There are three ways in which a child may be sup plied 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.1 To this subject doctors and hygienists have given much attention for a long time.

1 It should not be inferred from this that mother's milk is the nest under all circumstances. It not infrequently happens that a mother, disregarding all indications to the contrary, will continue to nurse her baby after it has become disastrous both to herself and the infant to do so. If a baby remains puny, and the mother is exhausted and languid without any known cause, it is the part of wisdom to call in the aid of a physician, and have the milk analyzed. Good and careful feeding is infinitely better than nursing a baby upon impoverished milk, even if the quantity seems sufficient. A mother, in nursing her child, should do so at stated regular intervals. If it is injurious for a grown person to eat at odd times all day long, it is far more injurious for an infant. It will not hurt a child to be occasionally hungry, or even to cry,

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

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.3 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,4 and kept in an ice-box, or refrigerator, at a temperature of 50° to 60° Fahr.5

When obliged to buy the ordinary milk of commerce, select if possible that which is put up in glass whereas it will hurt it seriously and perhaps induce life-long dyspepsia if food is introduced into the stomach while there yet remains in it that previously taken in an undigested, or partly digested, condition. The cry which a young mother thinks indicates hunger, and hopes to allay by feeding, is often only a dyspeptic pain, which is increased by the very means she takes to lessen it.

1 The milk of goats and asses is said to be more easily digested than cow's milk, but is procurable only in exceptional cases.

2 From Uffelmann's "Hygiene of the Child."

3 See chapter on Milk.

4 Vessels for holding milk may be made sterile by boiling them in water for fifteen minutes. Glass is best.

5 A low temperature retards the growth of micro-organisms.

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.1 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.

1 Test for reaction, fat, and specific gravity. See article on Milk.

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.1 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: