ptomaines. The milk which we subject. to the sterilizing process should be pure and fresh, otherwise we shall fail in our object. Infant mortality in New York city during the hot weather has markedly decreased since the introduction of the sterilizing process, and depots for the sale of sterilized milk have been established where the poor can obtain such milk for about one cent a feeding.

Sterilizing at a low temperature does not destroy pathogenic germs in milk. The question of the transmissibility of the bovine tubercle bacillus to human beings is, according to Koch's experiments, sub judice. The assumption that the sterilizing process is responsible for the condition. known as scurvy is erroneous. The Arctic explorer, Dr. Nansen, personally told the author that during his three years' trip not one case of scurvy developed among his men, and he attributed their immunity to the thorough sterilization of all perishable food.

In household sterilization the milk food is steamed in a set of bottles, each containing sufficient food for a single feeding, i. e., enough for twentyfour hours. The rubber stoppers usually furnished with the steamer are to be used only when the milk is to be preserved more than a day or two (on a voyage, for instance). Ordinarily a firm pledget of non-absorbent cotton is twisted into the neck of the bottle before the heat is applied. The bottles are so constructed that they can readily be cleaned; and in feeding, the cotton is removed and an ordinary black rubber nipple is adjusted.

In a recent elaborate report issued by the Wisconsin Agricultural College, steaming for twenty minutes at 140° F. is recommended as a safe procedure for preserving infants' food from day to day. But it must be borne in mind that milk food steamed at a temperature below the boiling point of water (212°) will not keep sweet unless rapidly cooled and kept on ice.

In traveling with infants and young children the ordinary milk obtainable in transit must not be used. An adequate supply of sterilized milk food should be carried along. This can be prepared in the household or secured from a milk laboratory such as those now established in all large cities, or condensed milk or evaporated cream can be carried along and diluted with boiled water (1 to 12).

Pancreatized Milk (Peptonized Milk)

This is predigested milk prepared with the aid of a "peptonizing preparation" which is sold in glass tubes, with full directions for its use. In ordinary cases of acute and chronic milk indigestion the writer seldom

makes use of pancreatized milk. Its use is indicated occasionally for a week or two in cases of acute febrile illness, when the stomach is so rebellious as to reject almost everything put into it, and it is serviceable for rectal alimentation whenever it is indicated. Peptonized milk has a bitter taste, and children are not fond of it, and it is never indicated as a regular food for healthy children.

Directions for Peptonizing Milk.-COLD PROCESS:

Mix the sodium bicarbonate and pancreatin in a cup of cold water. Add a pint of cold milk and then shake well and place on ice.

HOT PROCESS.-Prepare as above directed, but place in a dish of water at a temperature of 115°, and keep there for ten minutes. Then place on ice.

Buttermilk. As nourishment in subacute and chronic diarrhoeal disease of infants buttermilk has been recommended by Dutch physicians. Some very satisfactory results following its use in older children and convalescent adults have been observed.

Condensed Milk and Evaporated Cream.-Milk kept in grocery stores. is unfit for infants' use. When parents are unable to buy pure certified milk or are not intelligent enough or willing to handle it properly, fresh condensed milk may be fed. It must be diluted with boiled water or barley water or oatmeal water in the following proportions: 1 to 12 for the first month; 1 to 10 for the third month; 1 to 8 for the sixth month.

If fresh condensed milk is used, sugar and cream must be added. Canned condensed milk is sufficiently sweet and does not require additional sugar. Condensed milk sufficiently diluted to bring down the percentage of casein to the breast milk standard will require the addition of cream or fat. Evaporated cream in cans may be used for this purpose. Each feeding should be separately prepared. Feeding on condensed milk is not expensive and is simple as regards its preparation, but the results are not so satisfactory as with fresh and pure cow's milk.

Asses' and Goat's Milk for Infant Food.-Feeding with asses' milk has given good results, and is frequently employed in France. Children take about one quart of milk a day. Asses' milk comes nearer to human milk than any other, but contains a low percentage of fat (one half of 1 per cent), and is not adapted for more than the first two months of infancy. Goat's milk contains a high percentage of fat. A goat furnishes from two to three quarts of milk daily. The milk has a peculiar animal taste unless the goat is stall fed.

DILUENTS OF COW'S MILK

Boiled Water; Farinaceous Water; Whey.-When raw cow's milk is to be fed, the author prefers giving boiled water as a diluent up to three months. When sterilized or Pasteurized cow's milk is to be fed, the writer's experience is in accord with the teachings of A. Jacobi, who says:

"The barley and oatmeal are the two substances I mostly employ, as their chemical constituents are nearly alike, with the exception of a large

portion of fat in oatmeal, which is not found in barley. Barley water or thinned and sweetened oatmeal may be given to the child even at the breast. The indications for the use of one or other lie in the condition of the infant. Where there is a decided tendency to constipation, I prefer oatmeal; where there is no such tendency, as usual, or perhaps even a tendency of the bowels to be loose, I employ barley."

If whole cereals are used instead of flour, two to four tablespoonfuls to a quart must be taken (with some salt), and cooked for one to two hours. An equal part of top milk is added to such a decoction and some cane sugar. (See article on Home Modification of Cow's Milk.) The mixture, when fed, should have a temperature of 80° to 90° F. Whey, deprived of its fat, has been suggested as a diluent of cow's milk.

Dextrinized Gruels. In exceptional and selected cases more satisfactory results are obtained if the gruel which is used to dilute or modify the cow's milk is dextrinized by means of malt diastase or cereo.

Whey. In case of inability to digest the casein of cow's milk, or an idiosyncrasy toward milk, the milk can be curdled with rennet or pepsin, and the curd removed.

In feeding with whey, sugar and cream must be added to make up for the deficiency of both in the whey.

MILK LABORATORIES AND PRESCRIPTION WRITING FOR MILK FOOD

Through the efforts of Dr. T. Rotch, of Boston, and the Walker-Gordon Company, milk laboratories have been established in our large cities in connection with model dairies. They furnish pure, clean milk and cream

of full strength or modified. Milk food is delivered in bulk or in bottles containing a single feeding, according to the physician's order or prescription. The price for a day's rations of modified milk varies from 30 to 80 cents. Clean milk is delivered for 15 cents a quart. This plan has advanced the knowledge of infant feeding, has made it possible for parents to obtain clean milk for their children, and is a great convenience in cases in which home modification of cow's milk cannot properly be carried out.

Babcock Milk Tester

Several methods of rapidly determining the amount of fat contained in milk with the aid of chemical reagents have been devised. One of the most accurate is the Babcock milk test. The little machine constructed to apply this test, of which several patterns are made, is in use in almost all well conducted milk receiving stations. It requires about a tablespoonful of milk for a sample, and the exact percentage of fat in it can be determined by this test in ten or fifteen minutes. The result is obtained by the