If milk can be obtained under conditions of thorough cleanliness, immediately cooled and placed in sealed bottles and delivered within 12 hours, it is, on the whole, better for infant feeding than milk antiseptically treated.

Sterilization - assuming the absence of spores of tubercle bacilli, tetanus bacilli and a few other extremely resistant germs - is accomplished by subjecting milk for ten or twelve minutes to a boiling temperature. The bottles and cotton stoppers should first be sterilized by dry heat, as in an oven, at the same temperature, for half an hour or so. Sterilization destroys the amylolytic ferment of milk, which may be dispensed with, it renders more difficult the coagulation and digestion of the casein and, of course, coagulates the lactalbumin. The fat coalesces so as to become less readily absorbable. Lactose, by prolonged boiling, is more or less converted into monosaccharids, which probably does no harm, since it is virtually a predigestion. Antitoxic and antiscorbutic substances are destroyed. Thus, except for the destruction of bacteria, sterilized milk is distinctly less valuable than fresh milk.

Pasteurized milk is a compromise between fresh and sterilized milk. The process is the same except that the temperature used is 160 - 170 Fahrenheit, instead of boiling point. The lower temperature will destroy practically all of the germs accidentally introduced and most of the tubercle bacilli, if any are present. The untoward changes produced by sterilization are not so pronounced.

The choice between fresh milk, sterilized and Pasteurized milk must be made according to circumstances.

Budde process of sterilizing milk. To one liter of milk, obtained as clean as possible, 15 c.c. of hydrogen peroxid solution is added. The milk is then heated to 51 - 52 centigrade (124 F.) for three or four hours. This destroys the hydrogen peroxid and the nascent oxygen liberated, kills the bacteria. Milk thus treated keeps for about ten days - though it should not be kept if used for infant feeding.

Formaldehyde and other preservatives should not be allowed in milk.

In all cases, the child's lips, tongue and mouth and the breasts of the mother, should be kept decently clean and borax solutions.

followed by pure water, recently boiled, should be used before and after feeding. Short rubber nipples, not long tubes, should be employed on nursing bottles and both bottle and nipple should be thoroughly cleaned and sterilized before using. The milk should be kept in sealed bottles, on ice, until just before using, and not more than one day's supply should be prepared at once.

For traveling or when there is suspicion of the milk supply or actual danger of specific infection, as during an epidemic of scarlet fever, typhoid etc., sterilization should be practiced.

Goat's or sheep's milk may be used for infants that do not thrive on cow's milk.

Buttermilk freshly soured, not that which has accumulated for several days before churning, may occasionally be used for infant feeding. It contains about 2.5% of protein, 1/2 - 1% of fat and 3 - 3.5% of lactose. It should not have an acidity of over 70% with decinormal alkali and phenolphthalein, but commercial buttermilk usually has an acidity of 90 - 95%. It should not be used continuously, on account of the lack of fat. Lactose may be added in equal amount to that contained in the buttermilk, to bring it up to the required standard.

One white of egg contains almost exactly the amount of protein required in a day by a child in the first week; two for the fourth week; three for the third month; four for the last three months of the first year. Thus albumin water may be used as an emergent ration and lactose and even cream may be added.

Meat juice and certain extracts contain about three times the percentage of protein in human milk. Thus, for furnishing protein, one third of the standard amount of breast milk may be given. They should not be used continuously. Lactose and cream may be added, unless, as in many summer complaints, fevers etc., it is thought best to suspend these forms of food.

Various proprietary foods, condensed milk etc., may be used for infant feeding in emergency.

Do not use a proprietary food unless its composition is attested by impartial and reliable authority.

Do not use foods containing any appreciable quantity of starch until after the sixth month. Amylolytic ferments may be present before this time, or their development in sufficient strength may be delayed.

Remember that magazine advertisements critically inspected are a good criterion of the merits of a food. These usually show a fat, soft, flabby infant.

A reasonably well nourished child can, in case of diarrhoea or acute febrile disorder, get along very well for three or four days without nourishment. Saline solutions may be used to relieve thirst. If the principal element in the fever is the fermentation and putrefaction of milk or other food in the alimentary canal, it is far better not to try to administer organic food of any kind for a few days, unless the baby is critically weak.

In any case, whether in infant or adult, the proper amount of salines may be administered by following the composition of the blood.

The author's formula, modified from Schmidt is as follows:

Sodium chlorid.......................5.54 grams

Sodium phosphate.....................27

Potassium chlorid.....................36

Potassium sulphate....................28

Calcium phosphate....................30

Magnesium phosphate..................22 to be added to 1 liter of distilled water.

This solution may be used in preparing milk modifications.

In haemorrhagic conditions, gelatin solutions may be used to advantage in diluting cow's milk. If there is the least suspicion of infantile scurvy, use orange juice or fruit jelly dissolved in water. A few teaspoonfuls of unsweetened orangeade etc., should be given daily whenever the baby is fed artificial or sterilized foods. Boil the gelatin thoroughly to insure against internal anthrax infection and be sure that it is really animal gelatin and not a vegetable mucilage.

Do not forget that the infant, like the adult, can not digest well if fatigued or nervous or suffering from intestinal or other autointoxication. The young child should spend practically all its time in nursing and sleeping. Even after three or four months, it should not be tickled, played with, rocked and mauled but should be allowed to play quietly. Avoid exposure to bright sunlight unless the eyes are protected. Keep the child out doors as much as possible but avoid too inclement weather. The child should be dressed so as to avoid cold and dampness, including dampness due to urine and saliva but, on the other hand, many children are too warmly dressed. If the child's body and clothing are habitually wet with sweat, it indicates either some serious disturbance or too warm clothing.

Marasmus is a term often loosely employed to indicate any conspicuous failure of nutrition, including tuberculosis. It should probably be applied to an intrinsic failure to assimilate proteins due to a hypothetic lack of power properly to disintegrate and recombine the protein molecule or to the presence of precipitins against foreign proteins. On either hypothesis, there is substantial agreement with the clinical observation that a true marasmus is practically limited to artificially reared infants. If a return to breast feeding is impossible, it may suffice to secure the occasional services of a wet nurse, or to convey human milk from some mother who has an excess. Even a partial ration of human milk may restore the power to assimilate other milk. Marasmus may, however, consist in a condition analogous to achylia totalis of adults and in such cases, which are mainly limited to premature infants, nutrition may fail even with an abundant supply of normal maternal milk.

If the supplying of human milk is impossible or if it fails, various changes of diet and attention to digestion may be tried, but the prognosis is rather unfavorable.

Pyloric hypertrophy and obstruction occurs without discoverable cause in certain infants, although it is probable that, since attention has been called to this condition, the diagnosis has sometimes been made without proper foundation. Obstinate vomiting of practically all of the ingesta, resulting constipation and relative absence of faecal contents except those due to elimination from the tributary glands and the intestine itself, with loss of weight and obvious malnutrition, establish the diagnosis of

First bicuspids (replacing first deciduous molars).....10th year

Second bicuspids (replacing second deciduous molars).. .11th year

Canines.......................................12 - 13th year

Second molars (7th tooth from center in each half of each jaw)...................................12 - 15thyear

Third molars ("wisdom teeth", 8th from center) . .17 - 21st year often not appearing till 30th year and sometimes not till later or not developing fully.

By using teething rings, preferably of non-toxic rubber, and by carefully lancing the gum or pushing it aside with an ivory instrument, much of the reflex discomfort of teething may be avoided. Most of the serious disturbances ascribed to teething are due to careless methods of feeding and, especially to the development of bacteria in the food. As teething is pretty continuously in process after the fourth month, till long after weaning is accomplished, the applicability of the term to a disturbance of digestion is usually conspicuous by its absence.