found a milkman who was good enough to let them have " one cow's milk," at an extra price of course, and to this they attributed the improvement in the child's condition. Almost immediately after leaving the house I noticed on the sidewalk, three or four doors up from this house, a milkman emptying milk from his large can into two or three small ones, one of which he handed in at the door of the house I had just left. This was their "one cow's milk," and probably a fair sample of the article usually sold as such. The mixed milk of a good herd is to be preferred, in any way, to that of a single animal. It is less likely to be affected by peculiarities of feeding, and less liable to variations from alterations in health or different stages of lactation.

Pregnancy seems to be given as the chief reason why most women wean their baby during the hot weather, if questioned on the subject. Seldom or never have I seen any serious result to a nursing baby from the mother becoming pregnant; and at any time during the summer months I should always strongly urge a mother to continue nursing her babe till the middle of September, that is, till the cool weather comes on. In giving expression to this opinion, I know I am running contrary to the teaching and the practice of many. Laziness or unwillingness of some mothers to nurse their babies, and the desire to turn them over to the sole care of a nurse, is, many a time, the cause of babies being weaned long before they should be. If a child does not thrive on milk alone, some of the farinaceous articles of diet may be added, with the understanding that milk should form the basis of the diet. Barley water is certainly the most frequently used, and probably the best one, though, if there be a tendency to constipation, oatmeal water or thin gruel at one or two meals a day will be preferable. Either of these substances should be boiled at least four or five hours (Eustace Smith), to insure thorough cracking of the starch granules, and then strained. They may be added to milk in the proportion of one to three or four, or even one to two.

J. Lewis Smith, at the meeting of the American Pediatric Society, 1889, advised for this purpose barley flour, which, in a double boiler, has been subject to the heat of boiling water for seven days. This flour is so largely used that it has been placed in some of the drug stores in New York for sale. The flour ball recommended by Eustace Smith over twenty years ago in his work on Wasting Diseases of Children was a step in this same direction. Arrowroot, from the large amount of starch, should not be used. Stale bread has been suggested also; and I have observed on many occasions the avidity with which children will take this. One method of preparing it is by taking a slice or two of the centre of the loaf, pouring boiling water on it, allowing it to

stand soaking for half an hour, pouring off the water, adding fresh boiling water, and then boiling briskly for another half hour. If the water be now strained off it forms a stiff jelly. A portion of this may be added to milk or milk and cream. Some children will take this without any sugar if salt be added. Beef tea or beef broth, chicken broth, mutton broth, etc, I scarcely ever advise, though they are recommended by almost all the authorities as foods. It should be recollected in advising these foods that mutton causes constipation, and that veal and beef are frequently the cause of diarrhoea (Adams). According to Eustace Smith, the farinaceous particles retard the curdling of milk by getting between the particles of the coagulum. The casein is thus separated, not in several large clots, but in minute portions, which are more easily attacked by the digestive fluids. In other words, they act as a mechanical diluent.

Rotch, in the Boston Med. and Surg. Jour, 1889, took up this very subject, and from a series of experiments came to the conclusion that the views concerning the various diluents used for this purpose are not only theoretical, but incorrect. He started out with the fact that the total amount of nitrogenous matter in human milk is from 1 to 2 per cent., and in cow's milk about 4 per cent. A portion of this is coagulable, and a part of this coagulable portion consists of a chemical combination called casein. The non-coagulable portion in human milk is greater than in cow's milk. The reverse of this is true of the nitrogenous portions of cow's milk. This difference in coagulable quality has induced observers to attempt to break up the larger curd of cow's milk with diluents and attenuants; but he believes that since these nitrogenous matters are two to four times as great in cow's milk as in human milk, it is more practical to dilute these matters until the dilution corresponds to that found in human milk, when the coagulum will be found to correspond to that of human milk and will not need to be broken up. It is claimed that the curd of human milk is small, soft, and friable, and that of cow's milk is large, tough, and tenacious; but Rotch found that where the percentage of albuminoids in human milk reaches that in cow's milk, the curd resembles that of cow's milk. In support of this, he instances the case of a wet nurse whose milk on plain food contained 2.59 per cent. of albuminoids. After a three weeks diet of greater amount and richer quality, with less exercise, the percentage reached 4.61 per cent., and the babe vomited thick curds. On a return to plainer food and skimmed milk, the percentage fell to 2.9 per cent. and the babe ceased vomiting. He gave in detail ten experiments with cow's milk, twenty-four hours old, each treated differently by boiling, sterilizing, lime water, barley water, etc., and then digesting artificially; in nine, curds were found in different

sizes, the size decreasing as the proportion of diluents was increased, until in the tenth, in which the proportion was one part milk and five parts plain water, no curd was found-in this respect resembling woman's milk tested at the same time. These results show that a diluent is of service, not so much for any particular chemical quality or ingredient it may contain, as for its power of diluting the milk.

In the "Cyclopedia of Diseases of Children," this same experimenter gives a formula for making a preparation which has the same chemical constituents as human milk. It is as follows:

The sugar water is of the strength of 3 17 to a pint of water. The limewater here is of the whole amount, and distinctly alkaline to the taste; while in Rotch's preparation it is 1-16, and not at all suggestive of alkalinity.

I have prescribed the former preparation very frequently during the last two years for children under, as well as those over a year, suffering from malnutrition, and found it to be nearly always well digested.

Arthur V. Meigs, at the meeting of the American Pediatric Society held in Washington in 1889, suggested an improvement in the preparation of the mixture named after his father. He thought that the cream, as ordinarily obtained in cities, is kept so long that it is very liable to become sour; and therefore directs now that the mixture be prepared as follows: One quart of ordinary milk is placed in a high pitcher and allowed to stand in a cool place for three hours; then one pint is slowly poured off, care being taken that the pitcher is not agitated, the object being to obtain the upper layer of fluid, rich in fat, and leave the lower, comparatively poorer, portion behind. When a child is to be fed there are taken of this:

This makes only four ounces, and if the child requires eight ounces at once double the quantities must be mixed. This is simply warmed and is ready for use. It is more economical and less liable to ferment than the mixture known to the profession as the Meigs' mixture. In place of the sugar water, I advise my patients to use boiled water and half a teaspoonful of sugar of milk. I also advise them to put it in the steamer and steam for from 20 to 30 minutes. This will keep for a day or two longer in the hottest weather.

Whether the milk is prepared after this formula or not, it is always advisable to use only the upper half or third-the "top milk," as it is called "across the lines."

Within the last few weeks I have been giving this modified Meigs' mixture to a child a year old, and who was weaned four months ago. His capabilities for digestion were no greater than those of a good, healthy baby at six months. At once the mixture appeared to be digested, and now he is thriving on it better than on anything since his birth, though a short time before I had tried Rotch's preparation, and had to abandon it after a few days. Within twentyfour hours on Rotch's mixture the breath became sour; then followed vomiting of curds and the presence of curds in the stools.

Condensed milk is frequently recommended by physicians and largely used by the laity. It contains a large proportion of sugar, often forms fat quickly, and thus makes large children. Children fed on condensed milk, though fat, are lethargic and flabby; although larger, are far from being strong; have little power to resist disease; often cut their teeth late and are likely to drift to rickets (Louis Starr.)

Another writer-Baruch, in the DIETETIC GAZETTE, July, 1888-writes in a similar strain. He says that children fed on a solution of condensed milk will take more food, absorb more water into the tissues, and produce less blood and muscle. Hence they cannot resist disease, and while they appear to be nourished they are anæmic, lymphatic, and they readily become scrofulous if the tendency exists.

Sometimes milk in every form, and however carefully prepared, ferments soon after being swallowed, and excites vomiting and causes great flatulence or distress, while it affords little nourishment. With these cases the best plan is to withhold milk entirely for some time and try some other food.

Whey is a very good substitute, and frequently tides a child over a critical period. I think of one now who lived ten days on it alone, improving daily.

found a milkman who was good enough to let them have "one cow's milk," at an extra price of course, and to this they attributed the improvement in the child's condition. Almost immediately after leaving the house I noticed on the sidewalk, three or four doors up from this house, a milkman emptying milk from his large can into two or three small ones, one of which he handed in at the door of the house I had just left. This was their "one cow's milk," and probably a fair sample of the article usually sold as such. The mixed milk of a good herd is to be preferred, in any way, to that of a single animal. It is less likely to be affected by peculiarities of feeding, and less liable to variations from alterations in health or different stages of lactation.

Pregnancy seems to be given as the chief reason why most women wean their baby during the hot weather, if questioned on the subject. Seldom or never have I seen any serious result to a nursing baby from the mother becoming pregnant; and at any time during the summer months I should always strongly urge a mother to continue nursing her babe till the middle of September, that is, till the cool weather comes on. In giving expression to this opinion, I know I am running contrary to the teaching and the practice of many. Laziness or unwillingness of some mothers to nurse their babies, and the desire to turn them over to the sole care of a nurse, is, many a time, the cause of babies being weaned long before they should be. If a child does not thrive on milk alone, some of the farinaceous articles of diet may be added, with the understanding that milk should form the basis of the diet. Barley water is certainly the most frequently used, and probably the best one, though, if there be a tendency to constipation, oatmeal water or thin gruel at one or two meals a day will be preferable. Either of these substances should be boiled at least four or five hours (Eustace Smith), to insure thorough cracking of the starch granules, and then strained. They may be added to milk in the proportion of one to three or four, or even one to two.

J. Lewis Smith, at the meeting of the American Pediatric Society, 1889, advised for this purpose barley flour, which, in a double boiler, has been subject to the heat of boiling water for seven days. This flour is so largely used that it has been placed in some of the drug stores in New York for sale. The flour ball recommended by Eustace Smith over twenty years ago in his work on "Wasting Diseases of Children" was a step in this same direction. Arrowroot, from the large amount of starch, should not be used. Stale bread has been suggested also; and I have observed on many occasions the avidity with which children will take this. One method of preparing it is by taking a slice or two of the centre of the loaf, pouring boiling water on it, allowing it to

Beef

stand soaking for half an hour, pouring off the water, adding fresh boiling water, and then boiling briskly for another half hour. If the water be now strained off it forms a stiff jelly. A portion of this may be added to milk or milk and cream. Some children will take this without any sugar if salt be added. tea or beef broth, chicken broth, mutton broth, etc, I scarcely ever advise, though they are recommended by almost all the authorities as foods. It should be recollected in advising these foods that mutton causes constipation, and that veal and beef are frequently the cause of diarrhoea (Adams). According to Eustace Smith, the farinaceous particles retard the curdling of milk by getting between the particles of the coagulum. The casein is thus separated, not in several large clots, but in minute portions, which are more easily attacked by the digestive fluids. In other words, they act as a mechanical diluent.

Rotch, in the Boston Med. and Surg. Jour, 1889, took up this very subject, and from a series of experiments came to the conclusion that the views concerning the various diluents used for this purpose are not only theoretical, but incorrect. He started out with the fact that the total amount of nitrogenous matter in human milk is from 1 to 2 per cent., and in cow's milk about 4 per cent. A portion of this is coagulable, and a part of this coagulable portion consists of a chemical combination called casein. The non-coagulable portion in human milk is greater than in cow's milk. The reverse of this is true of the nitrogenous portions of cow's milk. This difference in coagulable quality has induced observers to attempt to break up the larger curd of cow's milk with diluents and attenuants; but he believes that since these nitrogenous matters are two to four times as great in cow's milk as in human milk, it is more practical to dilute these matters until the dilution corresponds to that found in human milk, when the coagulum will be found to correspond to that of human milk and will not need to be broken up. It is claimed that the curd of human milk is small, soft, and friable, and that of cow's milk is large, tough, and tenacious; but Rotch found that where the percentage of albuminoids in human milk reaches that in cow's milk, the curd resembles that of cow's milk. In support of this, he instances the case of a wet nurse whose milk on plain food contained 2.59 per cent. of albuminoids. After a three weeks diet of greater amount and richer quality, with less exercise, the percentage reached 4.61 per cent., and the babe vomited thick curds. On a return to plainer food and skimmed milk, the percentage fell to 2.9 per cent. and the babe ceased vomiting. He gave in detail ten experiments with cow's milk, twenty-four hours old, each treated differently by boiling, sterilizing, lime water, barley water, etc., and then digesting artificially; in nine, curds were found in different

sizes, the size decreasing as the proportion of diluents. was increased, until in the tenth, in which the proportion was one part milk and five parts plain water, no curd was found-in this respect resembling woman's milk tested at the same time. These results show that a diluent is of service, not so much for any particular chemical quality or ingredient it may contain, as for its power of diluting the milk.

In the "Cyclopedia of Diseases of Children," this same experimenter gives a formula for making a preparation which has the same chemical constituents as human milk. It is as follows:

The sugar water is of the strength of 3 17 to a pint of water. The limewater here is of the whole amount, and distinctly alkaline to the taste; while in Rotch's preparation it is 1-16, and not at all suggestive of alkalinity.

I have prescribed the former preparation very frequently during the last two years for children under, as well as those over a year, suffering from malnutrition, and found it to be nearly always well digested. Arthur V. Meigs, at the meeting of the American Pediatric Society held in Washington in 1889, suggested an improvement in the preparation of the mixture named after his father. He thought that the cream, as ordinarily obtained in cities, is kept so long that it is very liable to become sour; and therefore directs now that the mixture be prepared as follows: One quart of ordinary milk is placed in a high pitcher and allowed to stand in a cool place for three hours; then one pint is slowly poured off, care being taken that the pitcher is not agitated, the object being to obtain the upper layer of fluid, rich in fat, and leave the lower, comparatively poorer, portion behind. When a child is to be fed there are taken of this:

This makes only four ounces, and if the child requires eight ounces at once double the quantities must be mixed. This is simply warmed and is ready for use. It is more economical and less liable to ferment than the mixture known to the profession as the Meigs' mixture. In place of the sugar water, I advise my patients to use boiled water and half a teaspoonful of sugar of milk. I also advise them to put it in the steamer and steam for from 20 to 30 minutes. This will keep for a day or two longer in the hottest weather.

Whether the milk is prepared after this formula or not, it is always advisable to use only the upper half or third-the "top milk," as it is called across the lines."

Within the last few weeks I have been giving this modified Meigs' mixture to a child a year old, and who was weaned four months ago. His capabilities for digestion were no greater than those of a good, healthy baby at six months. At once the mixture appeared to be digested, and now he is thriving on it better than on anything since his birth, though a short time before I had tried Rotch's preparation, and had to abandon it after a few days. Within twentyfour hours on Rotch's mixture the breath became sour; then followed vomiting of curds and the presence of curds in the stools.

Condensed milk is frequently recommended by physicians and largely used by the laity. It contains a large proportion of sugar, often forms fat quickly, and thus makes large children. Children fed on condensed milk, though fat, are lethargic and flabby; although larger, are far from being strong; have little power to resist disease; often cut their teeth late and are likely to drift to rickets (Louis Starr.)

Another writer-Baruch, in the DIETETIC GAZETTE, July, 1888-writes in a similar strain. He says that children fed on a solution of condensed milk will take more food, absorb more water into the tissues, and produce less blood and muscle. Hence they cannot resist disease, and while they appear to be nourished they are anæmic, lymphatic, and they readily become scrofulous if the tendency exists.

Sometimes milk in every form, and however carefully prepared, ferments soon after being swallowed, and excites vomiting and causes great flatulence or distress, while it affords little nourishment. With these cases the best plan is to withhold milk entirely for some time and try some other food.

Whey is a very good substitute, and frequently tides a child over a critical period. I think of one now who lived ten days on it alone, improving daily.

Or barley water may be used. Or keeping a child for some hours on whiskey and water, or whiskey and water may be alternated with the barley water, or a teaspoonful or two of the juice of raw beef will often. be retained when everything in the shape of milk is rejected.

Such foods are only to be used temporarily, until the tendency to fermentation within the alimentary canal ceases; then milk may be gradually and cautiously resumed.

Having arrived at the conclusion that cow's milk, modified, is the most suitable article of diet for babies and young children after weaning, we must look on another side of the question which is probably nearly as important; that is, the quantity and frequency of feeding.

Many mistakes are made in regard to these points. Emmet Holt says: "It has been my experience and observation that artificially-fed children are often fed two or three times too much and also too frequently, especially at night. There is no doubt that indigestion and diarrhoea are due in many cases quite as much to the quantity and frequency of feeding as to quality of the food given." Keating, of Philadelphia, also says: "The great mistake has been overfeed

ing."

So crude an idea have the majority of mothers in regard to quantity that I have been in the habit of late years, in the case of children who are very ill, of putting my directions in writing, giving the kind of food, the amount, and the frequency of feeding.

If a child from 12 to 18 months is well and his appetite demands additional food to the milk, he may have stale bread broken up in his milk, stale wellcooked bread and butter, a crust, stale bread moistened with red-dish gravy from beef or mutton, a sandwich of scraped beef, almost raw, or part of a soft-boiled egg with stale bread-crumbs in it. Any of these may be given once or twice a day except the last-named.

There is no well-recognized rule of feeding applicable to all cases. Each one must be regulated by its own particular requirements, and that line of feeding carried out which proves best suited to it. If a certain diet appears to agree with a child, as little variation as possible should be made in it. The child should be fed five or six times a day at nearly the same hours.

I do not like diet tables; as a rule, they are too suggestive of hospital life; but the following formulated by Louis Starr, of Philadelphia, seems a good

one :

First meal, 6 A.M.: Cup of milk, with cream-biscuit or a slice of buttered bread.

Third meal, 12 A.M.: A slice of buttered bread with about half a pint of weak beef tea, or mutton, or chicken broth.

Fourth meal, 4 P.M.: Tumblerful of milk with crackers or buttered bread.

Fifth meal, 8 P.M.: A tumblerful of milk, with bread and crackers.

By the time the child has reached the age of about two years, he is usually able to digest oatmeal or cracked-wheat, and these he may have with his eight o'clock meal, and with the mid-day meal he may be allowed a piece of rare roast beef to suck, some mashed potatoes moistened with the dish gravy, and a little rice or farina. The other meals had better vary as little as possible from the diet table just given.

I try as well as possible to keep these little ones on an almost wholly milk diet till the dreaded "second summer" is over, and longer still if the child's digestion is not very good.

Up to this age it is probably better that the child should have its meals at a separate table rather than with the other members of the family. If it does not see food, it is not so likely to want it and get something it should not have.

Between two and three years of age a child is often more difficult to manage than a younger one, for it can walk about and help itself to all sorts of things. Its increased growth and size demand a greater variety of food than the younger ones. Its powers of mastication, its increased flow of saliva, its improved digestion and increased assimilation call for this. It should be fed four times a day, with a drink of milk between meals if hungry. If well, it may be allowed ripe fruits in moderation, provided care be taken to prevent it swallowing seeds and rinds. A popular fruit is the banana; but Dr. Adams' experience has been such that he considers it more productive of eclampsia than any other fruit, and consequently he cannot recommend it. (Cyclopædia of Diseases of Children.)

An important point, often neglected, is the matter of drink. Every young infant requires water several times a day, and the demand increases with the age of the child. The water should be pure, and not too cold. In hot weather especially, they should have it frequently.

It is scarcely necessary to say that the major portion of this paper refers to children who are suffering from improper feeding, and not so much the well ones, whose capability for digesting all manner of things is often a marvel.- Canadian Practitioner.

A. M. Lévy has bequeathed the interest of 50,000 francs to the Pasteur Institute, for researches on