"Top milk" as ordinarily used, contains 7 per cent. fat. To obtain it a quart bottle of milk, just as it is received from the dairy, is allowed to stand in a refrigerator for four or five hours, and then the upper portion is removed by a cream dipper having a capacity of one ounce. The quantity taken depends upon the grade of the milk; if poor, the upper 11 ounces are removed; if good average quality, 16 ounces; and if very rich, 22 ounces.

It is important to remember that the top milk must be dipped not poured off, and that the whole quantity must be taken, not, only, the number of ounces required to make any given mixture. This milk when used in making a properly combined food mixture gives a proportion of fat to proteids of 2 to 1; while a similar combination made of whole milk, from a good mixed herd, contains equal fat and proteids and requires the adding of 1 part gravity cream to each 3 parts of whole milk to make the high fat percentage.

High fat mixture may often be usefully employed, especially during the first six months of infancy; they are proportioned as follows:

Ounces.

Ounces.

Ounces.

Ounces.

Ounces.

Ounces.

Ounces.

Ounces.

Ounces.

Top milk (7%)...

2

3

4

5

6

7

8

9

10

Milk sugar........

1

1

1

1

1

1

1

1

1

Lime-water.......

1

1

1

1

1

1

1

1

1

Water (boiled)....

17

16

15

14

13

12

11

10

9

The first three formulas are to be employed up to the third week of life; afterward the strength is slowly increased until the sixth or seventh month, when it is better to change to a whole milk mixture. This is done by removing more and more of the upper milk; for example, take first 20 ounces and then 24 from the quart of milk and finally use the whole milk well stirred together. Thus:

Milk, 4 or 5%

Of upper 20 ounces use ounces II.

Of upper 24 ounces use ounces 12.

Of whole milk use ounces 13.

Milk sugar..........

ounce 1.

ounce 1.

ounce 1.

Lime-water............................

ounce 1.

ounce 1.

ounce 1.

Barley-water.........

ounces 8.

ounces 7.

ounces 6.

The third formula should be reached by the ninth month, and, beyond a gradual increase in quantity, needs but small change during the rest of the first year.

Dr. Joseph E. Winters* employs a cream food during the first three weeks. Afterward he uses, for different ages, a specified quantity of the upper layer dipped from a quart of whole milk sixteen hours after milking, and modified by the addition of milk sugar, lime-water and filtered water. As this scheme of feeding has proved very successful I present it in the following table:

* "Feeding in Early Infancy," reprint from Medical Record, March 7, 1903.