As much more difficulty is experienced in feeding infants during the first twelve months than during the second, it would be well to pause here to consider what had best be done in case the food described should disagree.

If, after feeding, vomiting occur, with the expulsion of large, firm clots of caseine, the effect of adding lime water or barley water must be tried.

For instance, at the age of six weeks make each bottle of :

Sometimes, particularly if there be diarrhoea, boiling makes the milk more tolerable, and in this condition it may be used instead of fresh milk in either of the above mixtures. Condensed milk, too, can be employed temporarily, making each portion of :—

Condensed milk
Cream

Hot water

I teaspoonful.
I tablespoonful.

5 tablespoonfuls.

Should further alteration be necessary, goats' or asses' milk may be substituted for cows' milk, the strong odor of the former and the laxative properties of the latter being removed by boiling. One ass is capable of nourishing three children for the first three months of life, two children for the fourth and fifth months, and one child after this period to the ninth month. The milk should be used warm from the udder.

"Strippings" is another good substitute for cows' milk. It is obtained by re-milking the cow after the ordinary daily supply has been drawn, and contains much cream and but little curd. Assimilable

proportions of this are:

And if the small amount of caseine, in such a mixture, be still undigested:

Strippings.
Barley water

3 tablespoonfuls.
3 tablespoonfuls.

Another good food is that recommended by Dr. A. V. Meigs. It consists of a combination of two parts of cream, containing from fourteen to sixteen per cent. of fat; one part average milk; two parts lime water, and three parts sugar water, the latter consisting of seventeen and three-fourths

drachms* of milk sugar to one pint of water. This makes an alkaline mixture with the percentage of its ingredients closely corresponding to human milk.

When, in spite of careful preparation, all of these foods give rise to indigestion with fever, and the expulsion, by vomiting and diarrhoea, of hard curds from the stomach and intestines, the expedient of predigesting the milk must be resorted to.

The best method is to peptonize the milk by. pancreatin. That manufactured under the name of extractum pancreatis, by Fairchild Brother & Foster, of New York, has proved most efficient in my hands. To accomplish this artificial digestion, put into a clean quart bottle five grains of extractum pancreatis, fifteen grains of bicarbonate of sodium, and four fluidounces of cool, filtered water; shake thoroughly together, and add a pint of fresh, cool milk. Place the bottle in water, not so hot but that the whole hand can be held in it for a minute without discomfort, and keep the bottle there for exactly thirty minutes. At the end of that time put the bottle on ice to check further digestion and to keep the milk from spoiling. The fluid obtained, while somewhat less white in color than milk, does not differ from it in taste; if, however, an acid be

* About eighteen teaspoonfuls.

†The subject of peptonization is further considered in Chapter IX.

added, the caseine, instead of being coagulated into large, firm curds, takes the form of minute, soft flakes, or readily broken-down feathery masses of small size. When the process is carried just to the point described, the caseine is only partly converted into peptone; but every succeeding moment of continued warmth lessens the amount of caseine until peptonization is complete. Then the liquid is grayish yellow in color; has a distinctly bitter taste, and shows no coagulation whatever on the addition of an acid. This artificial digestion, therefore, may be carried just as far as circumstances indicate, although it is ordinarily best to stop it short of complete conversion, as children object to the markedly bitter taste, and often, on account of it, absolutely refuse the food. Partial peptonization, too, is usually sufficient to adapt the milk to ready assimilation. To seize the proper moment for arresting the process, the person conducting it must be told to taste the milk from time to time, and as soon as the least bitterness is appreciable, to remove the bottle from the hot water and place it upon ice for cooling and use. Such milk may be sweetened with sugar of milk, and given pure or diluted with water. For an infant of six weeks each meal may consist of:

To this, cream may be added when desirable, and by diminishing the quantity of water and increasing that of milk the strength of the food may be made greater at any time.

Although every precaution be taken, the last of a quantity of predigested food is very apt to grow bitter; and if the attendants will take the trouble, it is much better to peptonize every meal separately. This is readily done by obtaining a number of powders of pancreatin and bicarbonate of sodium, so proportioned that each packet shall contain the proper amount for one bottle of food.

Bicarbonate of sodium.

nine grains.
twenty-four grains.

Mix and divide into twelve powders, and dispense in waxed papers. DIRECTIONS.-Put one powder into a nursing bottle with two fluidounces of filtered water and two fluid ounces of fresh sweet milk; shake together and keep warm in a water-bath for about half an hour before feeding; sweeten with half a teaspoonful of milk sugar.

The great advantages of partial peptonization are that the necessity for lime water, barley water and thickening substances to keep apart the curd is done away with, and that, when the digestive disturbance requiring a careful preparation of food is removed, an ordinary milk diet can be gradually resumed by regularly diminishing the time artificial