Chapter XIII: Part II: Recipes (6)

Potato Soup. Croutons.
A small Piece of Beefsteak. Creamed Potatoes.
Baked Custard. Coffee.

_Lunch._

1 Cup of Chicken Broth, with Rice.

_Supper._

Raw Oysters. Banquet Crackers.
Graham Bread, Toasted. Wine Jelly. Tea.

FIFTH DAY.

_Breakfast._

An Orange.
Coffee. Mush of Wheat Germ, with Cream and Sugar.
Broiled Mutton Chop. Toast.

_Lunch._

1 Cup of Mulled Wine.

_Dinner._

Chicken Soup. Bread.
Creamed Sweetbreads. Duchess Potato.
Snow Pudding. Cocoa.

_Lunch._

Siphon Soda, with Coffee Syrup and Cream.

_Supper._

Buttered Dry Toast. Orange Jelly.
Sponge Cake and Cream. Tea.

CONVALESCENT'S DIET

Convalescent's diet includes the liquid and light diets, and, in addition, all easily digested and nutritious food. For meats, game, especially venison and birds, beef, mutton, and chicken may be given, but never either pork or veal. They are difficult of digestion. Eggs in all ways, soft-cooked, scrambled, poached, and as omelets, well-baked potatoes, creamed potatoes, celery, snow pudding, cream of rice pudding, and tapioca cream, jellies, both those made from gelatine and fruits, Graham bread, Graham gems, rusk, and, in fact, any well-made bread, and good cake.

A convalescent may use for drinks plenty of good milk, cocoa, _carefully made_ tea and coffee, occasionally good wine, and the different mineral and drinking waters. Some foods to be avoided are pastry, dark or badly made cakes, pork, veal, any highly seasoned meat dish made with gravy, all kinds of fried food, sausages, heavy puddings, badly made bread, lobsters and crabs.

SPRING

No. 1

_Breakfast._

An Orange.
Porridge of Wheat Flakes, with Cream and Sugar.
Omelet, with Broiled Ham.
Coffee. Hot Graham Gems and Butter.

_Lunch._

1 Cup of Hot Beef Broth. A Cream-cracker.

_Dinner._

Chicken Soup. Creamed Fish.
Mashed Potato. Snow Pudding.
White Cake. Tea.

_Lunch._

1 Cup of Hot Milk.

_Supper._

Broiled Squab on Toast. Creamed Potatoes.
Bread and Butter. Jelly.
Cocoa.

No. 2

_Breakfast._

An Orange.
Farina Porridge, with Cream and Sugar.
French Chops (Mutton). Baked Potato.
Cream Toast of Graham Bread.
Cocoa.

_Lunch._

1 Cup of Cracker Gruel.

_Dinner._

Mock-bisque Soup. Sticks.
Roast Beef. French Peas. Mashed Potato.
Bread and Butter.
Baked Cup Custard. Coffee or Claret.

_Lunch._

1 Cup of Hot Bouillon.

_Supper._

Scrambled Eggs. Creamed Potatoes.
Water Toast, with Apple Compote.
Feather Cake. Tea.

SUMMER

No. 1

_Breakfast._

Blackberries.
Farina Porridge, with Cream and Sugar.
Broiled Steak. Baked Potatoes.
Dry Toast. Cocoa.

_Lunch._

1 Tumbler of Kumiss.

_Dinner._

Potato Soup made with New Potatoes.
Baked Fish. Mashed Potatoes. Peas.
Chicken Salad. Lemon Jelly.
Tea.

_Lunch._

Soda-water, with Vanilla Syrup and Cream.

_Supper._

Cold Broiled Chicken. Bread and Butter.
Blueberries. White Cake.
Cocoa.

No. 2

_Breakfast._

Blueberries.
Broiled Perch. Baked Potatoes.
Hot Snow Cakes, with Butter.
Coffee.

_Lunch._

Milk-punch.

_Dinner._

Broiled French Chop. Duchess Potato.
Peas. Tomato Salad.
Tapioca Cream. Wine Jelly.
Lemonade.

_Lunch._

Egg-nog.

_Supper._

Hot Water Toast, Buttered. Berries.
Omelet, with Parsley.
Tea. Soft Custard in Cups.

AUTUMN

No. 1

_Breakfast._

Oatmeal Mush, with Cream and Sugar.
Broiled Steak. Baked Potatoes.
Oatmeal Muffins, Hot, with Butter.
Coffee.

_Lunch._

1 Cup of Hot Beef Broth. A Banquet Cracker.

_Dinner._

Celery Soup. Sippets. Roast Pheasant, with Jelly.
Potatoes. Stewed Mushrooms.
Velvet Cream. Cocoa.

_Lunch._

A thin Sandwich of Bread and Butter. Tea.

_Supper._

Raw Oysters. Cream Toast. Baked Apples.
Rusk. Tea.

No. 2

_Breakfast._

Cantaloup.
Farina Porridge, with Cream and Sugar.
Broiled Mutton Chop. Baked Potatoes.
Dry Toast. Coffee.

_Lunch._

1 Cup of Hot Chicken Broth.

_Dinner._

Oyster Soup. Sticks.
Roast Beef. Creamed Potatoes.
Celery Salad.
Coffee Cream. Tea.

_Lunch._

A Cup of Hot Oatmeal Gruel.

_Supper._

Poached Egg on Toast. Cocoa.
Graham Bread and Butter. Sponge Cake.

WINTER

No. 1

_Breakfast._

An Orange.
Oatmeal Porridge, with Cream and Sugar. Coffee.
Broiled Steak. Baked Potato. Cream Toast.

_Lunch._

Egg-nog.

_Dinner._

Celery Soup. Croutons.
Roast Chicken. Creamed Onions. Duchess Potato.
Lettuce Salad (plain). Velvet Cream. Coffee.

_Lunch._

Cocoa Cordial. Sponge Cake.

_Supper._

Fancy Roast of Oysters. Dry Toast.
Chocolate, with Whipped Cream. Orange Jelly.

No. 2

_Breakfast._

An Orange.
Wheat Germ, with Cream and Sugar.
Broiled Partridge. Dry Toast. Coffee.

_Lunch._

1 Cup of Hot Chicken Broth.

_Dinner._

Consommé. Bread.
Roast Beef. Mashed Potatoes.
Tomato Salad.
Cream of Rice Pudding. Coffee.

_Lunch._

1 Cup of Mulled Wine.

_Supper._

Venison Steak, with Port Wine Sauce.
Toast. Sponge Cake, with Sweet Cream.
Cocoa.

SERVING

If cooking be a science, then serving is an art. It perhaps more closely resembles painting than any other, for a well-spread table should be a picture, and each separate dish a choice bit in the landscape. The invalid's tray should be a dainty Dresden water-color of delicate hues and harmonious tints.

It is not easy to give definite directions in regard to serving, for it involves so much of good taste in so many directions, and depends so largely upon the individual and the circumstances. It requires intelligent study, a cultivated habit of thought, and the appreciation of symmetry, and the harmony of colors; to do it well one must ever judge anew and arrange again, for no two meals are exactly alike in all their details.

Of course, the most important thing in serving is the thing to be served. A badly prepared or unwholesome dish, no matter how beautifully it may be presented, is worthless--perhaps even worse, for it may prove a positive source of evil. An indifferently done steak, served on a silver platter, is less acceptable than one perfectly cooked on plain china, or a bit of burned toast on Dresden ware than a daintily browned piece on a common white plate. Put the force, therefore, of your efforts on securing that which is wholesome in itself, adapted to the needs of the patient, and perfectly cooked; then serve it in the most attractive manner at your command.

Good serving is a necessity for the sick. It should never be regarded as simply ornamental. When a person has the hunger of health, colors and dishes are not of great account; but when one is ill, or exhausted with fatigue, sometimes a pretty color, a dainty cup, or beauty of arrangement makes all the difference, and one is tempted to eat when otherwise the food would remain untouched.

Simplicity should rule at all times the arrangement of an invalid's tray. Anything like display is entirely out of place. Japanned trays of oval shape are the ones in general use. When one is fortunate enough to possess a silver tray, the dishes may be placed directly upon it, or on a doily, which covers the center of it. All other trays should be completely covered with a dainty snowy napkin, or tray-cloth.

After the napkin has been neatly spread upon the tray, place a plate in the middle of the side nearest to you, and then arrange the other dishes about it, with the tiny earthen teapot on the right, and the sugar-bowl and cream-pitcher of silver next to it; the knife, fork, and spoons should be on the right and left of the plate, never in front of it. The various dishes to be served should then be arranged symmetrically in other parts of the tray, not scattered about without the appearance of order.

Never crowd a tray. Calculate beforehand how many dishes you will probably have, and select a size accordingly. Serve a single glass or a single cup on a small round or oval tray with a doily, never on a large tray, such as might be selected for a meal.

When practicable use silver dishes for meats, soups, coffee, hot milk, or any hot food; when these cannot be had, use hot china.

Avoid discords in color. Most women have an instinctive appreciation of color, and by giving some thought to the subject of harmonies, and observing the methods of others who are known to have good taste in such matters, bad blunders in the arrangement of a tray or a table may be avoided.

_Red_ with _yellow_, _blue_ with _green_, and _yellow_ with _pink_ are inharmonious combinations of color; but _yellow_ with _white_, _blue_ with _white_, _dull orange_ with _brown_, _violet_, and _pale gold_ are exquisite together.

A cup of chocolate in pale pink or dull red, coffee in buttercup yellow, especially when served without cream, and green tea in Nile green, appeal to the eye as well as to the taste, giving double pleasure--gratifying two senses instead of one.

Color plays a very important part in serving food. It produces strong effects in some persons who are deeply moved by harmonies or discords in it, as others are by harmonies or discords in music. Color appeals to the esthetic side of some natures much more forcibly than many of us are aware.

The story is told of a lady, possessed of unusually keen color-perception, who had been living for many months in a house furnished in monotonous hues, and in which the table was always set in plain white cloth and white china. Being invited to lunch with a friend in the neighborhood, she was moved to tears at the sight of a beautiful table, decorated with a scarlet cloth, flowers, and harmoniously contrasting colored china.

The effect of the colors upon the emotions was similar to that which is sometimes produced by an exquisite strain of music. Who can say how much of subtle refining influence may be exerted by such things? Regarded as a general thing only in the light of the ornamental, they are too often looked upon as luxuries, and therefore dispensable; but whatever ministers to the esthetic side of the mind must be elevating, and the influence of neatness, of beautiful surroundings, of harmonious colors, of art in any form, inevitably produces an effect upon character. In time such surroundings become necessities, and when the individual is deprived of them they are missed, and he feels a sense of dissatisfaction with those of meaner kind--perhaps dissatisfaction with a poorer or lower life in any way--and imperceptibly these seeming ornaments of existence may be the means which shall lift many an one into a higher plane of life, so that, aside from their practical value, all the niceties of household affairs may have a lasting effect for good upon character.

To be progressive, one must be constantly in a frame of mind to learn, and ever on the alert for information. Fashions change in serving foods as in other things. However, there are certain fixed principles which always remain unchanged. Perfect neatness, orderly and pleasing arrangement, and harmonious coloring are ever essential.

For the invalid's tray use the prettiest china obtainable. In a private house there are always some choice and precious pieces--teacups, quaint silver pitchers and spoons, pretty plates, and delicate thin tumblers. These will be gladly placed at the disposal of the sick one, especially if the nurse will volunteer to be responsible for them.

To prepare a meal for an invalid after planning the food, the first necessary articles are a tray clean on both sides, a neat napkin to spread over it, and exquisitely clean dishes done by a servant known to be neat, or by one's self. It not infrequently happens, especially in houses in which the mistress leaves everything to the servants, and never goes into the kitchen, that dishes are washed in such surroundings of dirt, and wiped with such unclean towels, as to be dangerous for any one to use. It is therefore necessary for a nurse to understand about such matters, and to see to it that her patient's dishes are above suspicion. In fact, it is a dainty attention on her part to care entirely for the tray-dishes of her charge.

In some forms of disease it is absolutely necessary, in order to prevent contagion, that a nurse should attend altogether to the tray and dishes, for it would almost never occur that any member of a household would understand an effectual method of sterilization.

In a contagious disease everything that goes to the bedside--dishes, knives, forks, spoons, napkin, the tray itself--should be rendered sterile by boiling in water for half an hour, or by treatment with steam for a similar time, before any one, except the nurse, even touches them.

Nothing should be used in the way of linen or dishes that cannot be washed without spoiling; therefore fancy silk doilies and other similar furnishings are to be avoided.

When it is necessary to taste of food before giving it to a patient, take some into a separate dish, and use a separate spoon or fork; or, if it is a liquid, take out a little with a spoon into another spoon, being careful that the one used for tasting does not at any time touch the liquid.

Never touch the bowls of spoons, nor the inside of plates and cups, with the fingers, unless the hands are prepared by thorough cleansing for it. A nurse who understands antiseptic surgery, and knows how easily contagion is carried, will appreciate the necessity of these precautions. The hands should be washed after arranging a bed, using a handkerchief, arranging the hair--in fact, always before handling either food or dishes.

Food and drink should not be allowed to remain exposed to the air for any length of time. Most kinds of food are excellent media for micro-organisms to flourish in, and consequently the food, if it be such as might be eaten afterward, deteriorates.

Then, from an esthetic point of view, it is the height of untidiness to allow a tray to remain in the sick-room any length of time after the meal has been eaten. It should be immediately removed with all traces of the meal, as should also fruit, glasses for water, lemonade, milk, etc., which may be used at different times during the day.

If the patient objects and wishes to have what is left for future use, assure him that it is near at hand, and being kept cool and clean for him. By punctually fulfilling promises made about such matters, he will very quickly learn to trust a nurse, not only in these, but in other things.

For decoration for a tray nothing should be used besides pretty china and flowers. A slender glass or silver vase with a blossom or two, or a delicate fern with a white or pink flower, are always suitable. It is well to use ferns and other fresh green decorations liberally, especially in winter. Green is always grateful to the sight, and sometimes a single spray will give pleasure to an invalid for hours.

Violets, roses, orchids, and all flowers that are dainty in themselves, are always in good taste, but a very few or a single blossom is all that is allowable. A big bouquet on a tray or an invalid's table is as out of place as a whole roast or a whole pudding. Flowers with strong odors or primary colors should be avoided, such, for instance, as marigolds, fleur de lis, and dahlias. They are handsome in a garden or a hall, but not at the bedside.

Little attentions in the way of ornamentation, and thoughtfulness as to an invalid's meal, are deeply appreciated. They show that an effort has been made to please, and to many sick ones the feeling that they are a constant care to those about them is a very oppressive one. It should be the pleasure of a good nurse to dispel such thoughts. It is the duty of every nurse to do so.

Variety for those who are sick (after they are out of danger, and waiting for strength to return) is just as necessary as for those who are well, and for the same reason--that is, to furnish the body with all those substances required for perfect nutrition. Many think that because a person is ill, or an invalid, he must be denied all things that are good, and fed upon such dishes as well persons generally abhor, like water gruel, thin oyster stews, and half-cooked corn-starch pudding.

It is curious how such an idea should have been lodged in the mind, but it is probably a relic of the old treatment in the days before antiseptic surgery and the modern practice of medicine. Now, as soon as a patient is out of danger, careful feeding with a variety of wholesome, perfectly cooked, nutritious food--of course, wisely administered as to quantity--is an essential part of the treatment, and constitutes nearly the whole cure in some forms of disease of the nervous system.

The body, depleted and exhausted by long-continued sickness, is without resources, and must draw from food (and, of course, air) all those substances needed for repair and the restoration of bodily vigor. To insure this, different kinds of food are required, for no single one, not even milk, contains everything needed.[44] Fruits of various kinds, green salads and vegetables, fish, beef, and mutton should be used, as well as milk, eggs, chicken, and toast.

Ease in serving the sick is an accomplishment in a nurse, and a certain amount of _seeming_ indifference is an advisable quality to cultivate. It is a good plan to take every _possible care_ in preparing a meal for a sick person, and then to appear not to notice whether he eats; for sometimes sensitive people, in their desire not to disappoint, or in their endeavors to please, will eat when they do not care for food.

Endeavor to remember individual tastes, and try to gratify them; always do so when it is in your power, for these individual preferences are often true instincts of the individual nature striving to secure that which is best for it. If a man asks for the second joint of a fowl, don't take to him a cut from the breast, even though _you_ may think it the choicest portion.

Food should be given at _regular intervals_. If a patient is very ill, the rule is to administer nourishment in small quantities and often. Sometimes a patient is too feeble to help himself to food, and then he must be fed by the nurse. When such is the case, she should be extremely careful, no matter what the pressure of other work may be, not to hurry him. Give him plenty of time,--first, that the food may remain in the mouth long enough to be mixed with the saliva, for saliva is one of the digestive juices; and second, so that it may be thoroughly masticated and broken; otherwise it will be thrown into the stomach in large masses, and may not digest at all.

The _quantity_ of food given will always depend upon the condition of the person, and will consequently vary for each individual. Give rather _too little_ than too much, with, of course, the understanding that there is always an abundance to be had. A little is often a challenge, especially to one of delicate appetite; a large quantity is always vulgar. It is much better to carry a second portion to one who needs it than to offer too much at first.

No exact and definite directions can be given for the serving of special dishes, for a nurse's resources in the way of china, etc., are so uncertain; but a few hints in regard to some principles that, no matter what the circumstances are, never change may be found of service.

For instance, water, lemonade, milk, milk-punch, and all other cold drinks are most healthful when _cool_, not ice-cold. Ice-cold water, ice-cold milk, and all chilled drinks are _always forbidden_ for both sick and well, except in fevers, in extremely hot weather, and in unusual cases, when only a few spoons of liquid are taken. Even in these cases it is a question whether _cool_ liquids would not do as well. We all know the danger of taking a large quantity of ice-cold drink when overheated. Even death has frequently resulted from it.

Serve tea, coffee, cocoa, bouillon, broth, gruel, and all hot drinks in cups which are _hot_, not lukewarm. Soup as a part of a meal should be served in a covered silver dish when practicable, for silver may be made very hot, and no other is so pretty. In lieu of silver use a covered china dish, or a bouillon-cup made hot in an oven beforehand. Remember that the _warmth_ of all these foods is one of their valuable qualities.

Beef-juice and beef-tea may be offered in a red wine-glass, to conceal the color, which is sometimes at first unpleasant to those unaccustomed to the use of rare beef; but the taste of these is so acceptable and savory that, after taking a few spoons, the objection vanishes.

Cups and tumblers ought not to be filled to more than within a half inch of the top. The best argument for this custom is, that it is considered good form; but there is a good reason back of it, as is the case in most other established customs. If a cup be filled to the brim it cannot be moved without spilling the liquid over the outside; this occasions wiping, which it is especially difficult to do, and waste of a certain portion of the contents; then it is not easy to drink from a cup so filled.

Fruits, such as oranges, grapes, peaches, and tomatoes, should be served cool, but not cold or chilled. The ideal way to eat fruits is without artificial cooling. A peach is never so delicious as at the moment it is gathered from the tree, just ripe, and tomatoes have the finest flavor eaten directly off the vines; but it is seldom that these fruits or others can be so obtained, and we, knowing that fruits do not keep well except in cool places, are apt to associate a certain degree of coolness with them. The objection to serving fruits very cold is that, besides the fact that they are not as readily digested so, their delicate flavor is lost, for the cold contracts the sensitive papillæ of the tongue, and thus the power of tasting is temporarily deadened.

Oranges, peaches, and plums may be used uncooked, as they are extremely easy of digestion so, and also grapes, unless there is objection to the seeds, in which case they should be cooked, and the seeds strained out. Apples and pears are safer cooked; tomatoes may be eaten either way.

Transparent jellies are pretty served in glass dishes, and ice-cream, sherbets, and ices in china saucers, or ice-cream dishes of pink, or other delicately warm colors. Ice-cream, uncolored, in shell pink, is much more attractive than it is in cold mauve or green. Water-ices, which usually have color of their own, may be served in dishes to match it. Raspberry or strawberry ice is lovely in dull rich red; apricot ice in yellow--that is, a certain shade of écru which harmonizes with the color of the fruit--and pineapple and lemon ice in Dresden ware are very pretty.

Eggs should be opened into a hot, though not very hot, egg-glass. It is the proper thing to do so even when a patient is well enough to open them for himself, for, although the supply may have been obtained from the very best sources, there is always the risk that some of the eggs may be old, too old to be good.[45]

Oysters in the half-shell are served simply with salt, pepper, and lemon-juice, or horse-radish. A quarter or a half of a lemon is placed on the oyster-plate with the oysters, and after the salt and pepper are sprinkled on a few drops of lemon-juice are squeezed over each oyster, or a bit of horse-radish is placed on each.

Broiled oysters may be served with a sauce of melted butter, seasoned with salt, pepper, and lemon-juice or vinegar.

Toast is particularly acceptable with nearly all kinds of cooked oysters, and fancy shapes, such as tiny rounds, squares, and points, are excellent with stews, soups, and roasts, instead of crackers.

Dry toast ought to be eaten directly off the toaster, and, except in serious illness, butter may be given with it. Orange, gooseberry, raspberry, and other marmalades, currant, apple, and grape jellies, and baked sweet apples or apple-sauce, are excellent with either dry or water toast. Cooked apples in any form are delicious with milk and cream toasts.

It is the fashion just now to serve junket, slip, soft custard, lemon cream, tapioca cream, and similar delicate desserts in cups and saucers, not glasses. The quainter the pattern of the china, the prettier the effect.

* * * * *

A plan for a breakfast, to consist of a peach, rolled wheat porridge, beefsteak, baked potato, coffee, and toast:

(1) Put the porridge, which should have been cooked the day before, on the fire to heat, and the potato into the oven to bake.

(2) Set some water to boil for the coffee, and the milk to heat to serve with it.

(3) Trim the steak, which should be a small piece an inch thick, an inch and a half wide, and three or four inches long; cut the bread, and make a butter-ball by rolling a bit of butter between two spatters made for the purpose.[46]

(4) Set a plate, cup and saucer, and dishes for serving the food, in the warming-oven to heat.

(5) Arrange the tray with a fresh napkin, knife, fork, spoons, salt and pepper, fine granulated sugar and cold cream for the porridge, and some lumps of loaf sugar for the coffee.

(6) Fifteen minutes before the potato is done make the coffee, and ten minutes later broil the steak; in the interim pare the peach, laying it open from the stone, and toast the bread.

Now, if calculation as to the time has been well made, everything will be ready--the potato baked, the porridge steaming, the coffee cooked, and the steak and toast waiting in the oven.

(7) Serve the fruit on a tiny fruit-plate, the porridge in a hot saucer, and the coffee, together. When the fruit and porridge are finished, offer the potato, wrapped in a doily to keep it warm, the steak in a hot covered silver dish, and the toast on an individual bread-plate. Or all may be served together when for any reason it seems best to do so: for instance, if the tray has to be carried a long distance, or up many flights of stairs.

The above arrangement is simply beginning with the things which require the longest time, and then taking each in such order that all shall be finished at the same moment.

By understanding the length of time required for each dish, there need be no hurrying, nor will anything be cooked too soon.

Dinner should be planned in the same way, and also supper. Even when there is not much cooking to be done the same idea prevails--that is, to begin with whatever requires the longest time, and to do last those dishes which spoil by standing; in other words, to be systematic, (1) because your meal is in better condition when so done, and (2) because it is easier for yourself. There then will be neither hurry nor worry, and work which ends with a satisfactory result is always a pleasure.

THE FEEDING OF CHILDREN

There are three ways in which a child may be supplied with food during its infancy: by its mother; by a substitute for its mother--a wet nurse; and by artificial feeding. This chapter will treat only of the latter method.

The child is fortunate whose mother can supply it with a sufficient quantity of wholesome milk. There is nothing more to be desired for it during the first ten or twelve months of its life. But often a mother, for one reason or another, is not able to nurse her child, and other means of feeding must be sought. In such cases, among the wealthier classes, a wet nurse is sometimes employed; but with the majority of people there is no alternative except artificial feeding. When this has been decided upon, the question naturally arises as to what shall be the best substitute for the natural nourishment of the child--mother's milk, which must always be taken as the perfect type of infants' food.[47] To this subject doctors and hygienists have given much attention for a long time. Many kinds of food preparations have been made and tested. The result has been that, almost without exception, authorities agree that milk from healthy, well-fed cows, properly prepared, is the most valuable substitute for human milk that is at present known.[48]

The following analyses give the comparison between cow's milk and human milk:

_Human Milk._ _Cow's Milk._
Nitrogenous substances 2.35% 4.30%
Fat 3.40% 3.80%
Sugar 4.85% 3.70%
Salts .20% .60%
Water 89.20% 87.60%[49]

Cow's milk varies considerably in nutritive properties, and for the growing infant who receives no other food it is extremely important that it be of the first quality. It should be tested in every possible way to enable one to form a correct estimate of its value, and unless unquestionably good should be rejected.[50] When fresh from the cow, not more than two hours old, and of superior quality, it need not be sterilized, but should be put into perfectly cleansed and sterile vessels,[51] and kept in an ice-box, or refrigerator, at a temperature of 50° to 60° Fahr.[52]

When obliged to buy the ordinary milk of commerce, select if possible that which is put up in glass jars. There are farmers who do this. Each jar is sealed, marked with the owner's name and address, and the date of sending. Such milk does not become contaminated with bad air in transit, cannot be tampered with by middlemen, and must be free from dirt, as it would show through the glass; each customer gets exactly a quart, with all the cream that belongs to it; moreover, the owner, having attached his name, has thus put his reputation at stake, and is not likely to sell inferior milk. When this is not practicable, search for the best and cleanest dairy, and see that the milk is delivered as soon as possible after being received at the dairy. Milk should not be bought from small stores.

The best milk comes from cows that have good pasturage, with clean running water, and that are fed in winter on dry fodder and grain, and not on ensilage and brewery waste.

According to the reports of the American Public Health Association, _one fifth_ of all the deaths among infants may be traced to the milk supply, and there is no doubt that most of the sickness of bottle-fed children, during the summer months, is directly due to the unhealthy condition of their food.

It then becomes the imperative duty of every mother, nurse, or other person who has the care of children, to learn, if she does not already know, the simpler tests for milk, and something of the philosophy of the feeding of her charge.[53] When such knowledge is more general, and women are able to determine intelligently the quality of the milk which is offered them, then will milk-dealers be forced to cease mixing, adulterating, and otherwise tampering with the milk, which, as a general thing, is sold at the farms in excellent condition.

The first object is to secure a good quality of milk; then comes the consideration of how it shall be prepared: this must be in such manner as shall render it as nearly like human milk, in composition and digestibility, as possible.

Comparison of the tables just given shows that cow's milk contains more nitrogenous matter and salts, and less sugar, than human milk.[54] By diluting with water to reduce the protein and salts, and adding sugar and a little cream, the proportions of these different substances may be made to approximate those in mother's milk. In both the sugar is the same--lactose, or milk-sugar; the fats are also much alike in each; but the albuminous matter of cow's milk differs somewhat from that of human milk, particularly in the way in which it coagulates in the presence of acids. Human milk forms into small, light, feathery curds; cow's milk into large, compact, not so easily digested masses. It is necessary, therefore, to seek the means for preventing the coagulation of milk in large curds in the stomach of the child--in other words, to so treat cow's milk that it shall coagulate more like human milk. This may be done in two ways:

(1) By mixing into the milk some substance which shall separate the particles of albumen from each other, and so cause it to form into smaller masses.

(2) By partial predigestion.

To accomplish the first, it is necessary to use some diluting substance of a harmless nature; if it be nutritious, so much the better. For this, Mellin's food, barley-water, veal broth, lime-water, and gelatin are recommended.

Mellin's food is a partially predigested grain, in such a condition that it can be assimilated by the infant; barley-water is valuable for its potash salts, in which cow's milk is deficient, and which the growing babe needs; veal broth is rich in lime; and lime-water neutralizes the acid of the gastric juice, so that milk is not acted upon so strongly, and consequently forms into a lighter curd.

The second method is that of partial predigestion, and is accomplished by the use of peptonizing agents, among which Fairchild's peptogenic milk-powder is good (directions for its use will be given later). On account of the expense of these preparations it is not probable that they will come into general use, except in cases of sickness.

It is therefore evident that dependence must be placed almost entirely upon attenuants to render the casein of cow's milk more easily digestible. Probably for this Mellin's food is as good, if not better, than any other of the recommended preparations. It is not injurious, is nutritious in itself, and is a good diluting agent, causing milk to form into looser curds than it would otherwise do, and it contains sufficient sugar to require no further addition of this substance.

Now arises the question whether milk shall be sterilized for infants' feeding. The weight of evidence seems to be as follows: if it is possible to see the conditions under which the cows live, and to _know_ that they are unquestionably good, that the animals are in perfect health, that the milk is drawn from cleansed udders into cleansed vessels by clean hands, kept in a cool place, and used fresh, then it is probably wise not to sterilize it. All milk otherwise obtained should be made sterile before using, and as soon as possible after milking. Looking to the standard--human milk--there are no organisms in it. That alone is sufficient reason why cow's milk should be freed from them.[55]

Again, most bottle-fed children do well during the cold weather of autumn and winter; in summer the mortality is very great among them, especially in the poorer districts of large cities. It is well known that the chances for life with children nourished by mother's milk are greater than with those artificially fed. Why should this be? There is no doubt that it is owing to the presence in cow's milk of extraneous substances, the products of bacterial growth--products which are often absolute poisons; and it is highly probable that cholera infantum, in a vast majority of cases, may be traced to the action of such poisons.

Under favorable conditions of temperature, such as prevail in the warm months of summer and early autumn, micro-organisms grow with almost incomprehensible rapidity in any substance which is suitable food for them. Milk is such a substance; and, as bacteria multiply with wonderful rapidity, millions forming in a few hours in every thimbleful,[56] it is perfectly evident that they must produce something. This something may or may not be of a harmful nature, depending upon what species of organism produces it. I have no evidence at hand to show what is the nature of the product of any one organism which finds a home in milk; but there are instances on record where the nature of the product of certain bacteria is known: for example, the diphtheria bacillus. This little rod, growing upon the outside of the tonsils in the human throat, produces a most virulent poison, which, taken up by the circulation, pervades the whole body, and often so enfeebles its functions as to destroy it.[57]

Reasoning from analogy, it is not impossible to suppose that other organisms may produce substances of a similar character, poisonous in their effects, and which, when taken into the alimentary canal, may produce very grave digestive disorders.[58]

Further, bacteria, by their multiplication, use some of the constituents of milk for their food, thus changing its composition. It is very important to prevent this growth, or, in case it has begun, to check it before it has rendered the milk unwholesome food. Hence the necessity of sterilizing _immediately_ all milk which is not received directly from the cow. Besides, cows are often infected with tuberculosis, foot-and-mouth disease, splenic fever, pneumonia, and other dangerous disorders. Their milk may be a direct cause of infection. When it is sterilized there is less danger from it; but even then it is not, of course, a wholesome food, because of the poisons which may be produced in the animal during the progress of the disease, and because a sick and weakened cow cannot give wholesome milk.[59]

In many cities, through the influence of children's hospitals and sanitariums, the knowledge and methods of sterilizing milk for infants' food are gradually spreading.

Circular wire frames, made something like casters, and fitted with eight bottles, each holding enough milk for one feeding, may be bought for the purpose of sterilizing at almost any pharmacy. The frame is to be set in a kettle with water in the bottom, which on boiling produces steam, the heat of which does the sterilizing.[60] This is an easy method. Another good way is to sterilize at a lower temperature for a longer time, as less change is produced in the constituents of the milk by the lower degree of heat. This may be easily done by immersing the bottles in water at 190° Fahr., and maintaining that temperature for an hour.[61]

=Care of Feeding-bottles.= Great care must be taken in cleansing feeding-bottles. When they can be washed immediately after using, it is easy to make them perfectly clean; but when this is impracticable they should be put to soak in _cold_ water, then washed with hot soap-suds, and last boiled for ten minutes in clear water. If flecks dry on the inside, put a teaspoon of rice, or coarse salt, into the bottle with a little water, and shake well until all is removed. Never use shot: it might cause lead poisoning.

Plain rubber nipples alone should be used, never the tube attachment. The nipples should be washed clean and dried after each nursing. Before again using the nipple it should be put into boiling water for ten minutes, and only the rim of it should be touched in handling. The nipple should never be put into the mouth of another person to test the milk.

=Condensed Milk.= When a large percentage of the water of milk is evaporated, and sugar added, a thick syrup is formed, known as condensed milk.

It is made extensively in Switzerland and America. When sealed air-tight in cans it will keep indefinitely.

Its average composition--a mean of 41 analyses by Prof. Leeds--is as follows:

Water 30.34%
Fat 12.10%
Milk-sugar 16.62%
Cane-sugar 22.26%
Albuminoids 16.07%
Ash 2.61%
-------
Total, 100.00

Owing to the additional sugar it is impossible to dilute it so that the protein and sugar shall approach the standard of human milk.

Children fed with it are plump, but have soft flesh; they are large, but not strong, and lack the power of endurance and resistance to disease. Their teeth come late, and they are very likely to have rickets.[62] This is enough to indicate that it is not a proper food upon which to feed a child exclusively.

Condensed milk is valuable in emergencies or in traveling, and may also be used occasionally when for any reason the milk supply fails. It has the advantage of being free from ferments and easily kept.

There are physicians who recommend the use of condensed milk, and no doubt, compared with the germ-laden, watery fluid called milk, obtainable in the poorer sections of large cities, it is infinitely better. It should always be diluted with at least ten times its bulk of water.

=Preserved Milk.= Preserved milk is milk which has been condensed and canned without the addition of sugar. It would be a valuable food for children were it not that it is expensive, and will keep but a few hours after the can is opened. By sterilizing it in flasks with narrow necks, plugged with cotton, it may be kept as other milk is for an indefinite time. As soon as the can is opened, the contents should be poured into a glass or earthen vessel, for, on exposure of the milk to the air, chemical action takes place with the tin.[63]

=Farinaceous Foods.= There are many farinaceous forms of food prepared for the use of infants and children. Probably the most valuable of them are those made according to the Liebig process. The starch of the grain from which such foods are prepared is, in the process of manufacture, changed into soluble dextrine, or sugar (glucose), by the action of the diastase of malt: the very thing which an infant cannot do.

When we consider that the digestion of starch in the alimentary canal consists of this change into glucose, and that it is effected principally by the saliva and the pancreatic juice, the significance of the value of such foods will be seen.

It is also well to bear in mind that neither of these functions (the secretion of saliva and pancreatic juice) is developed in an infant until it enters the third month of its life, and then but very imperfectly. That alone shows the necessity of _excluding all starch_ from its food up to that age.

Mellin's food and malted milk are prepared according to the Liebig process. In them the starch has been converted into soluble matter by the action of the ferment of malt. It is really a partial predigestion. Mellin's food does not contain milk.

The following analysis of Mellin's food is one made by Professor Fresenius, of Wiesbaden, Germany:

Non-nitrogenous substances soluble in water 69.38%
Non-nitrogenous substances insoluble in water 3.18%
------
_Total carbohydrates_ 72.56%

Nitrogenous substances soluble in water 4.69%
Nitrogenous substances insoluble in water 5.06%
-----
_Total albuminoids_ 9.75%

_Total salts_, mostly phosphoric acid, carbonic
acid, and potassa 4.37%
------
_Total moisture_ 13.32%

Cane sugar, none. Reaction, alkaline.

Comparative analysis of Mellin's food, prepared for use, with that of woman's milk and cow's milk.

_Mellin's _Woman's _Cow's
_Constituents._ Food._ Milk._ Milk._
Fat 2.36% 4.00% 3.30%
Albuminoids 2.83% 2.50% 3.50%
Carbohydrates 6.81% 6.50% 5.00%
Salts and inorganic matter .74% .50% .70%
Water 87.26% 86.50% 87.50%
Cellulose A trace. -- --
Cane-sugar None. -- --
Starch None. -- --

DR. A. STUTZER, Bonn, Germany.

This analysis shows that Mellin's food bears comparison with milk. It is easily digested, and as an _attenuant_ for milk may be used without harm during the early months of life, but it should not be used to the exclusion of milk for more than a few days at a time, and then only when milk is not retained by the stomach.

Later it is doubtless a valuable addition to the regular daily food of the child.

Malted milk is made from selected grain and desiccated or dried milk. To prepare it for the infant it needs only the addition of water. It is probably one of the best substitutes for milk, but should not be used for any length of time when it is possible to get good milk.

The starch of grains may be converted into dextrine and glucose by the action of heat as well as by the action of diastase, so that when flour is subjected to a certain temperature, and for a certain time, this change is produced.

Nestlé's food, Imperial Granum, Ridge's food, and some others are made very carefully from selected wheat by this process. Nestlé's food contains dried milk.

These foods are all valuable when made into gruel or porridge, but should be used very sparingly under the age of twelve months, and then only as attenuants for milk, _not as substitutes_ for it.

Dr. Mary Putnam Jacobi, editor of "Domestic Hygiene of the Child," by Uffelmann (a translation), in speaking of the value of the various preparations of infants' food on the market, says: "There is not the slightest reason to prefer them to milk or its preparations, except that the latter requires more care; and for any intelligent and affectionate mother this reason is quite insufficient.... During the first year the baby is building up tissues and organs that are to last him throughout life; and these will work well or ill according to the degree of perfection and precision of structure which they attain at the beginning. And this depends to an immense extent upon the suitability of the food, not only to be digested, but to be absorbed, and then to be assimilated and organized.

"So mysterious are the properties of the molecules of albumen and fat, when once they have been thrown into the whirl of the living organism, that we must strive to deviate as little as possible from the exact forms given to us in nature, if only because we do not know what remote effects might result from the deviations. If nature provides the albumen of milk and a living fluid, we cannot expect the same results from any other albumen, or from long dead organic matter, as condensed milk."

The farinaceous foods have value, but they cannot replace good milk, which should be almost the sole food of the child to at least the age of ten months, and the principal nutrient to the age of two years.

When a baby is nursed, and its mother has an abundance of milk, it takes nothing else during the first ten or twelve months of life. When a baby is artificially fed, this fact should be borne in mind. The important thing is to attain as nearly as possible to the standard that nature has set.

Biedert's cream mixture and the whey mixture are valuable for young infants and those which for any reason do not thrive on milk.

=Amount for Each Meal.= A child is nourished, not by what it swallows, but by what it digests. Giving too much or too concentrated milk is very unwise, for the delicate system cannot manage it, and too frequently the meal becomes a source of pain rather than of strength. Each individual babe will require a little different treatment in this respect from every other.

In general, for the first six weeks from two to four tablespoons at a feeding may be given; from that age to six months, from four to eight tablespoons, gradually increasing the amount to twelve tablespoons at one year.

=Dilution.= Cow's milk is more easily digested when diluted with water, and we are more likely to dilute too little than too much. The amount of water used should vary with the age and strength of digestion of the child. As a rule the new-born infant should have two parts water to one of milk; at four months equal parts of milk and water; at ten months one part water and two parts milk. When digestion is particularly feeble, it may be necessary to dilute milk with six or eight times its bulk of water.

=Manner of Giving.= It is best to give milk from a bottle so constructed that suction is necessary, for it induces the flow of the digestive juices. Use the plain rubber nipple; those with tube attachments which extend into the bottle are to be avoided, on account of the difficulty of making them perfectly clean inside. Cultures from these tubes always give large numbers of bacteria, as do also those made from the nipples, unless they are boiled.

The _intervals_ of feeding will vary somewhat with the age of the child. Once in two or two and a half hours during the day for the first six months, and every three hours from the sixth to the twelfth month, is the general rule.

The _temperature_ of the meal should be 100° Fahr.

A babe needs less variety in its food than older children, and they in turn require less than grown persons; but both must have a certain proportion of the five essential food principles.

There is an impression in the minds of many that children should not have fat. This has perhaps sprung from the fact that mother's milk has a watery, thin appearance. It seems not rich; nevertheless it has a due proportion of fat, and it is extremely important that this be maintained when cow's milk is diluted, for this cream is the best addition.

Fat is needed not only for the growth of brain and nerves, which is very rapid in children, but also for the perfect formation of other tissues.

The following table is that given by Dr. Louis Starr as a guide for feeding:

GENERAL RULES FOR FEEDING.

_Age._ _Intervals of _Average Am't _Average Am't
Feeding._ each Meal._ in 24 hours._
First week 2 hours 2 tablespoons 1¼ pints
Second to sixth week 2½ hours 3-4 tablespoons 1½-2 pints
Sixth week to sixth month 3 hours 6-8 tablespoons 2½-3 pints
At six months 3 hours 12 tablespoons 4½ pints
At ten months 3 hours 16 tablespoons 5 pints

For the First Week; One Feeding

1 Tablespoon of whey.[64]
1 Tablespoon of water.
⅔ Tablespoon of cream.
⅙ Teaspoon of sugar.

Or Biedert's cream mixture:

1 Tablespoon of cream.
¼ Teaspoon of milk-sugar.
3 Tablespoons of water.

Or,

1 Tablespoon of milk.
¼ Teaspoon of milk-sugar.
3 Tablespoons of water.

If it is desirable to make at once a sufficient quantity of Biedert's cream mixture for several feedings, the above rule multiplied by eight will furnish enough for eight bottles, and is as follows: one cup of cream, three cups of boiling water, and one tablespoon of milk-sugar. Mix all together; put the mixture in equal portions into eight feeding-bottles, and plug each with cotton. Either sterilize it or put it immediately on ice to keep.

After the First Week, and Until the Sixth Week

Use either the cream mixture, the whey mixture, or the following:

2 Tablespoons of cow's milk.
4 Tablespoons of water.
1 Teaspoon of Mellin's food.
⅓ Teaspoon of milk-sugar.

From the Sixth Week to the Sixth Month

Water and milk in equal quantities, with a little cream and milk-sugar, and some attenuant, such as Mellin's food or barley jelly.[65]

2 Tablespoons of cow's milk.
2 Tablespoons of water.
1 Tablespoon of cream.[66]
1 Teaspoon of Mellin's food.
⅜ Teaspoon of sugar.

The above proportion to be maintained, but the amount to be varied according to the age of the babe.

If at any time this disagrees, use instead Biedert's cream mixture or the whey mixture. When both of these fail it may be necessary to peptonize the food.

_To peptonize milk_:

No. 1

2 Tablespoons of milk.
2 Tablespoons of water.
1 Tablespoon of cream.
1 Small measure of peptogenic milk powder.

Put all into a clean porcelain-lined saucepan and heat it, stirring slowly until the mixture boils: this should not require more than ten minutes.

No. 2

A special preparation for sick or feeble infants, or those suffering from indigestion.

2 Tablespoons of milk.
2 Tablespoons of water.
1 Tablespoon of cream.
1 Small measure of peptogenic milk powder.

Put all into a bottle, shake it well, place it in a bath or kettle of hot water of a temperature of 115° Fahr. (so hot that the hand cannot be borne in it long without discomfort), and keep it at that temperature for exactly thirty minutes; then pour it into a saucepan, and heat quickly to the boiling point. By this method a very thorough predigestion takes place. The process should be stopped before the bitter taste is developed.

From the Sixth to the Tenth Month

Increase the proportion of milk and of Mellin's food, or other attenuant used.[67]

4 Tablespoons of cow's milk.
3 Tablespoons of water.
1½ Teaspoons of cream.
1 Tablespoon of Mellin's food.
½ Teaspoon of milk-sugar.

Boil the water, then add the milk, Mellin's food, cream, and sugar, or put all together in a feeding-bottle, place in a kettle of water heated to 190° Fahr., and keep it at that temperature for one hour.[68] This amount is only a general rule, and may, of course, be varied according to the age and individual need of the child. The _proportion_ of the ingredients should, however, not be changed.

From the Tenth to the Twelfth Month

6 Tablespoons of cow's milk.
3 Tablespoons of water.
1½ Tablespoons of cream.
1 or 2 Tablespoons of Mellin's food.
1 Teaspoon of milk-sugar.[69]

_Mellin's Food with Condensed Milk._ Although, as has been previously stated, condensed milk is not a proper food for children, there are times when it may be necessary to use it: for instance, in traveling, or when the daily supply of milk for any reason fails.