the filled nursing bottle into a vessel of hot water. It may be heated quickly over a gas jet by setting the bottle into a tin mug filled with water and holding it over the flame. Suggestions concerning the modification of food, when milk thus prepared does not agree with infants, will be given in another chapter. When the mother's supply of milk is scanty, and the baby cries with hunger, occasional meals of the above preparations will be a great aid in its management.

In the artificial feeding of infants in the Woman's Hospital, sterilized milk is used for the various preparations employed, as a rule.

Sterilization of Milk.-By sterilizing milk is meant the process of destroying any poisonous matter which may have found its way into it. Exposure to the atmosphere and admixture with particles of dust and dirt during its transportation, with want of care as to cleanliness of vessels, etc., in which the milk is kept, induce certain fermentative changes, which cause it to sour and to produce digestive disturbances. Sterilization destroys the germ of poisonous matter by subjecting the milk to a high degree of heat under pressure. Many forms of apparatus have been devised for this purpose. The one in use at the Woman's Hospital is called Blair's Sterilizing Apparatus.* It is very similar in general construction to the one devised by Dr. Louis Starr and shown

* Arnold's steam sterilizer has also been employed more recently with very satisfactory results. By this arrangement the milk is steamed instead of boiled.

in the cut.

This consists of an oblong case of tin fitted with a tight cover. Into this a movable wire basket, holding ten bottles, is placed. The bottles are of flint glass, graduated and fitted with rubber corks having a

glass plug fitted into an opening in their centers. The rules for using the sterilizing apparatus are as follows:Ist. Cleanse the bottles thoroughly.

2d. Fill each with the milk you wish to use, put in the rubber cork without the glass plug (this leaves a small opening in the rubber cork); set the bottle in the

*"Hygiene of the Nursery."

basket, then in the boiler; fill the boiler with water almost as high as the milk in the bottle; boil about ten minutes, or, better, as Dr. Starr expresses it, "until the expansion that precedes boiling has taken place in the milk; then put the glass plugs tightly in each stopper and boil for fifteen or twenty minutes more. Should the rubber corks incline to come out during the second boiling, put them in firmly.

3d. Keep in a cool place till needed for use.

4th. When to be used, place a bottle of the milk thus prepared in the tin mug which accompanies the apparatus. Pour hot water in the mug until it is as high as the milk in the bottle. Heat the milk to the temperature desired for feeding (99° Fahr.); remove the rubber cork and put on rubber nipple, and feed.

5th. Cleanse each bottle immediately after the milk in it is used. Do not keep milk in a bottle that has had some used out of it.

6th. If the steaming process is preferred, place the basket, without the bottles, in the boiler, fill with water up to but not above the bottom of the basket, place the bottles in the basket and proceed as before.

Milk should be sterilized as soon as possible after it has been served each morning. Each bottle, when emptied, should be thoroughly washed. If the whole contents of the bottle are not used after it is opened, the remainder must not be used for the child nor allowed to remain in the bottle.

Milk sterilized in this way will keep for days without

spoiling, as it is hermetically sealed and has been deprived of all unhealthy germs. Dr. Louis Starr makes the assertion that it will keep for eighteen days if the heating is continued for thirty minutes.

Sterilized milk is useful when traveling, as it may be carried without any trouble, the difficulty of obtaining fresh milk being thus overcome. Its use makes the management of babies during the heat of summer much easier.

A word remains to be said concerning feeding-bottles and rubber nipples.

The Nursing Bottle should be of clear glass, with a rounded bottom, of a shape convenient to clean, so that no particles may cling about corners which cannot be reached, serving as a source of trouble afterward. The graduated bottle is very nice, as it enables the quantity of each of the materials used in the preparation of the feeding to be mixed directly in the bottle, instead of being first measured out in a graduate.

Feeding-bottles with India-rubber tubes are very objectionable, for the tubes are difficult to keep clean, and a drop or two of milk left behind will often be sufficient to turn the next supply sour, causing the infant much sickness and suffering. Nurses are prone, also, with these tubes, to place the baby in its crib with the bottle of milk by its side and the nipple in its mouth. The heat of the child's body tends to sour the milk, the liquid may run low, and the child suck in considerable air. The neck of the bottle should always be kept filled

with the liquid while the child is nursing, hence the position of the bottle must be changed. A feedingbottle fitted with a rubber nipple requires to be held in the nurse's hand during the feeding, and is, on that

account, to be preferred. There should always be two nursing-bottles for each baby, one being kept under water or filled with a soda solution while the other is in use. Immediately after the meal the bottle should be cleaned, etc. Scalding water should be used, and then