Tenth Month.—He can now take a little beef juice, beginning with one teaspoonful once a day and soon twice a day; then increase to two teaspoonfuls at a time and keep on until he is taking eight teaspoonfuls daily.

This should be given between his regular meals. Some babies cannot take beef juice; orange juice may then be tried, strained through cheesecloth or fine muslin and be given at first in doses of one teaspoonful and increased until baby gets the juice of one-half an orange.

If the mother is nursing baby and he has been given one bottle of milk daily, as advised for a four-months-old babe, he can now have two bottle feedings daily. Every healthy baby should be weaned when one year old, and it is better to do it gradually in this way. The baby's food should now be given him every three and one-half hours up to ten p. m., thus making five meals in twenty-four hours of seven to eight ounces at each meal.

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Eleventh Month.—Baby can now have added to his diet another cereal like farina well cooked,—twice as long as the directions advise and it should be half solid when finished. Begin with one teaspoonful and then try two. This should be given in addition to his beef juice or orange juice. It should come between his regular meals, which should now be given at four-hour intervals. He should take eight or nine ounces to a meal.

Twelfth Month.—Baby should go to bed at six p. m., and take long morning nap. He should have five meals a day of such food as directed later.



INFANTS' FEEDING.

What is the best food for an infant? Mothers' milk.

What is the composition of mothers' milk? About thirteen parts solids and eighty-seven parts water.

Name the solids? Fat, sugar, proteids and salts.

What is sugar? Milk sugar or "lactose."

What are the proteids? The curd of the milk, which is very similar to the white of an egg, and is the muscle making element in the milk.

Is it necessary to have all these elements? Yes.

What benefit is the fat? It is needed for the growth of the bones, nerves, fat of the body and also for producing heat.

Give the use of sugar? It is needed to produce heat and make fat in the body.

Use of the proteids? They are needed for the growth of the cells of the body, such as those of the blood, the various organs of the muscles.

What do the salts do? Help in the growth of bone.

What is the use of water? Water keeps the food minutely subdivided or in solution, so that the infant's delicate organs can digest it. It also enables the body to get rid of the waste material.



NURSING.

Should all mothers make an attempt at nursing their babies? Yes, as a rule.

What are the most important conditions that may prevent nursing? Tuberculosis now or in the past or, in fact, any other serious chronic diseases; very delicate health herself. Some acute disease like typhoid fever or cancer.

How soon after labor should the baby be put to the breast? As soon as the mother is able to have it.

What is the food called that it then obtains? Colostrum.

What does this do? It aids in cleaning the baby's system.

Should the mother nurse the baby inclining or lying? Yes.

Does nursing drain the mother? Not if she is reasonably well. It is a natural process.

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If the mother cannot nurse immediately after labor, what should you feed baby? The baby will not starve in a few days. Give it warm water regularly every few hours, or a little cream and warm water.

Are there any impediments to nursing? Sometimes the baby is tongue-tied.

Is the baby ever too weak to nurse? Yes.

What should be done in that case? Draw the milk from the breast and feed it through a free flowing nursing bottle. Such babies are generally born prematurely.

Are the mother's nipples ever at fault? Yes, they are; poorly developed, retracted, that the baby's tongue cannot surround it to draw upon it.

What can be done for them? They should be drawn out, and sometimes a breast pump is needed for this.

Should the nipples be treated after nursing? They should be dried and clean clothing put against them. Some recommend washing them with a mild solution of boric acid.

Are they ever so tender that nursing is painful? Yes.

What can be done for this? The nipples should be drawn out before confinement; if neglected use the following: Compound tincture of benzoin one-half ounce. After each nursing wash them clean with warm water or water and a little alcohol and after drying them, put on the tincture of benzoin with a camel's hair brush. It will not hurt the baby.

What can be done with cracked nipples? Apply benzoin as before directed, and use a glass or rubber nipple shield until it gets well.

How can caked breasts be prevented? The breasts should be kept emptied and well protected, both while nursing and during the intervals. Empty with a breast pump if necessary.

If mother's clothes are wet by the excess milk, what can she do? Use a breast-pump and drink and eat less fluid; eat more solid.

Should a baby nurse at both breasts? It is better.

If the breast contains pus, what can be done? Nurse at the other breast, but if both breasts are affected it must stop breast nursing.

Should an infant nurse from a mother who is taking medicine? Not as a rule.

When will the mother be able to nurse again? It is hard to tell. If the child is six months old the child should be weaned if the mother is seriously ill, and children with delicate stomachs should always be weaned, when the mother is sick.

If the mother has not enough nurse, what can be done?—Nurse partly and feed it the rest.

Can the milk secretion be increased? Yes, by regulating the mother's diet. She should drink freely of good cow's milk and have an occasional bowl of gruel, soup, etc.

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How long can you wait to see if the mother can have milk? It is well to wait several days, nurse all there is and supply the deficiency by bottle feeding.

How often should the baby nurse at first, and how long? Every four or five hours for the first few days—usually nurses fifteen to twenty minutes; one night nursing.

When is there a full secretion of milk? Usually on the third day.

How often should the baby be nursed afterward? After the third day every two hours and twice at night.

How often during the rest of the year? For two to three months every two to two and one-half hours during the day, two times at night; three to five months about every three hours up to ten p. m.; and one time at night; five to twelve months every three to three and one-half or four hours and not at night.

Is it necessary as a rule to give additional food the first few days? No; give plenty of water.

What important things should be attended to in nursing? First, a regular time night and day. Second, nipples should be kept clean.

What should a nursing mother eat? Her diet should be simple and plentiful, and lots of fluids; she should have three regular meals a day, and gruel, cocoa, or milk at bedtime and sometimes between meals. She can use cereals, most soups, most vegetables; avoid sour tart fruits, salads, pastry, and desserts. She may eat egg, meats once or twice daily, but in most cases but once. Tea and coffee if taken should be very weak, and ordinarily no wine or beer.

Are fruits eaten by the mother likely to injure baby? Sour fruits do in some cases, but sweet fruits and most fruits that are cooked do not, and are useful for the bowels.

Should the mother take special care of herself? Yes, she should lead a simple, natural, happy life, with outdoor exercise, as soon as possible after the confinement. She should make her bowels move daily by food and habit; she should not worry, should sleep plenty and should nap for an hour during the middle of the day.

Will the milk of the mother be affected by nervousness? Yes, more so than by her diet; worry, anxiety, fatigue, loss of sleep, household duties, society functions, have an injurious effect upon the child. Mother's grief, excitement, anger, passion, act upon the child through the milk.

How does the return of the menstruation affect the milk? The quantity is lessened, the infant is not satisfied. Sometimes the quality is affected and the child may suffer from restlessness, colic, and acute indigestion.

Should regular menstruation prohibit nursing? Not always; as a rule both functions do not go together. If the child thrives, it can keep on nursing, although it might be well to feed the infant, at least partly, during the period.

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How can you determine that the baby is well nourished? Good color, sleep for two hours after nursing, is quiet, good-natured and comfortable when awake; has normal bowel movements, three stools daily and gains gradually in weight.

How can you tell when a baby is poorly nourished? It neither gains nor loses weight; it is listless, tired, indifferent, cross, fretful, irritable and sleeps poorly. It looks pale, anemic, and it becomes soft and flabby. If the milk is scanty, it nurses long; at other times it tries the breast and turns away seemingly disgusted.

What should be done? This depends upon the conditions; should the child gain nothing for three or four weeks or lose weight, immediate weaning may be necessary; at least other food must be given in addition to the breast food. Feeding may be alternated with the breast nursing.

How do the symptoms show when the mother's milk disagrees? The child, is in constant discomfort; it sleeps little, is restless, cries much, gulps up gas, passes it by the bowels, or it accumulates in the bowels causing colic. There may be vomiting, but more often bowel trouble. The bowels may be constipated but usually there is diarrhea—frequent, loose, green, with mucus and gas.

What should you do in such a case? If the child does not gain or loses weight and there is little chance of improvement in the mother's milk, the child should be weaned immediately. If the child gains in weight, try a little longer to improve the mother's milk.

Why do some babies nurse so often? The milk does not satisfy.

When the baby has thrush, should the mother take special care of the breasts? Yes, they should be cleaned after every nursing.

How much does the baby's stomach hold at birth? Six to seven teaspoonfuls.

Is vomiting a healthy sign in infants? Frequent vomiting is not natural; see if his bands are too tight; find out if he has been danced or handled after nursing.

When is it harmful? When it is frequent. If it comes up directly after a meal looking just as it was when taken, the child may be over-fed.

What can be done? Reduce the quantity, or do not let it nurse so long or so often. If vomiting takes place a half hour after feeding, in sour swelling masses, it may be getting food too rich in cream, and then the time between nursings should be lengthened; or dilute the breast milk by giving one to two teaspoonfuls of plain boiled water, barley water, five or ten minutes before nursing; the mother should eat less hearty food, especially of meat.

If baby has frequent colic, what is the cause? The milk has too much proteids.

What should be done? Eat less meat, keep quiet, and happy, do not worry, etc.

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How many stools does a healthy baby have daily? About two.

What color? Yellow color and pasty consistence.

If a nursing baby has too many stools, what change should be made in the mother's diet? She should eat food that would cause costive bowels in her.



LOOSE STOOLS IN NURSING BABIES.

They are caused by the mother eating improper food. If the stools are very yellow, foul, greasy or ropy the mother is eating food that produces too much fat (cream) in her milk. If curds appear there is not enough fat, and too much of the proteids (skim milk). When the stools are very green with much mucus in them, the food should be reduced.

If a nursing baby is constipated, what can be done? More boiled water should be given between nursing. The mother should take exercise at least two hours each day out of doors; her bowels should move every day, even if she must take a laxative. She should take plenty of pure, rich milk, cocoa, oatmeal and cornmeal gruels, and some kind of tonic if she is weak. Tea and coffee should not be used. Ripe fruit (not tart), some green vegetables and a little meat can be eaten. Starchy foods should be avoided. Sometimes baby does not get enough nurse. Then she should be fed and given plenty of pure water between meals.

If a nursing baby has frequent colic attacks, what should be done? The food is probably too strong. The mother should eat food that will produce less fat (cream) in her milk. The baby can be nursed at longer periods for a time; or give an ounce of hot water just before nursing. The mother should take plenty of exercise, enough sleep and have a free movement of her bowels, so as to keep well and free from nervousness.



WEANING.

When and how should this be done? This may usually be begun at nine or ten months by substituting one feeding a day for one nursing. Later two feedings, etc., until weaning is gradually accomplished. Some advise one bottle feeding regularly each day much earlier, as before stated.

Give reasons for weaning earlier? Some serious illness of the mother, pregnancy, but the main reasons usually are that the child is not thriving.

When should the weaning be completed? Generally at one year, It may be advisable to wait longer in warm, damp weather.

Is there any danger in nursing longer? Yes, as the milk is scanty; the child may get rickets or anemia.

Is gradual weaning the best method? Yes.

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Should a wet nurse be preferred to bottle feeding? Yes, if you are sure you can get a good and perfectly healthy wet nurse. Her habits, etc., must be unobjectionable—she should be chosen by a physician.

When should a "weaned" child use the bottle, and when the cup? If the weaning is done at the eighth or ninth month the bottle should be used; if weaning is done from the tenth to the eleventh month, the baby should be taught to drink or be fed with a spoon.

How can you overcome some of the difficulties of weaning? As before recommended, by feeding every nursing infant once a day or by giving water regularly from out a feeding bottle, as this accustoms the baby to the bottle. This is very good, for the mother is sometimes away at nursing time, for a few hours and the baby can be fed, and when weaning comes, it is much easier.

How soon should a child stop nursing from a bottle? If the child is well this should be begun at the end of the first year, and after it is fourteen months old, it should not have the bottle except at the night feeding.

What is the objection to longer bottle nursing? They become attached to the bottle and refuse solid food when it is proper to give it. They get the bottle habit; also, it is troublesome and unnecessary. Then they will not take milk in the future, when the bottle is finally taken from them; an exclusive milk diet for children of two to three years old often results in poor nutrition and anemia.

Give the process of training a child to give up the bottle? There is little trouble if it is begun at the right time; pour the milk in a small cup or glass and the child will drink little by little. Give only a small portion of the food in this way, at first, and the balance from the bottle. The child will in a few weeks time learn to drink out of the cup without difficulty. If the child is two or three years old, take the bottle away entirely and let the child get hungry, and give it only milk in the cup and nothing else. Some children may go for a day without food, but hunger will master them finally. As soon as he has learned to drink milk from his cup, cereals and other solid foods are gradually added to his dietary and the child has not only been taught to give up his bottle, but he has also a training which is often necessary.

Can you give a baby just weaned as strong cows' milk as one of the same age who has been fed upon cows' milk from birth? Not generally; it would be almost certain to cause indigestion. You must remember that the change in food is a great one, and the feeding should be begun with a weak milk and increased gradually in strength as the baby becomes accustomed to the cows' milk.

What are the proper proportions for an infant weaned at four or five months? About the same as that given to a healthy bottle-fed baby of two months, except the quantity should be larger. The food can be gradually increased, in most cases, so that by the end of two or three weeks the usual strength can be given.

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What strength is given to a bottle-fed baby of two months? From the top of a quart bottle of pure milk, that has stood from three to six hours, skim carefully off the top six ounces and then pour off three ounces of milk and mix them with the top milk (first skimmed off) making nine ounces in all; add to this nine ounces twenty-four ounces of boiled water in which you should have dissolved four teaspoonfuls of granulated sugar, or six or seven teaspoonfuls of milk sugar; add a pinch of salt and a pinch of bicarbonate of soda, or else two ounces of lime water.

Give the proper proportion for a baby who is weaned at nine or ten months? About the same as for a bottle-fed baby of four or five months. The increase to be as above given.

What is the formula for a bottle-fed baby of four months? For a healthy baby, six ounces of top milk skimmed from the top of a quart bottle of milk, six ounces of milk, then poured off, twenty-four ounces of barley or oatmeal gruel, six teaspoonfuls of milk sugar or three of granulated sugar, a pinch of salt and a pinch of bicarbonate of soda or if lime-water is used instead take one ounce of lime-water to each twenty of the milk or gruel. He should have four ounces of this mixture every three hours up to ten p. m., and then one meal at about two a. m.; none until six or seven a. m.

Will a child lose weight when placed upon this diet? It will often do so for a week or more, but he will soon gain gradually and regularly.



SPECIAL MONTHLY RULES FOR A BOTTLE-FED BABY.

Formula of food.—For the first month: skim off carefully the top six ounces from a quart bottle of pure milk, add to this twenty-four ounces of boiled water, in which water three teaspoonfuls of granulated or six teaspoonfuls of milk sugar have been dissolved, and then add a pinch of soda, or else one and one-half ounces of lime-water. Mix all these ingredients thoroughly, and then pour the correct quantity into each of ten clean nursing bottles. Tightly cork these bottles with clean cotton, and they can all be pasteurized or heated to a temperature of 155 degrees F. (Some say higher).

What strength is given to a bottle-fed baby of two months? From the top of a quart bottle of pure milk that has stood from three to six to eight hours, skim carefully off the top six ounces and then pour off three ounces of milk and mix them with the top milk (first skimmed off) making nine ounces in all; add to the nine ounces, twenty-four ounces of boiled water in which you should have dissolved four teaspoonfuls of granulated sugar, or six or seven teaspoonfuls of milk sugar; add a pinch of salt and a pinch of bicarbonate of soda, or two ounces of lime-water.

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Formula for the third month.—(This is often used), Carefully skim off the top six ounces from a quart bottle of pure milk, then pour off six ounces of milk, twelve ounces in all, and now add twelve ounces of boiled water in which three teaspoonfuls of granulated or six of milk sugar have been dissolved, with a pinch of soda or else two ounces of lime-water; add then twelve ounces of barley or oatmeal gruel, divide into eight bottles, pasteurize, etc.; cool quickly and place where the temperature is 50 degrees F., until meal time, when one of the bottles should be warmed by placing it in warm water. Pour a little out in a spoon to test the warmth, etc.; when the milk is lukewarm remove the cotton cork and attach the rubber nipple. He should be fed regularly and equally every three hours up to ten p. m., then have one at two or three a. m., and nothing until seven a. m. He should get three and one-half to four ounces at each meal, so that much should be put in each bottle.

What is the formula for a bottle-fed baby of four months? For a healthy baby, six ounces of top milk skimmed from the top of a quart bottle of milk, six ounces of milk then poured off, twenty-four ounces of barley or oatmeal gruel, six teaspoonfuls of milk sugar or three of granulated sugar, a pinch of salt and a pinch of bicarbonate of soda; or if lime-water is used instead, take one ounce of lime-water to each twenty of the milk and gruel. He should have four or five ounces of this mixture every three hours up to 10 p. m., then one meal at about 2 a. m. None until 6 or 7 a. m.

Will a child lose weight when placed upon this diet? It will often do so for a week or more, but he will soon gain gradually and regularly.

Formula for the fifth month.—Skim off the top six ounces as before, then pour off nine ounces of milk and mix it with the top-milk, add twenty-four ounces of barley or oatmeal gruel, a pinch of salt, four teaspoonfuls of granulated or seven of milk sugar, a pinch of bicarbonate of soda and proceed as before. He should be fed every three hours during the day until 10 p. m. Give five to six and one-half ounces at each meal, making six meals in the whole twenty-four hours.

Formula for sixth month.—Six ounces of the top-milk skimmed off from a quart of pure milk, ten ounces of milk then poured off. Twenty-four ounces of barley or oatmeal gruel, in which has been thoroughly dissolved four teaspoonfuls of granulated or seven of milk sugar, a pinch of bicarbonate of soda, and a pinch of salt. Pasteurized as before, etc. Give baby from four to six ounces at each meal every three hours up to 9 or 10 p. m. If the day is exceedingly warm, pour out one or even two ounces from each bottle of the regular mixture and substitute boiled water for it. If the baby is inclined to vomit, it will be better during the hot weather to use less of the top milk, four, or five ounces instead of six or eight, and add so much more gruel. Barley gruel is better than oatmeal gruel unless baby is constipated. Again if the baby has delicate digestive organs, one meal each day during the very hot weather, can be made of mutton broth prepared as follows: Cut up one pound of neck of mutton, one pint of cold water and a pinch of salt; this is cooked very slowly for three hours until half a pint is left, adding a little water from time to time as it boils away; strain through muslin and allow to cool, and when cool take off all of the fat. Add this to an equal quantity of barley water and feed lukewarm to the baby from the nursing bottle. These measures may ward off summer complaint and assist in teething.

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Formula for the seventh month.—From a quart of pure milk carefully skim off the top six ounces, pour off fifteen ounces of the milk and add twenty-one ounces of barley or oatmeal gruel to which has been added dissolved four teaspoonfuls of granulated or seven of milk sugar, a pinch of bicarbonate of soda. Give six or seven ounces at each meal and six meals in twenty-four hours.

Formula for the eighth month.—Skim six ounces of top-milk as before directed, pour off seventeen ounces of milk, add twenty-one ounces of barley or oatmeal gruel, four of granulated or seven teaspoonfuls of milk sugar, a pinch of salt and bicarbonate of soda. Give six and one-half to seven ounces every three hours up to 10 p. m.

Formula for the ninth month.—Use six ounces of top-milk skimmed off as before, twenty ounces of milk poured off, twenty-two ounces of either barley or oatmeal gruel, a pinch of bicarbonate of soda and salt added to the gruel, and five teaspoonfuls of granulated or eight of milk sugar dissolved in boiled water and put in the gruel. Give seven or eight ounces of this every three hours up to 10 p. m.

Formula for tenth month.—The milk in a quart bottle is stirred and thirty ounces of this is taken and twenty ounces of either barley or oatmeal gruel is added to it, to which three teaspoonfuls of granulated or seven of milk sugar, a pinch of salt and a pinch of bicarbonate of soda have been added. Feed the child every three and a half hours up to 10 p. m., making five meals in twenty-four hours, and seven to eight ounces at each meal.

Formula for eleventh month.—Stir up the entire quart of milk, add thirteen ounces barley or oatmeal gruel and to this add one tablespoonful of granulated or two of milk sugar dissolved in boiled water, a pinch of salt and a pinch of bicarbonate of soda. Treat as used; eight or nine ounces are given at each feeding, and five feedings given during the twenty-four hours.

Formula for twelfth month.—Stir up the entire quart of milk; add eleven ounces of gruel, one tablespoonful of granulated or two of milk sugar, a pinch of salt and bicarbonate of soda. The child should now have five regular meals daily, arranged about as follows: Six a. m., nine ounces of this modified milk; 8 a. m., teaspoonful of prune jelly or strained juice of an orange; 10 a. m., seven ounces of the modified milk and two tablespoonfuls of a well cooked cereal; 2 p. m., five ounces of beef juice or six ounces of mutton or chicken broth, or else a coddled egg (alternate on different days), five or six ounces of modified milk and a small piece of zwieback; 6 p. m., nine ounces of modified milk; 10 p. m., ten ounces of modified milk.

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BARLEY AND OATMEAL GRUELS.

How is barley gruel made? Rub up one teaspoonful of the flour with a little cold water, and then stir this into a pint of boiling water, add a pinch of salt and boil it fifteen minutes, strain if it is at all lumpy.

How is oatmeal gruel made? In the same way, but use two teaspoonfuls of the flour.



SPECIAL RULES OF FEEDING AND NURSING FOR EACH MONTH IN CONNECTION WITH THE FORMULA GIVEN.

How can milk be pasteurized? A regular pasteurizer can be bought for three dollars; or the bottles, ten or less, can be placed in a pot partly filled with water which is rapidly brought to the boiling point about 155 degrees F. These bottles are filled with each regular feeding before being put in the water. The milk should not boil. Then remove the pot from the fire and allow the bottles to stand in it for one-half hour, then take them out and cool them as quickly as possible by allowing first warm and then cold water to run over the outside of the bottles; when they are cold, place them on ice or where the temperature is about 50 degrees F., and keep them until meal-time. Then one of the bottles is placed in warm water until the milk is lukewarm, the cork can then be removed and the nipple applied. These ten bottles were equally filled with the modified milk as prepared under the formula for the first month.

How much modified milk should be placed in each bottle? For the first week of life one to two and one-half ounces are placed in each of the ten bottles, and two or three and one-half ounces for the last two weeks of the first month.

What should be done if the baby vomits or has curds in his stools? Use a little less cream and a little more water. Remember, two tablespoonfuls equal one ounce.

What kind of bottles should be used? Round cylindrical bottles with the ounces marked on them.

What color of nipples? Black rubber nipples.

How should the bottle be treated when emptied? Rinse it out with cold water and then allow it to stand full of cold water with a pinch of soda or borax in it.

How should the bottles be prepared before the food for the whole day is put in them and pasteurized, etc.? They should be thoroughly rinsed in hot soap suds, and then rinsed and boiled in clear water for ten minutes.

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What about the nipples? Rinse them first in cold then in hot water and allow them to stand in a covered cup of boric acid solution or borax water solution one teaspoonful to a pint of water. Once or twice each day they should be turned inside out and scrubbed with a brush and water. The hole in the nipple should be only large enough for a rather coarse needle to go through. The hole in the nipple can be made by such a needle heated red hot and then run through the nipple.

When can you begin to add barley and oatmeal gruel to the baby's milk? In the third month. The gruel should be made daily. If the child is not constipated use barley gruel; if constipated use the oatmeal gruel.

If you cannot get the flour, how can you prepare the gruel from the grain? Take two teaspoonfuls of barley or three of oatmeal and allow it to soak over night in cold water; add one quart of cold water the next morning and boil steadily down to a pint, (for about four hours), then strain through muslin.

Do some physicians advise feeding nursing babies one or two meals daily, beginning the fourth month? Yes.

What strength should it be? Use the formula for bottle-fed babies of the first month and the same amounts.

How can you calculate the amount necessary? Take one-eighth or one-fourth either for one or two meals daily of the separate ingredients mentioned in the formula for the first month.

Following order may be as follows: First give baby three ounces of the formula, and if all goes well in a day or two give him three and one-half ounces and miss one meal at the breast. After one week if the baby is well suited, give him three ounces of the formula for the two-months-old baby; wait a few days, then give him four ounces of this formula at the one meal. Then in a week's time if all goes well, give him four ounces of the formula for the three month's baby. Use this for one week, and then give him four and one-half ounces of the same formula. If after another week is past, there are no signs of indigestion, give him four ounces of the four-month formula, and if he enjoys this very much wait for a day or two and then increase the amount to four and one-half ounces of the same formula, and then to five ounces; as he grows older give him of the same formula as the bottle-fed infant of the same age, and the same amount at the one feeding; if he vomits or has curds in his stools or colic keep him on a weak formula longer than formerly advised.

If you have fed a breast-fed baby one meal a day from the bottle when can he be given two feedings from the bottle? During the tenth month.



COWS' MILK.—Does cows' milk contain all the elements present in the mother's milk? Yes, but in different proportions.

Why not use prepared foods? They are not thought so good, and are more likely to produce poor nutrition.

What is, the difference between cows' milk and mothers' milk? Cows' milk contains nearly three times as much casein (curd) or cheesy matter, and only about one-half as much sugar.

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What kind of cows should be selected? They should be healthy and the milk should be clear and fresh.

Is it best to select Jersey cows? The milk from Jersey and Alderney cows is generally too rich; common grade cows are best.

Should the milk be from one cow? It should be from the mixed or herd milk since that varies little from day to day.

How fresh should the milk be? In winter it should not be used after it is forty-eight hours old; in summer not after it is twenty-four hours old, and sometimes it is unsafe in a shorter time.

How should the milk be cared for at the dairies? It must be kept clean and free from being contaminated. Cows, milkers and stables must all be kept clean, and the milk must be carried in sealed bottles; those that handle the milk must not be near a contagious disease; all milk pails, bottles, cans, etc., used for the milk must be steamed and boiled before being used.

Should it be immediately cooled after leaving the cows? Yes, and kept at a temperature of about 50 degrees F.

How should the family care for it after it is delivered fresh from the cows? Strain it for infants through a thick layer of absorbent cotton or through several thicknesses of cheese-cloth into quart jars or milk bottles, covered and cooled immediately. This is best done by placing the bottles in ice water or cool spring water that comes up to their necks and allow them to remain there at least one-half hour. What you wish to use for the children who drink plain milk you may pour into one-half pint bottles, and these should be placed in an ice chest or in the coolest possible place. The first rapid cooling is very important and adds greatly to the keeping qualities of the milk, for the milk loses its heat quickly when cooled in water, but very slowly when it is simply placed in a cold room. After standing for four or five hours or longer, the top milk can be strained off; the cream may be removed after waiting twelve to sixteen hours.

How should it be cared for when received in bottles? The temperature of the milk is always raised during the delivery, so it should be cooled as before described. If it was bottled at a dairy the cream or top milk can be removed in an hour or two.

How should milk and cream be cared for by the family when purchased in bulk? This milk should never be used for infants, as it is liable to be contaminated. Both cream and milk should at once be poured into vessels, covered and kept in a cool place. There will not be much cream or top milk upon such milk.

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How should refrigerators be treated? The inner portion should be of metal. An ordinary metal refrigerator, as sold, if encased in a wooden box makes the best kind. A covering of felt and heavy quilting can be made for the refrigerator which can be removed easily when wet or soiled—it must be kept absolutely clean. The compartments for the milk should be so arranged that the milk bottles be either in contact with the ice or near it. The supply of ice should always be abundant, or the temperature of the milk will not be low enough. The temperature should not be higher than 50 degrees F.; it is oftener 60 to 65 degrees F. To tell the temperature, use a nursery thermometer and this should be used from time to time to know what temperature the milk is in. Milk is often spoiled in too warm temperatures in refrigerators, and also in unclean refrigerators. Many cases of sickness are caused by it. The refrigerator should carry a temperature of near 50 degrees F., and be absolutely clean, and the compartment for the milk should be absolutely separated from other food compartments.



MODIFIED COWS' MILK.

Can cows' milk be fed to infants without being modified? No; because, although the elements are similar to those in mothers' milk, they are not identical, and are present in different proportions.

Is this a matter of great moment? Yes, for very few infants can digest cows' milk unmodified.

What does modifying cows' milk mean? It is changing cows' milk so as to make it more nearly like mothers' milk.

What is this changed milk called? Modified milk; and the original milk is known as "plain milk," "whole milk," "straight milk" or "milk."

State the principal differences between cows' milk and mothers' milk? Cows' milk contains a little more than half as much sugar. It contains nearly three times as much proteids (curds) and salts, and the proteids are different and much harder to digest. The reaction is decidedly acid, while the mother's milk is faintly acid or neutral.

Any other things of importance to consider? Yes; mothers' milk is always fed fresh and sterile, while cows' milk is always more or less contaminated by dust or germs which increase rapidly with the age of the milk in proportion to the amount of dirt in it and with any increase of temperature at which the milk is kept. So pasteurization and sterilization are done to destroy the effect of germs.

How can the acidity of cows' milk be overcome? By adding lime-water or bicarbonate of soda.

How much lime-water should be used? About one ounce to twenty ounces of food.

How much bicarbonate of soda? About twenty grains to twenty ounces of food.

Suppose there is a tendency to constipation in the infant? You can then use Phillip's milk of magnesia, or some other good preparation, adding one-half to one teaspoonful to each twenty ounces of food.

How can the sugar be increased? By adding milk or granulated sugar to the cows' milk.

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How much milk sugar is added to twenty ounces of food? About one ounce will do for the first three or four months. This makes it between six and seven per cent sugar.

How should you prepare the sugar? Dissolve it in boiled water and strain if there is a deposit after standing, by pouring it through a layer of absorbent cotton one-half inch thick placed in an ordinary funnel.

Is not granulated (cane) sugar recommended also? Yes; but all infants cannot use it. It is cheaper, but a good article of milk sugar should be bought. It costs from twenty to sixty cents per pound. The cheap variety contains many impurities.

But if cane sugar is used, how much is needed? Usually about one-half or a little over one-half as much as milk sugar, or about one half ounce to twenty ounces of food.

What occurs if too much is used? The sugar is likely to ferment in baby's stomach and cause colic. The milk is made too sweet.

If you continue to overfeed granulated sugar, what happens? Gas, colic, restlessness, uneasiness, lining of the bowels becomes reddened and irritated; the redness shows externally around the rectum, and in severe cases around the hips.

Unless the amount of sugar is now reduced, what occurs? There follow frequently watery, splashy stools with much gas and foul odors.

Is cane or granulated sugar safe to use after six months? It does not usually produce so much trouble later on.

Suppose milk sugar produces irritation? The quantity used should be reduced to one ounce to twenty-five ounces of food or even less for a short time.

As a rule should milk sugar be preferred the first six months? Yes.

What are the best grades of milk sugar? Merck's, Mallinkrotz's, or Squibb's.

Is sugar added to sweeten and make the milk palatable? No; although it does that, its use is to furnish one of the needed elements for the growth of the baby, and it is required by young infants in the largest quantity.

How do we know that this is true? Because in good mothers' milk the amount of sugar is greater than that of the fat, proteids, and salts combined.

As cows' milk has nearly three times as much proteids (curds) and salts as mothers' milk, how can these be diminished? By diluting the cows' milk.

How much should cow's milk be diluted for a very young infant? Diluted twice will give almost the same proportion of proteids present as in mothers' milk, but as the proteids of cows' milk are so much harder for the infant to digest, the milk should, in the beginning, be diluted five or six times for most infants.

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Does the diluted cows' milk with lime-water and sugar added resemble mothers' milk? No; for this mixture does not contain enough fat.

How can this be remedied? By increasing the fat in the milk before it is diluted.

How is this done? By adding top milk or milk and cream.

What is the top-milk? It is the upper layer of milk, one-third or one-half of milk removed after it has stood a certain number of hours,—six to eight hours.

How is the strength of the top-milk measured? By the fat it contains. A ten per cent milk contains a ten per cent of fat; a seven per cent milk contains a seven per cent of fat.

Are these strengths used for infant feeding? Yes, they are most used.

What increases the percentage of fat in the top-milk? 1. The longer time it stands. 2. Manner of its removal. 3. Number of ounces removed. 4. Thickness of the milk used.

When is top-milk removed? If milk is fresh from the cow or before the cream has risen, is bottled and rapidly cooled, it may be removed in four hours. It does not make much difference in bottled milk, and it may stand much longer.

How should top-milk be removed? Skim carefully off with a spoon, or cream- dipper (specially prepared) holding one ounce. It may be taken off with a glass or rubber syphon, never pour it off.

How can ten per cent top-milk be obtained from the different kinds of cow's milk? From rather poor milk (three to three and one half per cent fat) remove the upper eight ounces from a quart.

How can it be obtained from good average milk (four per cent fat?) Remove the upper eleven ounces or one-third.

From rich Jersey milk (five and five one-half per cent fat)? By removing sixteen ounces or upper one-half from the quart.

How is seven per cent top-milk obtained? 1. By removing the upper eleven ounces or one-third of a quart from poor milk. 2. By removing the upper half from average milk. 3. By removing two-thirds or about twenty-two ounces from rich Jersey milk. As stated before the seven per cent and ten per cent are the two kinds generally used.

If top-milk is treated in this way, is it like the human milk? The proportion of the fluids and solids are about the same, but the elements are different. The curd (albuminous element) is still different in structure and action from the same element in human milk. The curd of human milk when it is met by the gastric juice in the stomach coagulates in minute particles, and the pepsin acts upon this very readily, but the curd of cows' milk being much coarser and firmer coagulates under these conditions, into large hard clots or masses, and these are quite indigestible if the child's stomach is sour from an under amount of acid being present.

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How can we prevent this? By adding some bland and nonirritating substance to the milk which will mingle with the particles of curd and separate them until the gastric juice can act upon each separate particle and digest it.

What can we use for this purpose? Barley or oatmeal water or gruel is best.

What is cream? It is the part of the milk containing the most fat.

How is cream now obtained? By skimming after it has stood for twenty-four hours, "gravity cream"; by a separator, and it is then known as "centrifugal cream"; (most of the cream now sold in cities is "centrifugal cream").

How much fat has the usual "gravity cream?" Sixteen to twenty per cent.

How much fat is contained in cream removed from the upper one fifth of a bottle of milk? About sixteen per cent.

How much does the usual centrifugal cream contain? Eighteen to twenty per cent fat.

How much does the heavy centrifugal cream contain? Thirty-five to forty per cent fat.

Should the milk be boiled for babies in the summer time? No, not usually.



FOOD FOR HEALTHY INFANTS.—FOR EARLY MONTHS.

These directions, etc., are for healthy infants. Directions for such as are suffering from digestive disturbances will be given later. I have in preceding pages given formulas for feeding children. I give these additional, because not all children can be fed the same way and it may be well to have the two sets of formulas.

What important parts are to be remembered when we are modifying cow's milk for the early month's feeding? That sugar is the most easily digested, fat comes next, while the proteids (curd) are the most difficult.

What relation should the fat and proteids bear to each other during the earlier periods? Usually in healthy infants the fat (cream) should be three times the proteids (curds). Some healthy infants do not digest fat so well and they should have only twice as much fat as proteids (curds—skim-milk).

What per cent milk must be used to obtain three times as much fat as proteids? Ten per cent milk.

How can we obtain ten per cent milk? As top milk, described on another page, or by using plain milk and ordinary cream (sixteen per cent), in equal parts mixed; or it may be obtained directly from the milk laboratories.

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Which is better to do, use the top-milk or mix plain milk and ordinary cream? If the milk is fresh from the cows, it is best then to use the top-milk, because the food can then be made up after it is only a few hours old.

If one uses bottled milk, in cities, the upper third may be used, but if milk and cream are bought separately it is usually more convenient to mix these, as cream will not rise uniformly upon the milk a second time.

What per cent milk must be used to obtain twice as much fat as proteids? Use for dilution a seven per cent milk, that is, milk containing seven per cent fat, as in this milk the fat is just twice the proteids.

How is this obtained? Same as top-milk, described on another page; or by mixing three parts of plain milk and one part of ordinary cream (sixteen per cent), or by obtaining it directly from the milk laboratories.

How should we prepare the food for the early months? Granted you make up twenty ounces at a time, first obtain the ten per cent, or seven per cent, milk to be used, then take the number of ounces of this called for in the formula desired. One must remember that to make twenty ounces of food one ounce of milk sugar (or three even tablespoonfuls) and one ounce of lime-water must be used. The rest of the food is boiled water and the per cent milk.

FIRST SERIES—Five formulas for early months for ten per cent milk: Formulas. 1 2 3 4 5 10 per cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz. *Milk Sugar 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 17 oz. 16 oz. 15 oz. 14 oz. 13 oz. ——- ——- ——- ——- ——- 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*The milk sugar takes no space as it is always dissolved in the boiled water.

How can we strengthen this food? By gradually increasing the milk (top milk) and decreasing the amount of water.

SECOND SERIES—Of five formulas for the early months from the seven per cent milk. This is weaker in fat (cream), etc., about one-third:

Formulas. 1 2 3 4 5 7 per cent, milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz. Milk Sugar 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 17 oz. 16 oz. 15 oz. 14 oz. 13 oz. ——- ——- ——- ——- ——- Food 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

How can I decide which series of formulas to use? A strong child with good digestion can be given from the first series, ten per cent milk.

A smaller, weaker child, and whose digestion is not so good, or with one who has tried the first series and did not do well, should use the second series of formulas.

[582 MOTHERS' REMEDIES]

What is the reason the food is made so weak at first? The infant's stomach is made to digest mother's milk, not cows' milk, so we must begin with weak cows' milk, and the infant's stomach can thus be trained to digest it. Strong milk would be very liable to seriously upset the child's digestion.

How rapidly can I increase the food in strength, that is, go from formula 1 to 2, 3, 4, and 5, of either series? This can not be told, absolutely. It depends upon the infant, how it bears the food. Usually you can begin on formula one on the second day, formula two on the fourth day; three, after seven or ten days, but after that make the increase slower. If the infant is large, strong and of good digestion, he may be able to take of formula five by the time he is three or four weeks old. A weak child, or one with feeble digestion must go much slower, and such an one may not reach formula five until it is three or four months old. Mothers should remember it is safer to increase the strength of the food very gradually; some infants should have an increase of only one-half ounce instead of one ounce; thus: three to three and one-half ounces, etc. Two or three days should be allowed at least between each increase of food.

May I not go by a general rule in increasing the food? Yes, increase the food when the infant is not satisfied, but is digesting well.

How does an infant show this? He drains the bottle hungrily and cries when it is taken away. He may begin to fret a half hour or so before the time for the next feeding. He often sucks his fingers immediately after feeding.

If I wish to prepare more than 20 ounces of food, what proportions shall I use? To make 25 ounces, add one-fourth more of each ingredient. To make 30 ounces, add one-half more of each ingredient. To make 35 ounces, add three-fourths more of each ingredient. To make 40 ounces, double each ingredient.

For example, 25 ounces of food would call for—2-1/2 ounces of milk; 1-1/4 ounces of milk sugar; 1-1/4 ounces of lime-water; 21-1/4 ounces of boiled water.

For 30 ounces of food, proportions would be—Milk, 3 ounces; milk sugar, 1-1/2 ounces; lime-water, 1-1/2 ounces; boiled water, 25-1/2 ounces.

How much more should be made at one time? Five ounces may be made, but the first few days only two or three ounces of the additional should be given; four ounces the next two days, and after two days more may give the five ounces additional that has been made; that is, twenty-five ounces in all.

How much increase can be given at each feeding? Not more than one-quarter of an ounce.

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FOOD FOR HEALTHY INFANTS DURING THE LATER MONTHS.

How long shall I continue this proportion, that is, the fat three times the proteids (curd)—skim-milk? Usually for three or four months.

What changes shall I then make in the food? After you are using formula five of the first series; that is, six ounces of the ten per cent milk in twenty ounces of milk, increase the fat slowly, for the proportion of fat (three per cent), is near the limit for healthy children.

How then shall I strengthen the milk? By raising the percentage of proteids (curds, skim-milk).

How can I do this? Use the formulas derived from the seven per cent milk and discontinue the ten per cent milk.

THIRD SERIES.—Five formulas for seven per cent milk for the later months— Formulas. 1 2 3 4 5 7 per cent milk 7 oz. 8 oz. 9 oz. 10 oz. 11 oz. *Milk Sugar 1 oz. 1 oz. 1 oz. 3/4 oz. 1/2 oz. Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 12 oz. 11 oz. 10 oz. 4 oz. 3 oz. Barley Gruel 0 oz. 0 oz. 0 oz. 5 oz. 5 oz. ——- ——- ——- ——- ——- 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*(As the milk sugar is dissolved in the boiled water the quantity is twenty ounces instead of twenty-one.) Oatmeal gruel can be substituted for barley gruel if there is constipation. To increase the food to twenty-five, thirty, or thirty-five ounces increase the milk ingredients by 1/4, 1/2, 3/4 and for forty ounces using two times as much.

How shall I increase the food during this period? Beginning with formula one of this series, which should usually follow five of the first or second series, you can usually make the increase in ten days to No. 2; in two weeks you can use No. 3; but proceed more slowly to four or five when you have reached them. The same formula may be continued sometimes for three or four months with no other change, except an increase in the quantity of the food, that is from twenty ounces to twenty-five, etc.

Is it necessary or important to reduce the proportion of fat as it is at first, reduced in passing from formula five of the first series to formula one of the third series? It is not necessary.

How much is this reduction? From 3 to 2.50 per cent.

How much increase of fat is there from the fifth formula of the second series to the first formula of the third series? From 2.00 to 2.50 per cent.

Can the first decrease be avoided? Yes, by taking off at first the upper thirteen ounces as top-milk, and using in a twenty-ounce mixture seven ounces of this in place of formula No. 1, and also by using for the next increase the upper fifteen ounces as top-milk—taking of this eight ounces in a twenty-ounce mixture in place of formula No. 2. Then follow three of this third series. This is only done when you think the formulas two and three of the third series do not give enough fat.

[584 MOTHERS' REMEDIES.]

Can I add any other food about the sixth or seventh months? Yes, foods in the form of gruel, and have this take the place of part of the boiled water and part of the sugar. Oatmeal and barley gruels can be added.

Can I make further changes at ten or eleven months? The proteids (skim-milk) may be further increased, sugar and lime-water reduced until plain milk is given.

How can I do this? Give at first one feeding of plain milk and barley gruel daily; later two feedings, then three feedings, etc. For example, suppose one infant was being fed with modified milk as formula 4 or 5, series 3, six feedings daily. The plain milk diluted with boiling water would take the place of one such feeding at first, then two, three, four, etc., feedings. Such changes to be made at intervals of two weeks. Proportions of milk and barley gruel should be, at first, about five and one-half ounces milk, two and one-half ounces barley gruel; later six ounces milk, three ounces barley gruel and then seven ounces milk, two ounces barley gruel until plain milk is alone used, and this can usually be reached at twelve to thirteen months. For five months' infants a pinch of soda may be added to each feeding when the lime-water is omitted. It is not generally necessary, however.

Do some infants dislike the milk after the milk sugar has been omitted? Yes; for such 1/4 to 1/2 teaspoonful of granulated sugar may be added for a time to each feeding and gradually reduced.



RULES FOR USING THESE FORMULAS.

They are only for healthy infants. Begin always with a weak formula, especially with an infant previously nursed at the breast, with one just weaned and with infants who have poor digestive powers, or whose digestive powers are unknown. Should the first formula tried be too weak the food can be strengthened every three or four days until the right formula is found. If the food is made too strong at first an attack of indigestion is liable to follow.

How shall I increase the strength of the food? This should be done very gradually. Do not advance more than one formula in the given series. It is frequently better to make the increase in half steps. Say when it is from three to four, give three and one-half, and then four.

How rapidly can I increase the quantity of food? This should not be more than one-fourth ounce in each feeding, one to one and one-half to two ounces daily.

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When should the amount of food be increased? An increase may be necessary every few days in the early weeks, but the same formula is often continued for two or three months during the later months.

What signs in the infant demand an increase? The infant is not satisfied, does not gain in weight, but it has good digestion—that is, it does not vomit and has good stools.

When should I not increase the food? So long as the child is satisfied, gains four to six ounces weekly, even when the quantity and strength of the food is considerably below the average.

Should you then increase the food if the child seems somewhat hungry, but still gains from eight to ten ounces weekly? It is not always a safe rule to be guided by the appetite.

How can I know whether to increase the strength or the quantity of the food? In the early weeks it is well first to increase the strength, the next time the quantity of the food, then the strength, then the quantity, etc. The quantity chiefly should be increased after the fourth or fifth month.

Should a slight stomach discomfort or disturbance follow after the food has been strengthened, what shall I do? If the disturbance is marked and continues and the infant does not seem able to accustom itself to the new food, you should go back to the weaker one and the next increase should be smaller.

Should I be worried if the gain in weight for the first few weeks of artificial feeding is slight, or even no gain? Not as a rule; if the infant loses no weight, sleeps well, is comfortable, does not suffer from vomiting, nausea, colic, you can feel sure the baby is doing well and is becoming used to his new food. As his appetite improves and his digestion is stronger the food may be increased every few days. Then the weight will soon increase.

Is constipation likely to occur from such a weak food? This is very often seen owing to the fact of their being little residue in the bowels, so if he has a daily stool, even if it is small and dry, it need not cause worry as it soon passes away with the using of stronger food.

What circumstances indicate that the food should be reduced? When the child becomes ill from any causes, or when there are any marked symptoms of indigestion.

How can I reduce the food? If there is but a slight disturbance and the daily food has been prepared, pour off one-third from each bottle just before each feeding and replace this quantity of food with boiled water; if the disturbance is more severe, immediately dilute the food at least one-half and also reduce, at the same time the quantity given; for a severe attack of indigestion, omit the regular food altogether and give only boiled water until a doctor has been called.

How shall I return to the original formula after it has been reduced for a disturbance of digestion? The increase must be very gradual after the immediate reduction. After a severe attack of indigestion, the milk should not be made more than one-fifth the original strength, and ten days or two weeks should elapse before the original strength food is given and, as stated, there should be a gradual slow increase.

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ABOUT ADDING OTHER FOODS TO MILK.

How long shall I continue the modified milk? Usually for about six months; but if the infant is doing well you can continue it for ten or eleven months. If the infant has trouble in digesting cows' milk other foods can be added at three or four months or even at the beginning.

What food can I first use? Barley, oatmeal, arrowroot, and farina.

Is it better to make them from the flour? Yes, they are more simple to prepare from the flour.

How shall I cook them? Cook them separately, and when used they take the place of some of the boiled water.

(For another way, see former pages.)

How shall I prepare barley gruel water? Take one teaspoonful of the flour and rub it up with a little cold water, and then stir this into a pint of boiling water; add a pinch of salt and boil it fifteen minutes; strain if it is lumpy. Oatmeal gruel is made the same way, only using two teaspoonfuls instead of one.

Barley Jelly.—One rounded tablespoonful of the flour, mixed with a little cold water, is added to one pint of boiling water containing a pinch of salt; cook twenty minutes in a double boiler and strain. A thinner gruel (barley water) is made by using half of the quantity of flour.

How much of the gruel can I use? If prepared by the last method one-sixth to one-half the total quantity of food; if the barley water is used it can be used in greater quantity if desired, as it is weaker by half.

Which one shall I use? Barley and oatmeal are generally used; oatmeal is more laxative.

What is their value as infant foods? Their chief value is to prevent the curd from coagulating in the stomach in hard masses, thus rendering it more digestible.

Would you advise this addition for all infants? No, for it does not agree with them all, and so it cannot be recommended for all infants.

Can I give anything more during the first year? Beef juice, white of an egg, and orange juice.

How and when may I use the beef juice? It may be begun at ten or eleven months in infants who are strong and thriving well. Two teaspoonfuls may be given daily, diluted with same amount of water, fifteen minutes before the midday feeding; in two weeks it may be doubled; and six teaspoonfuls can be given, in four weeks. Two or three tablespoonfuls is all that can be given a child of one year.

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Is beef juice of value in delicate pale infants? Yes, of much value, and it is more important for them, and it may sometimes be given them at five or six months in one-half the quantity mentioned.

When shall I give the white of egg (albumen) or albumin water? When the conditions are similar to those requiring beef juice especially in infants who digest the proteids (curd) with difficulty. You can give the one-half of the white of one egg at six months, and soon the entire white of one egg can be given.

What is the best way of preparing this? By coddling the egg.

Describe the way of preparation? Place a fresh egg with the shell on in boiling water and immediately remove all from the fire. The egg cooks slowly in the water for seven or eight minutes as the water gradually cools, and the white part becomes like jelly. Give the white with only a pinch of salt—it can be easily separated from the yolk.

When can I give orange juice? Usually about the eleventh or twelfth month, and it should be given about one hour before the feeding. You can begin with two teaspoonfuls at first, then one tablespoonful at a time, and later three or four tablespoonfuls. Orange juice is very good when constipation exists—strain it always, and it must be always fresh and sweet.



OVER NURSING.

Mothers who have a very large supply of milk are very likely to overfeed their babies if the milk is of good quality. This will drain the mother's strength. Some mothers allow their babies to nurse to relieve the uncomfortable feeling. If the infant vomits the surplus immediately they are not injured. Where the baby does not vomit, the surplus food passes into the bowels and causes colic and green and yellow gassy stools. If the mother's milk is too rich, only, and not too much and the baby vomits, this can be corrected by giving the baby some boiled water before each meal. The baby will not nurse so much then.



OVER-FEEDING.

What do you mean by this term? The infant gets too much food, and this is chiefly done at night.

Can I depend upon the infant's natural desire for food as to the quantity to be given? Not always, the habit of over-eating is frequently acquired, and is frequently seen in infants with a good digestion.

What harm results from over-feeding an infant? The food lies in the stomach or bowels, undigested, ferments, and causes gas and colic, and if the over-feeding is long continued, serious trouble arises. The baby becomes restless, fretful, irritable, sleeps badly, stops gaining weight and may lose weight.

[588 MOTHERS' REMEDIES ]

LOSS OF APPETITE.

What may cause this? Over-feeding or the use of milk too rich in fat.

What can I do for this trouble? If the child is well, offer food to him at regular hours only. Do not coax or force him to eat even though he takes only one-half or one-third of his usual quantity. Lengthen the intervals between the feedings. It may be necessary with a child under a year old to reduce the number of feedings to three or four in twenty-four hours. Give water at more frequent intervals, weaken instead of strengthening the food.



FOODS FOR SPECIAL CONDITIONS.

Some infants with weak digestive powers, and those suffering from various forms of indigestion, have often much trouble in digesting the fat of milk. To meet such troubles a series of formulas are given obtained from plain milk.

FOURTH SERIES-Formulas containing four per cent fat: 1 2 3 4 5 6 7 8 Plain Milk 5 oz. 6 oz. 7 oz. 8 oz. 9 oz. 10 oz. 12 oz. 14 oz. *Milk Sugar 1 oz 1 oz. 1 oz. 1 oz 3/4 oz. 3/4 oz. 1/2 oz. 1/2 oz. Lime-water 1 oz. l oz. 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 14 oz. 13 oz. 12 oz. 7 oz. 6 oz. 5 oz. 2 oz. 0 oz. Barley Gruel. 0 oz. 0 oz. 0 oz. 4 oz. 4 oz. 4 oz. 5 oz. 5 oz. ——- ——- ——- ——- ——- ——- ——- ——- 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*(Milk sugar is not counted in totals.) If more than twenty ounces are needed get the proportions by adding one-fourth, one-half, three-quarters, or double each ingredient.

Why does an infant so often vomit some of its food soon after feeding? The quantity may be too large or too rich food, the baby may feed too fast, the hole in the nipple may be too large, the clothing too tight, or you may press upon its stomach in moving the baby.

What are the causes of and changes needed for stomach troubles? It is usually a symptom of indigestion and is frequently caused by too much fat or sugar.

How can I remedy this? Reduce the fat or sugar, and increase the lime-water. Avoid the formulas made from the top-milk, or cream and milk. Those made from the seven per cent milk are not so likely to cause trouble; but you had better, if the symptoms are severe, use formulas of the fourth series.

What symptoms indicate that the baby is getting too much fat (cream)? Vomiting and yellow, foul, greasy, or ropy stools.

How much shall I reduce the milk sugar? Use only one-half ounce to twenty ounces of food or leave it out altogether.

How shall I know when to reduce the sugar, etc.? When there is excessive formation of gas in the stomach, causing distention and pain, or belchings of gas, and often a sour stomach. Reduce the amount of sugar and increase the lime-water one and one-half to two ounces in twenty ounces of food, increase intervals between the meats one-half hour and give less quantity.

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What food usually causes habitual colic? This is due to gas accumulating in the bowels, and is usually caused by the want of digestion of the proteids (curd).

How shall I overcome this? Use a weaker formula. Use formula 4 or 3 of first series; or use partially pasteurized milk, or use barley water instead of plain water.

If curds regularly or frequently appear in the stools, what changes shall I make? This usually accompanies colic, so use means just described—reduce the proteids (skim milk).

How shall I modify the milk for chronic constipation? This is difficult to overcome, and it is more frequent when infants are fed upon a plain milk diet, variously diluted, than when seven or ten per cent milk is used and diluted to a greater degree. But you cannot use food containing more than four per cent fat, that is, eight ounces of ten per cent milk or twelve ounces of seven per cent milk in twenty ounces of food. In some cases ordinary brown sugar in one-half the quantity can take the place of milk sugar, or Mellin's food, malted milk or cereal milk can be used in the place of the milk sugar. Milk of magnesia can be used for lime-water as before directed. Orange juice can be given to infants over nine months old.

What modifications should I make in very hot weather? The proportion of fat (top-milk or milk and cream mixed) should be less and when it is very hot, for a short period, it should be much less. Use seven per cent milk in place of ten per cent, that is, formulas from the second series, or plain milk, in place of the seven per cent milk, fourth series.

If a child has good digestion, but gains very little or no weight, what changes in the food should I make? Increase the quantity of the food if the child seems hungry; or increase the strength of the food, if the child will not take a greater quantity; do not coax or force the baby to eat, give him more sleep; fresh air, etc.

If there is no modified milk that will agree with the baby, what shall I do? If the infant is under four or five months old, a wet nurse would likely succeed. If a wet nurse cannot be obtained or if the child is older use some of the substitutes for cows' milk, like Borden's Eagle Brand, canned or condensed milk. This is better to use when the trouble is in the bowels and shows colic, gas, curds in the stools, constipation, or diarrhea. If it is due to indigestion it shows in vomiting, etc.

How shall I use condensed milk? The directions are on the bottle. But if the baby is three or four months old, and has symptoms of indigestion, dilute its food with sixteen parts of boiled water, or sometimes barley water if there is no constipation. As the symptoms improve it can be made stronger, one to fourteen, one to twelve one to ten, one to eight, such changes to be made gradually.

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How long can I use the condensed milk? Generally for a few weeks only as the sole food, then give one feeding a day of modified milk, for instance, No. 3 or 4 of the series; later two feedings and gradually increase until the milk feeding is entirely used.

Why can I not continue to use condensed milk? It is very low in fat and proteids and has much sugar in it; children who take this food for sometime often gain rapidly in strength and weight, yet have not much resistance, and they are very prone to develop rickets and scurvy.

Suppose baby is teething, has a cold, sore throat, etc., what change shall I make? Dilute the food for two or three feedings by using boiled water in place of an ounce or two of food; this much to be removed from the bottle before being given; if it is necessary to continue for several days, use a weaker formula.

What changes shall I make in this for serious acute sickness? For, diseases with fever like measles, bronchitis, pneumonia, etc., dilute the food and reduce the fat (cream from top-milk). Give the food at regular intervals, but not so often. Do not force food in the early part of acute sickness.

Suppose baby has acute gastritis, what changes shall I make? Stop all food and give boiled water, only, for ten or more hours, then try barley water or whey, but do not give any milk for at least twenty-four hours after all vomiting has ceased. When you again begin the modified milk use a small quantity with a low proportion of fat, and you can secure this by using a formula from the fourth series. You may also double the proportion of lime-water.

If baby is attacked with intestinal indigestion accompanied by loose bowels, what food shall I give? If it has but two or three passages daily, lower the proportion of fat (cream, etc.), in the manner above directed, and boil the milk for five minutes. Dilute it still more if curds are present in the stools.

But suppose the attack is more severe? If there is fever and the passages smell badly and are more frequent, stop all milk and use the diet given for acute gastritis. (Acute indigestion).

Do other conditions besides the food influence digestion? Yes, use proper clothing, keep warm feet, regular habits, fresh air. Clean bottles and food, given at proper intervals and temperature, quiet surroundings and absence of excitement are needed.

What common mistakes are often made in modifying milk and feeding infants? Never fail to follow the directions given for removing the top-milk. Remove all the top-milk of any given strength in making a formula, and not only the number of ounces needed for the formula. By using rich Jersey milk as if it were more common milk. The formulas given are based upon about four per cent fat. Food is very often increased too rapidly, particularly after stomach and bowel indigestion. The food in an infant of three or four months old attacked by acute indigestion should seldom be given in full strength for two weeks afterwards, only half steps should be taken like two to two and one-half, etc. Another mistake, when indigestion symptoms show the food is not reduced quickly enough; reduce the food immediately by at least one-half.

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How to prepare cows' milk at home; what is needed? Feeding bottles, rubber nipples, an eight-ounce graduated measuring glass, a glass funnel, a brush for bottles, cotton, alcohol lamp, a tall quart cup for warming bottles of milk, a pitcher for mixing food, a wide mouthed bottle of boric acid and one of bicarbonate of soda, a pasteurizer, and later a double boiler for cooking cereals will be needed.

What kind of bottles shall I buy? A cylindrical graduated bottle with a wide neck holding about 8 ounces. This makes washing them easier. You should have as many bottles for use as the baby takes meals a day (ten at first).

How shall I care for the bottles? Rinse them, as soon as the child is through nursing, with cold water, and let stand filled with cold water and a little bicarbonate of soda in the water. Before using them again wash them thoroughly with the bottle brush and hot soap suds and place them for twenty minutes in boiling water.

What kind of nipples are best? Straight ones which slip over the neck of the bottle, of black rubber, and the hole should only be large enough for the milk to drop rapidly when the bottle is held upside down.

How shall I care for the nipples? Boil new ones for five minutes at first. After using rinse them carefully in cold water and keep them covered in a glass containing a solution of borax or boric acid. Turn them inside out once a day and wash thoroughly with soap and water.

(There is a slight difference in the directions given by different authorities as to cleaning bottles and nipples, but the general way is the same.)

What kind of cotton shall I use for corking the bottles? Refined non-absorbent cotton is best, but the ordinary absorbent cotton will do.

Which is the best—an alcohol lamp, or the Bunsen burner? The Bunsen burner is the best, cheaper and simpler if there is gas in the house. Should you use the lamp, put it upon a table covered with a plate of zinc or tin, or upon a large tin tray. The French pattern is the best.

Give special directions now for preparing the food according to any of the given formulas? The hands must be clean, as well as everything else—food and utensils. First dissolve the milk sugar in boiling water, filtering, if necessary, then add to the boiled water and sugar the milk, cream, and lime-water, mixing all in the pitcher; a sufficient quantity for twenty-four hours is always prepared at one time. Divide this in equal quantities into the number of feedings for the twenty-four hours and cork the bottles with the cotton cork and cool the bottles rapidly, after having been pasteurized by standing first in tepid and then in cold water, and then place in an ice chest at 50 degrees F.

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FEEDING DIRECTIONS.

How shall I prepare the bottle at feeding time? Take one from the ice chest, warm it by placing it in warm water deep enough to cover the milk in the bottle. Then thoroughly shake it, remove the cotton cork, and adjust the nipple.

How shall I know that the temperature of the milk is correct? Pour a teaspoonful from the bottle before adjusting the nipple, and taste it, or pour a few drops through the nipple upon the inner surface of the wrist. It should feel quite warm, but not quite hot; or a baby thermometer may be placed in the water where the milk stands, and the temperature should be between 98 and 100 degrees F.

How can I keep the milk warm while the baby is feeding? Slip over the bottle a warm flannel bag with a draw-string.

What position should a child be in when feeding? During the first few months, except at night, it had better be held in the arms; later it can lie on its side in the crib, but the bottle must then be held by the nurse until it is emptied, or the baby will nurse and sleep, and nurse and sleep, etc.

How much time shall I give the baby for one feeding? Not longer than twenty minutes. Take the bottle away then and do not give it until the next feeding. Keep a sleepy baby awake, when well, until the food is taken, or remove the bottle.

Can I play with the baby after feeding? Never. It may cause vomiting and indigestion. Baby should lie quietly and sleep if possible, or at least not be disturbed.

FEEDING INTERVALS.

How often shall I nurse or feed baby during the first month? Ten times in twenty-four hours at intervals of two hours during the day and two times at night.

Why can I not feed baby oftener? Because it takes nearly two hours to digest a meal at two months, about two and one-half hours at five or six months, and if another meal is given before the former meal is digested, vomiting and indigestion will result. The following schedule is given by one authority on children for healthy infants for the first year:

Night No. Quantity Quantity Interval feedings of for for between 10 P. M. feedings one 24 meals to in 24 feeding, hours, by day. 7 A. M. hours. ounces. ounces. 2d to 7th day 2 hrs. 2 10 1 to 1-1/2 10 to 15 2d to 3rd week 2 hrs. 2 10 1-1/2 to 3 15 to 30 4th to 5th week 2 hrs. 1 10 2-1/2 to 3-1/2 25 to 35 6th to 8th week 2-1/2 hrs. 1 8 3 to 5 24 to 40 3d to 5th Month 3 hrs. 1 7 4 to 6 28 to 42 5th to 9th month 3 hrs. 0 6 5 to 7-1/2 30 to 45 9th to 12th month 4 hrs. 0 5 7 to 9 35 to 45

This schedule is for healthy children. The smaller amounts are required by smaller children with weak digestion; the larger amounts are required by large children with strong digestion. The interval is from the beginning of one feeding to the beginning of the next feeding.

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How soon can I make the intervals at two and one-half hours? Generally at five or six weeks.

When may I increase it to three hours? Usually at eight weeks or two months.

When should I lengthen the interval between feedings? When there is poor stomach digestion.

How is this shown? By habitual vomiting or regurgitation of food long after nursing is finished; also when the baby has a very poor appetite so that it always leaves some of its food.

When can I shorten the intervals? It is not generally advisable to feed any baby oftener than given by this schedule.



REGULAR FEEDING.

How can I teach baby to take regular meals? By commencing at birth to feed at exactly regular hours every day.

Shall I awaken baby to feed it? Yes, for a few days. In a short time he will waken at the same hours himself.

Should this regularity extend through the night? Only up to nine or ten o'clock. After ten let him sleep as long as he will.

How soon can baby go without food from 10 p. m. to 7 a. m.? At four months usually and always at five or six months; night feeding causes restlessness and poor sleep.



STERILIZED MILK.

What do you mean by sterilizing milk? It means to heat milk so as to destroy the germs.

Does cows' milk contain germs? Yes, even if it is handled faultlessly; but when carelessly handled the number of germs is enormous.

Are all of the germs injurious? Most are harmless or cause only the souring of the milk.

What other germs are occasionally present? Typhoid fever, diphtheria, scarlet fever, cholera, tuberculosis and many forms of diarrhea germs.

Do I need to sterilize milk under all circumstances? When you cannot obtain it fresh in warm weather. Hence during warm weather in cities and towns; when you do not know that the cows are healthy or that the milk has been cleanly handled; when milk is kept over twenty-four hours, especially if there is no ice at hand. When there are epidemics of typhoid fever, scarlet fever, diphtheria, or any form of bowel disease accompanied by diarrhea.

How many methods of heating milk are there? First, sterilizing, in which the milk is heated to 212 degrees F., for one hour or one and one-half hours. Second, pasteurizing, when you heat the milk to 155 degrees or 170 degrees F. for thirty minutes.

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Will the temperature of 155 degrees F. for one-half hour be sufficient to kill the germs of the diseases mentioned above? Generally.

How long will milk so treated keep on ice? Heated to 212 degrees F. for an hour will keep for two or three weeks; that heated (pasteurized) to 155 degrees F. will keep for two or three days.

Is cows' milk as digestible when sterilized? No, and it should be modified for infant feeding the same as milk not heated.

When milk is heated for an hour to 212 degrees F. (sterilization), is it injured in any way? It is rendered harder to digest, and is more constipating; scurvy may be caused if it is used as the sole food for a long time. It is so objectionable that the method is not recommended for general use.

When should I heat it 212 degrees F.? For use on long journeys of days traveling. Then you should heat for one hour upon two successive days, leaving the cotton stoppers in the bottles.

Does heating milk to 155 degrees F. for one-half hour injure it in any way? It does not affect the taste or make it more constipating. The unfavorable effects, if any, are slight. Get clean and fresh milk and the effects will be really of no account.

What pasteurizer would you recommend. Freeman's or Walker-Gordon.

What shall I do with the milk after it has been pasteurized? Cool it quickly by placing the bottles in cold water—never leave them in the room where pasteurized, and never place them, when warm, in an ice chest.

Why this caution? Because it requires from two to four hours to cool them in the air, or in the ice box, and during that time a good many undeveloped germs may mature and injure the keeping properties of the milk. You can cool the bottles of milk in cool water in from ten to twenty minutes if you change the water frequently, or if ice is put into the water.

What is modified milk of the laboratories? It is milk containing fat, sugar, proteids, etc., in definite proportions put up, usually, according to a physician's directions.



PEPTONIZED MILK.

What is peptonized milk? Milk that has been partially digested.

What part of the milk has been digested? The proteids (curd).

Does this alter its taste? No, if it is peptonized for only ten minutes, but if it is fully peptonized the milk has a bitter taste.

How can the bitter taste be avoided in partly peptonized milk? At the end of ten or fifteen minutes place the milk in a sauce-pan and raise it quickly to the boiling point; this kills the ferment so that the milk will not become bitter when it is warmed for feeding; or the milk can be cooled rapidly by placing the bottles first in cool and then in ice water; but in this way the ferment is not destroyed, and the milk may become bitter when warmed for feeding.

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How is milk peptonized? By the action of a peptonizing powder composed of a digestive agent known as the extractum pancreatis and bicarbonate of soda. This is added to the plain or diluted milk. This agent can be bought in tubes or tablets, and is the active ingredient of the peptogenic powder.

Will you describe the process? Place the plain or modified milk in a clean glass jar or bottle, and then rub up the peptonizing powder or tablet with a tablespoonful of milk, and add it to the milk and shake the bottle. Place the bottle in a large pitcher or basin of water of about 110 degrees F., or as warm as the hand can bear comfortably, and allow it to remain for ten to twenty minutes if you wish to peptonize the milk but partially; or if you wish it completely peptonized let it remain for two hours.

Is it better to peptonize the whole day's supply, or each bottle separately just before feeding? If you peptonize the whole day's supply at once raise the milk to the boiling point after it has been peptonized; if only the one feeding do not peptonize it more than ten minutes before feeding for the ferment will work while the child is feeding. It can be done either way.

Is not the completely peptonized milk distasteful? Not so in the case of young infants; older infants will take a few feedings without objection, but it cannot be used for children much older than five months.

How much of the agent should be used? For a single feeding of four ounces one may use one-eighth of a tube with a weak formula of milk or one-sixth with a stronger formula. For one pint of plain milk five grains of the extract and fifteen grains of bicarbonate of soda will be needed. This amount is usually put up in one tube or tablet. Less will be required in weaker formulas of modified milk.

What advantages has peptonized milk? Partially peptonized milk assists greatly in digesting the curd of milk. Young infants sometimes have trouble in digesting the curd. When completely peptonized it is good in attacks of acute indigestion.

How long may I give it? It may be used for a few days when completely peptonized; when partially peptonized it can be used for two or three months, and when you wish to give other food, leave off its use gradually by shortening the time of peptonizing and lessening the quantity of the powder used.

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FEEDING DURING THE SECOND YEAR

How many meals should a child have during the second year? Five.

Shall I prepare the milk for all day at one time? It is better to prepare the milk for all day during the second and third years. If you wish to modify it by adding cream, water, etc., prepare as done during the first year, and later when only plain milk is used, the quantities needed for the different feedings should be put into one or two bottles, pasteurized or not as necessary. In this way the different feedings are kept separate. Prepare the food as soon as possible in the morning alter the milk has been received.



FOR A HEALTHY CHILD OF TWELVE MONTHS.

6:30 a. m. or 7:00 a. m.—Milk, six to seven ounces, diluted with two or three ounces of barley or oatmeal gruel, and taken from a cup after thirteen months.

9:00 a. m.—One to two ounces of orange juice.

10:00 a. m.—Milk two parts, oatmeal or barley gruel one part, and from ten to twelve ounces in all may be given in a cup.

2 :00 p. m.—One or two ounces of beef juice, or the white of one egg, slightly cooked, and later an entire egg or mutton or chicken broth, four to six ounces.

6:00 p. m.—Same as 10 a. m.

10:00 p. m.—Same as at 6:30 a. m., except the milk can be taken from the bottle.

How long can this schedule be given? Until the fourteenth or fifteenth month, and then you can give the cereals thicker and with a spoon.

Can I give other fruit juices at fourteen or fifteen months? Orange juice is the best, but the juice of ripe peaches, red raspberries or strawberries in the order given, is good. Strain all carefully through muslin, for the pulp or seeds might cause serious trouble. You may now give one to four tablespoonfuls of the orange or peach juice, and about one-half the quantity of the others.

When shall I give the fruit juices? One hour before the second meal.

What diet shall I give between fourteenth and eighteenth months?

6:00 to 6:30 a. m.—Eight to ten ounces of plain milk from a cup.

8:00 to 9:00 a. m.—Juice of one-half orange strained.

10:00 a. m.—One, or later two or three tablespoonfuls of oatmeal or barley jelly, hominy cooked at least three hours, and on which you may put a little top-milk; a pinch of salt; no sugar and cup—about six ounces—of milk to drink; crisp dry toast, one piece.

2:00 p. m.—Beef juice one to two ounces, a soft boiled; coddled or poached egg, and a tablespoonful of boiled rice, or mutton or chicken broth, four ounces; one or two pieces of stale bread or zwieback; and if most of the teeth are present, one scant teaspoonful of scraped rare beef, slowly increased to one tablespoonful, alternating with two ounces of beef juice and a salt-boiled or coddled egg. (Some advise a little prune jelly, apple sauce, a baked apple or junket as a dessert). No milk, but little water can be taken.

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6:00 p. m.—Two tablespoonfuls of thoroughly cooked farina, or cream of wheat or granum, or arrow-root, on which is a little top-milk; salt, but no sugar, and eight ounces of warm milk which may be taken from the bottle.

10:00 p. m.—Warmed milk and eight to twelve ounces if necessary, by bottle.

How shall I prepare the beef? Take round or sirloin steak and scrape it with a large spoon on both sides, so that you obtain the pulp only, salt it a little, and place it with a very tiny piece of butter in a saucer, cover it with another saucer, remove the cover from the boiling teakettle, and place the saucer in its place; let it steam until it is just heated through, as it must look rare when done, Give at first one teaspoonful and gradually work up to one tablespoonful, but do not begin this diet in midsummer. Give baby plenty of water to drink between meals, boil and cool.

A diet for the eighteenth month to end of twenty-fourth month? Follow the same order. For most children milk at 10 p. m. is desirable; but if a child sleeps during the whole night it is not necessary to wake it at 10 p. m. for the feeding.

6:00 or 6:30 a. m.—Warmed milk ten to twelve ounces.

9:00 a. m.—Two or three ounces of fruit juices.

10:00 a. m.—Cereals similar to the last schedule; they need not be strained, but well cooked; crisp, dry bread, zwieback, warmed milk one cup.

2 :00 p. m.—Beef juice and one egg or broth and meat; beef-steak, mutton chop or roast beef scraped, very stale bread or two pieces of zwieback; one or two tablespoonfuls of prune pulp, or baked apple and water, but no milk.

6:00 p. m.—Farina, cream of wheat, or arrow-root well cooked with milk, salt, but no sugar; or milk or stale bread and milk.

10:00 p. m.—If required, ten to twelve ounces of pure milk.

What fruits may I give during this period? If the child has a weak stomach, only the fruit juices mentioned, but strong children may have in addition, baked apple, apple-sauce and prune pulp. Stew the dried prunes without sugar until they are very soft, and put all the fruit through a strainer thus removing all the skin; you may give one to two tablespoonfuls of this at one time. No cream should be given with the baked apple, and very little sugar with the apple-sauce These are very good for constipation, Remember to give water freely between the feedings, especially in warm weather. From one to three ounces may be given at one time either with a spoon, glass or bottle. Boil the water daily and cool. Do not allow it to stand in the room, but give fresh water to the child each time.