Proprietary foods, as is well known, are very largely used in this country in the rearing of healthy children. Many of the foods themselves are most excellent, and, in the hands of different practitioners, give consistently good results. When these foods are definitely chosen by the physician from among the various means at his disposal for the rearing of the infant, with a due appreciation of their composition, characteristics, and peculiarities, and are deliberately employed by him as being the best existent form of nourishment available, one may question the validity of his reasoning and possibly the reliability of his opinion as regards the healthiness of his patients, but the manner of his practice is above all reproach. He has definite, valid reasons for what he does, and these, combined with his clinical results are, to his mind, convincing, or at least sufficient. The science of infant feeding, the scientific substitution for mother's milk of a substance sufficient in all respects for the needs of the infant, is itself in its infancy; circumstances differ in different countries and in different localities, and our knowledge is not yet so profound that any one line of action can be singled out as definitely the best; but in this country at the present day, for the average healthy infant, suitably modified cow's milk and water is in my opinion the most satisfactory diet.

We settle, then, in our own mind that this average baby is to be reared on suitable modifications of cow's milk and water. What do we mean by "suitable modifications"? How is the milk to be modified? Is it to be used raw or heated? And if heated, to what degree, and for what length of time?

Owing to the many sources and forms of contamination of cow's milk which have previously been alluded to, and which, consequently, do not call for recapitulation, raw cow's milk cannot, as a rule, be considered a safe food for a young infant. Doubtless, in certain parts of the country and from a few dairies in towns, milk can be obtained approximately clean, but for the great majority of infants, the possibility of injury resulting from contaminated milk is too great to justify the physician in prohibiting the application of heat to it. And the drawbacks associated with this process of heating are not in themselves sufficient to warrant such a prohibition.

Rickets and scurvy are both diseases which have been attributed at times to the boiling of the infant's milk, but there is no reason to believe that, given a milk or milk-mixture of adequate composition, the application to it of a reasonable degree and time of heating will produce such conditions.

It is an unfortunate necessity we have to face, that the probability of cow's milk being seriously contaminated is so great, the danger must be obviated by boiling the milk. The process of pasteurisation has no advantages over that of scalding; and the latter, as being the more definite procedure, we consequently recommend. The infant's milk, then, obtained from a reputable dairy (preferably from cows tuberculin-tested), requires to be scalded before use. This process of scalding consists in placing the milk in an open dish on the fire, leaving it there till it commences to boil, removing it, putting a cover on the dish, and cooling the milk rapidly by setting the dish in cold water. The whole of the milk for the infant's use can be treated in this way on its arrival from the dairy, and it can be modified later as required, in which case the cream and water will require separate scalding.

Or, on the other hand, the total amount of milk, cream, water, and sugar required for the infant in the course of the day may be mixed together, scalded, and then stored for use. This latter is usually the more convenient method. Immediately after the process has been carried through, the milk-mixture is divided into quantities such as the infant is to receive at each feeding period, and into a properly sterilised bottle this quantity is poured. The bottle is then scaled with a rubber cap, and placed in a cool situation till required by the infant, when it is gently warmed by being set in warm water. Care of the milk in the house is of the utmost importance, and contamination must be most zealously guarded against. The bottles, also, and the teats must, likewise, be carefully chosen and attentively looked after. The bottle should be as simple as possible; it should have no rigidly defined neck, and no internal angles or corners. The neck must not be so narrow as to prevent the ready entrance of a brush to cleanse the interior: it may be an upright bottle with sloping neck and rounded internal curves at the bottom, or it may be a boat-shaped bottle. Either must be thoroughly rinsed and brushed out with boiling water after use, placed in weak boracic or soda solution, and washed out once more with boiled water before being used again. The rubber teats require like careful treatment.

So much, then, for the modification of the milk by heat and its subsequent prevention from contamination. How about the further modification of its composition? Water, as has previously been pointed out, is the best diluent, and cream and white sugar are added as desired. In the case of maternal suckling, the infant, during the first day or two of life, receives from the breast a modified form of milk - colostrum - which contains only a small amount of readily absorbed nourishment, and which acts as a mild purgative. To our artificially fed infant, therefore, during these first few days we give no milk, but only water with a little sugar dissolved in it, and by the third day feeding with milk-mixture is commenced. Realising as we do that cow's milk is an unnatural form of nourishment, we accordingly, though confidently expecting that its digestion and assimilation will be ready, and that no untoward results will ensue, wish to commence with as simple a form of food as possible, and to add the ingredients of our milk-mixture one at a time.