Chapter II (5)

The baby needs water as much as any adult person. Boil a fresh supply daily and cool and keep it in a covered dish or bottle. A little,--four to eight teaspoonfuls,--should be offered to the baby between each meal. It can be given from a spoon, a medicine dropper, or taken from a nursing bottle, and either hot or cold. This aids in overcoming constipation and teaches a breast-fed baby to use a nursing bottle, which will be of much benefit should sudden weaning be necessary.

During the second month his meals should be given every two and one-half hours during the day, having eight meals in twenty-four hours of three to four ounces at each meal. At night he should be fed at ten and two.

Meals for the Third Month.--Baby should be regularly nursed or fed every three hours up to ten p. m. Then have one meal at two or three a. m., and nothing more until seven a. m. If bottle fed he should be given three and one-half to four ounces at each feeding.

Fourth Month.--If the mother is nursing her baby, it is a good plan now to teach him how to use the bottle. Some doctors advise one bottle feeding each day from the start, for, should the mother's milk suddenly fail, or should she be obliged to stop nursing for any reason, there will be no struggle, which would be very hard for the baby if it happened in hot weather. Also the gradual accustoming of the digestive organs to the cow's milk before weaning must be commenced and does away in some degree, at least, with the danger from indigestion from the cow's milk given regularly.

Fifth Month.--Night feeding should now be discontinued; he should be taught to sleep from ten p. m. to seven a. m. There may be a few nights of crying and a struggle when the night feeding is first stopped, but he will soon learn to sleep without waking for his meal. He should be fed every three hours until ten p. m., and if bottle fed he should be given five to six and one-half ounces at each meal, making six meals in twenty-four hours.

Sixth Month.--The baby sleeps about two-thirds of the time. He shows signs of increasing intelligence. The baby should now accustom itself to taking either condensed milk or only the best prepared foods once or twice daily. The mother may become ill or unable to nurse for some reason, or wish to take a journey, etc., and baby is then prepared for emergencies.

When the baby is seven months old he will need more exercise than a clothes basket will afford. An exercise pen should be made.

Teeth.--As soon as the teeth come they should be kept clean, otherwise they will decay, milk is likely to remain in the mouth, turn sour and gradually destroy the enamel of the teeth.

With a soft linen cloth or a piece of absorbent cotton dipped in a solution of boric acid wash out the mouth and teeth, twice a day at least, carefully. A soft brush may be used later when baby has eight or ten teeth, and a little finely prepared chalk may be put on the brush, if there are any specks on the teeth. The baby should have three meals in twenty-four hours of six or seven ounces at each meal, if bottle-fed.

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Eighth Month.--Baby should be allowed to creep on the floor a little or in his pen. It is good exercise and it will benefit him, but he should not be urged to do it. Many mothers give baby potato, etc., at this period; this is bad, as potato is hard to digest on account of having so much starch. Bread and cakes are also prohibited; convulsions are often caused by such food. Milk gruel and broths are enough for the baby and he will thrive using them. Baby should feed every three hours up to ten p. m., six and one-half to seven and one-half ounces at each meal.

Mosquito Bites.--If baby is bitten by mosquitoes wash the spot off with a little camphor water, soda water, or a wet compress of witch-hazel should be kept on the bite or boracic acid or soda solution. Keep the baby from scratching the part by fixing his hands; scratching will further poison the part.

Flies.--They often carry germs of disease on their legs and wings, and they frequently light on baby's mouth or on the nipple of the nursing bottle. Diseases can be contracted in this way. The windows should be screened. Everything that the fly has touched should be washed with some light antiseptic solution.

Ninth Month.--His long morning nap should be encouraged and he should sleep in the early afternoon. If the baby is heavy his little moccasin or kid shoes will not now support his ankles and he should have a shoe with a piece of stiffening at the side. The shoe should have no heels; laced shoes fit better and should be preferred. The baby (bottle-fed) can take seven to eight ounces of the proper food every three hours until ten p. m.

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.