If, after feeding, vomiting occur, with the expulsion of large, firm clots of casein, or if there be diarrhoea with the expulsion of curds, the effect of adding lime-water or barley-water must be tried.

For instance, at the age of six weeks, make each bottle of -

Gravity cream (16%). . . .

Milk...................

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

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

Water..................

1 tablespoonful (fld. oz. 1/2). 2 tablespoonfuls (fld. oz. 1 ).

1/2 teaspoonful. 1 tablespoonful (fld. oz. 1/2). 2 tablespoonfuls (fld. oz. 1 ).

Or of -

Grayity cream (16%)....

Milk...................

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

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

1 tablespoonful (fld. oz. 1/2).

2 tablespoonfuls (fld. oz. 1 ). 1/2 teaspoonful.

3 tablespoonfuls (fld. oz. 1 1/2).

Sometimes, particularly if there be diarrhoea, boiling makes the milk more tolerable, and in this condition it may be used instead of fresh milk in either of the above mixtures. Condensed milk, too, can be employed temporarily, making each portion of -

Gravity cream (16%)....

Condensed milk.........

Hot water...............

1 tablespoonful (fld. oz. 1/2).

1 teaspoonful.

5 tablespoonfuls (fld. oz. 2 1/2).

Another good food is that recommended by the late Dr. A. V. Meigs. It consists of a combination of two parts of the cream, containing from fourteen to sixteen per cent, of fat; one part average milk; two parts lime-water, and three parts sugar-water, the latter consisting of seventeen and three-fourths drachms (about eighteen teaspoonfuls) of milk sugar to one pint of water. This makes an alkaline mixture with the percentage of its ingredients closely corresponding to human milk.

Whey* combined with cream and barley-water is more readily retained and digested than any of the above combinations, and may be usefully employed whenever curds are expelled by vomiting or diarrhoea; provided that in the latter condition there is not sufficient decomposition of the intestinal contents to require a no-milk diet. Whey contains a small amount of fat, the soluble proteids (lactalbu-min), the sugar and part of the salts of milk. On the other hand, casein is practically absent, being clotted by the rennet and separated in the process of preparation. Knowing its composition one can easily appreciate its value, especially when combined with cream in cases where casein is digested with difficulty. Of course, the food value of whey is less than of the cows' milk from which it is made, but as a temporary substitute in acute indigestion and as an initial food in cases of inherently deficient casein digestion, its usefulness cannot be questioned. A good whey mixture for an infant of six week is -

* See Chapter IX (Dietary).

Gravity cream (16%)..

Whey.................

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

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

2-4 teaspoonfuls (fld. oz. 1/4-1/2). 3 tablespoonfuls (fld. oz. 1 1/2).

1/2 teaspoonful 3 tablespoonfuls (fld. oz. 1 1/2).

For older children it is sufficient to double the cream and sugar and increase the whey and barley-water in equal quantities to make a five- or six-ounce bottle. With this food, too, it is easy to return to or institute milk feeding by substituting each day a small measured quantity of cow's milk for an equal measure of whey until the proper proportion of milk for the patient's age is attained, and the whey is supplanted or discarded.

Under the same conditions that whey mixtures are employed the process known as predigestion frequently gives most gratifying results.

Predigestion, or peptonization,* is best accomplished by means of the substance called pancreatin. That manufactured under the name of extractum pancreatis by Fairchild Brothers & Foster, of New-York, has proved most efficient in my hands.

It is sometimes necessary to carry the artificial process almost or quite to complete digestion of the casein; more frequently partial predigestion is sufficient.

For the first; put into a clean quart bottle five grains of extractum pancreatis and fifteen grains of bicarbonate of sodium (the contents of a "peptonizing tube"), with four fluidounces of cool, filtered water; shake thoroughly together, and add a pint of fresh, cool milk. Place the bottle in water, not so hot but that the whole hand can be held in it for a minute without discomfort, and keep the bottle there for exactly thirty minutes. At the end of that time put the bottle on ice to check further digestion and to keep the milk from spoiling. The fluid obtained, while somewhat less white in color than milk, does not differ from it in taste; if however, an acid be added, the casein, instead of being coagulated into large firm curds, takes the form of minute, soft flakes, or readily broken down, feathery masses of small size. When the process is carried just to the point described, the casein is only partly converted into peptone; but every succeeding moment of continued warmth lessens the amount of casein until peptonization is complete. Then the liquid is grayish-yellow in color; has a distinctly bitter taste, and shows no coagulation whatever on the addition of an acid. This artificial digestion, therefore, may be carried just as far as circumstances indicate, although it is ordinarily best to stop it short of complete conversion, as children object to the markedly bitter taste, and often, on account of it, absolutely refuse the food. Partial peptonization, too, is usually sufficient to adapt the milk to ready assimilation. To seize the proper moment for arresting the process, the person conducting it must be told to taste the milk from time to time, and, as soon as the least bitterness is appreciable, remove the bottle from the hot water and place it upon ice for cooling and use. Such milk may be sweetened with sugar of milk, and given pure or diluted with water. For an infant of six weeks each meal may consist of -