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action of centrifugal force combined with some chemical effects. The original cost of the machine is from $3 to $15, according to size and pattern, and a few cents' worth of materials are used at each operation. Its manipulation is easily learned, and it can be successfully operated by any careful person by following the directions which come with the apparatus.

COW'S MILK FOR INFANT FEEDING

Our principal aim is to take the composition of mother's milk as a standard, and to adjust cow's milk in accordance with this standard, cow's milk being the most available substitute for mother's milk which we have.

Modification of cow's milk is accomplished by reducing the proportion of proteids by dilution; by increasing the quantity of fat originally sufficient, but made insufficient in amount by the necessary dilution; by increasing the sugar and salt made insufficient in amount by the necessary dilution.

The manipulations necessary to modify or adapt cow's milk for infants can be carried out in the household or in milk laboratories. The introduction of percentage feeding has placed infant dietetics on a scientific basis and has given us milk laboratories, but success in infant feeding is not a matter of accurate percentages-as the general practitioner has erroneously inferred. Milk food ordered by prescription according to the percentage method and supplied by the laboratory has given very excellent results, but we may obtain the same gratifying results by home modifications, by simple dilutions, in which the principle of percentage feeding is carried out in a simple way.

For various reasons modifications of cow's milk, whether done in the household or in the laboratory, will not give uniform good results in difficult feeding cases, no matter how accurate we are in our manipulation of percentages. The chemistry of digestion is very complex, and the alimentary canal is not a test tube. The behavior of food in an infected intestine or feeble organism is often difficult to understand, and thus our best efforts will have their limitations. Success in feeding will not come to us with mathematical certainty. Minute differences in the composition of the proteids of cow's milk as compared with human milk have a theoretical but no practical interest. Suggestions for modifying cow's milk which take into consideration the minute differences in chemical composition are thrown to the winds. We cannot convert cow's milk into mother's milk, no matter how scientific we are. We are obliged to use cow's milk as Nature furnishes it, and without proper hygienic management neither home nor laboratory modification of cow's milk will fit the baby with a capricious digestion. With proper hygienic management, however, clean cow's milk, properly diluted or modified, will fit the vast majority of infants.

In the home modification of cow's milk, the greatest simplicity is desir

able for all concerned. Simple dilution of top milk with water or farinaceous. water will answer in the vast majority of cases, if the deficiency of sugar and salt is made up by adding these substances to the diluted top milk.

The following simple method of home modification has been practised by the writer for the past twenty years: If a quart bottle of average good milk stands four hours, the upper half of the milk will contain about twice as much fat as the milk before standing. This pint of so called top milk is decanted or dipped out by means of the Chapin dipper and forms the basis of bottle food for home modification. By diluting this pint of top milk in various proportions, viz.: 1–1, 1–2, 1–3, 1-4, 1-5, we obtain a food of various strengths as regards fat and proteids. The deficiency of salt and sugar is readily made up by the addition of these substances, and a food can thus be prepared which will vary in composition according to the requirements of the child to be fed. The cost of a daily feeding with the best milk obtainable is about twenty cents a day.

When clean milk can be had, the milk may be given raw. In hot weather and with the average milk supply the food must be sterilized. As an additional precaution the top milk may be filtered through a layer of cotton in a funnel.

The diluent may be boiled water, oatmeal or barley water, or whey.

15 ounces

No. 1.-For young infants (one month) and difficult feeding cases. Feed 1 to 2 oz. every two hours (twice at night).

No. 2.-Adapted for young infants with good digestion or for infants two to three months old. Feed 2 to 3 oz. every two hours (twice at night). No. 3.-Adapted for infants of from four to eight months. Feed 4 to 6 oz. every two and a half to three hours, eight feedings in twenty-four hours (once at night).

After the eighth month give six bottles and two feedings of cornstarch. pap with egg, or mutton or beef broth with rice or sago, tapioca, or pea soup. No. 4.-Rich milk adapted for children over one year old. Give five bottles, 6 to 8 oz. each, and two additional feedings as above mentioned.

Pour the mixture into small nursing bottles, each to contain one feeding, and cork with a pledget of clean cotton and sterilize in warm weather. Sterilized milk keeps without ice. Keep raw and Pasteurized milk food. on ice. Before feeding, heat to the body temperature by placing the bottle in hot water. Then remove the cotton and feed by means of a rubber nipple.

This method of modifying cow's milk does away with the addition of separated cream and is a distinct advantage over the so called cream mix

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ture, because separated cream, having a high market value, is not invariably fresh, has not a uniform composition, and is very prone to spoil and give rise to dyspeptic diarrhoeas and symptoms of milk poisoning in general.

Cow's milk modified in the household according to this simple method will agree with the vast majority of infants. In a difficult feeding case it is best to stop feeding milk for a few days and begin again with a low strength modified milk and gradually work up. When we encounter a positive idiosyncrasy for cow's milk we may be compelled to make use of some other foods. An idiosyncrasy for cow's milk in proper dilution should not be suspected until after the children have had proper hygienic management to help them digest their milk.

Infants and children who are kept indoors in cool and cold weather, and breathe the air of overheated and stuffy living apartments, will not

digest well, no matter what they feed on. It should be made a practice to send infants out of doors from the time that they are six weeks old. The insane fear of breathing cool fresh air is almost as pronounced to-day as it was in times before the advent of the germ theory of disease, and is responsible for most of the indigestion among children. A move in the right direction as regards the hygienic management of infants and children has been started in Boston by some of the wealthy families in the Back Bay district, who put their babies to sleep in a box on the flat roof or on a balcony or window sill, summer and winter. The method is begun when the baby is two months old, and may be continued as long as the custom of having a daily nap is kept up.

The baby is wrapped like an Indian papoose and strapped to the box or basket in such a way as to give freedom to the feet and arms and yet make it impossible for the child to crawl out. The crib is shielded from the wind and direct sun rays by an awning overhead. If the outdoor treatment is carried out, drugs and digestive ferments and the peptonizing process are hardly ever indicated.

To sum up, I would say that there are no universal rules for feeding cow's milk. What we must aim at is to individualize in each and every case, and not attempt to adapt one form of feeding to all cases and under all conditions. In a difficult feeding case cow's milk should be discontinued for a short time and cereal decoction and white of egg, etc., substituted. In resuming cow's milk we begin with a low strength and gradually work up to full strength milk and avoid overfeeding. Digestion of cow's milk is best stimulated by carrying children out of doors, not by drugging. Digestive ferments and peptonized milk are rarely indicated.

Idiosyncrasy for cow's milk is managed by selecting some substitute food, if possible the breast of a wet nurse. In some cases whey with cream and cereal decoction will fit the baby. digestibility from the casein.

The whey proteids differ as to

Cow's milk should be sterilized (steamed) in warm weather. The preservation of cow's milk by means of a harmless chemical is a desideratum; because the heating process slightly alters the digestibility of cow's milk. Behring has suggested the use of formaldehyde for preparing a permanent milk (1 to 10,000). Infants will usually thrive on properly modified cow's milk up to seven months. After the seventh or eighth month they are apt to become rhachitic unless they receive beef or mutton broth, with cereals and egg, in addition to cow's milk. With proper hygienic management to stimulate the motor function of the gastroenteric tract, we may let the secretions take care of themselves.

How to Feed. Select round, wide mouthed, graduated nursing bottle, and use black rubber nipples. Hold the bottle upside down and see that the hole in the nipple is large enough to allow the food to drop slowly, not run in a stream. Heat the food by placing the bottle in warm water for a few minutes, or heat the contents of the bottle in a dipper over a fire and return to the same bottle. Shake the bottle before feeding. Never warm any food that may be left in the bottle. Throw it away. give anything but cool water that has been boiled, between meals. a rule, children do not get enough water.

Never

Care of Nursing Bottles.-After feeding, rinse the bottle with cold water, and then wash with hot solution of borax (one teaspoonful to a quart) and a bottle brush. When the bottle is not in use, keep it full of water and the nipple lying in water in which a little borax has been dissolved. Before using the bottles, scald them with boiling water.

Raw milk should be fed only during the cold months. As soon as warm weather sets in the bottle food (milk food) must be sterilized or Pasteurized.

Strength of Milk Food.-In ordering milk for an infant, not only its age but its weight must be taken into account. There are some cases where the strength of the milk food may be increased rapidly. Usually it is best to begin with low strength milk food and gradually increase as the child gets older and heavier. The critical time in infant feeding is the first two months, and the difficult feeding cases are those in which infants have made a bad start.

It must be distinctly understood that there are no set formulæ for the various ages and weights of infants. The digestive capacity for food and food components-fats, proteids, and cereals-is different in various in

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dividuals and at various periods. It is lessened in hot weather and illness, and increased in cold weather. A steady increase in weight and the appearance of two gamboge yellow stools a day are the best indications of good feeding. The strength of the food may be modified once a month to suit the condition of the child.

TABLE FOR THE FEEDING OF THE HEALTHY INFANT DURING THE FIRST YEAR

Indications for Varying the Percentage of Fat, Sugar, and Proteids for Healthy Infants.-The exact indications for varying the percentage of fat, sugar, and proteids in cow's milk cannot be given in the present state of our knowledge. An excess of sugar usually gives colic, thin, green, acid stools, causing eructation of gas from the stomach and some regurgitation. and frequent passages of nearly normal appearance; in some cases round masses of fat are passed. Too little fat shows constipation and dry hard stools (also observed in children who get sufficient fat). The writer has rarely ordered milk food with more than 4 per cent of fat.

An indication of excess in proteids, or imperfect digestion of proteids, are the curds in the stool and colic, sometimes with constipation or diarrhoea or vomiting and regurgitation. Imperfect digestion of proteids or fat from lack of fresh air, from keeping children in overheated, close rooms, causes nearly the same symptoms as indigestion from other causes.

unwise to modify the milk so as to meet every temporary symptom of discomfort in the infant, but we should try the fresh air plan first, then reduce amount of feeding and finally modify the milk or food. If the symptoms persist, it will be necessary to cleanse the gastroenteric tract by means of a dose of oil, rhubarb and soda, or calomel, and give farinaceous water and white of egg for a few days and then return to a bottle food of less strength, which is more apt to be digested. For infants who are unable to assimilate the milk dilutions here recommended it is best to procure a wet nurse without much loss of time. The management of difficult feeding cases is discussed elsewhere. Premature infants, if deprived of breast milk, are fed on low strength food by means of a medicine dropper. They take from a drachm to an ounce about every two hours, and should be fed slowly.