COLyMB.AUBJjAR.|SOF^|.TE ^^H^erT'HSCENCES Rj^oeH^fSr--*" "ic^w TO Fe Children By Louise E. Hogan i*mm'mmHmmtmmmm§ 9*mn^x»m »» ■RJZOG HG7Z ColuntMa ®nitmilp 1 83G mtlieCtlpoflfttigdrk College of J^fjpfiiicians! anb ^urgeonfii Hihvavp Qri:F-bof Dt. Jerome P Webster /" ^ Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/howtofeedchildreOOhoga T HOW TO FEED CHILDREN /f^ A MANUAL FOR MOTHERS, NURSES, AND PHYSICIANS BY LOUISE E. HOGAN THIRD EDITION PHILADELPHIA J. B. LIPPINCOTT COMPANY 1899 liuz Copyright, 1896, BY J. B. LippixcoTT Company. Electrotypeo and Printed by J. B. Lippincott Company, Philadelphia, U.S.A. PEEFAOE, The substance of a number of papers that have appeared during the last two years in various journals * has been embodied in this book upon the request of members of the medical profession, mothers, and others interested in children. These articles have been care- fully revised, and much additional material has been used. All statements made are based upon facts ac- cepted very generally by scientists and physicians both here and abroad, where the greatest amount of original research has been made, and authority for these facts, when not credited in the text, may be found in the works of the following writers, which have been studied very carefully, in connection with much other reading relative to the subject: "Pediatrics," T. M. Rotch, M.D. ; " Infant Diet" and " Therapeutics of Infancy and Childhood," A. Jacobi, M.D. ; " Food in Health and Disease," I. Burney Yeo, M.D., F.R.C.P. ; "Diet after Weaning" (Keating's " Cyclopaedia"), by Samuel S. Adams, A.M., M.D. ; "The Mother's Work with Sick Children," Professor J. B. Fonssagrives ; " Prac- tical Dietetics," W. Gilman Thompson, M.D. The purpose of this book is to ofPer in a practical form a few suggestions concerning the application of * Popular Science Monthly, Lippincott's, Babyliood, etc. 1* 5 6 PREFACE. the principles of dietetics to feeding in the nursery and throughout the period of childhood. It is also hoped that the book will meet the require- ments of practitioners, who rarely have the time to direct in detail the management of children's diet. It is not the intention of the author to advise where a phy- sician is needed, but rather to suggest to the mother or nurse when he should be sent for, and how he may be aided in his eiSbrts by the exercise of intelligence and judgment in the selection and preparation of foods indicated for various ages and varying conditions of illness and convalescence. Owing to differences of temperament and constitution, each case needs indi- vidualization : hence, when there is the least doubt, even in conditions of health, a physician should be consulted without delay. In the hope, therefore, that when a physician is* available the counsel given will be explicitly followed, this little book is earnestly com- mended to mothers and those in charge of children, as well as to physicians who may wish to be relieved of the tediousness of making specific the general laws regulating dietetic practice. The author is deeply mdebted to T. M. Rotch, M.D., Boston, for the use of his book " Pediatrics," and to Samuel S. Adams, M.D., Washington, Leroy M. Yale, M.D., New York, and Edgar Dubs Shimer, Ph.D., Professor of Psychology, New York University, for suggestions and assistance in revision of manuscript and proof. Louise E. Hogan. Philadelphia, April, 1896. COJSTTENTS. OHAPTEK I. PAGE Reasons why Mothers should study Dietetics .... 9 CHAPTEK II. Infant Feeding 19 CHAPTER III. Cereals, Bread, Crackers, and Cake 56 CHAPTER IV. Broths and Soups 67 CHAPTER V. Meats, Eggs, Fish, Oysters, etc 74 CHAPTER VI. Inorganic Salts, Vegetables, Fruits, etc 85 CHAPTER VII. Laxative Foods 106 CHAPTER VIII. Nursery Desserts 113 CHAPTER IX. Summer Diet 119 7 8 CONTENTS. CHAPTEK X. PAGE Travelling Outfits and Precautions 133 CHAPTER XL Fat in Food 141 CHAPTER XII. Diet for the Approach of Cool Weather 146 CHAPTER XIII. Nursery Dietaries and Menus 152 CHAPTER XI Y. Diet in Illness 179 CHAPTEE XY. Diet for School-Children 190 CHAPTER XYI. Recipes 200 HOW TO FEED CHILDREN. CHAPTER I. Reasons why Mothers should study Dietetics. The study of dietetics as applied to the nursery and the period of childhood is constantly brought to the notice of mothers. A practical application of theory to individual needs is of great importance whatever system of feeding is decided upon. The usual hap-hazard method is founded on ignorance. Some knowledge of the physiology of digestion is necessary to select the foods that are suitable for the requirements of infants and growing children. All parents should understaud that the rearing of a child is fraught with great responsibility, which it is crim- inal to avoid. It is too frequently the custom among adults to think that what is provided for themselves in the way of food may be given with impunity to children. They forget that the food an adult can re- ceive and assimilate does harm to the tender organs of a child, — organs that depend very largely for their development upon a proper selection and administra- tion of assimilable foods. Carelessness and ignorance at this period of life are quickly followed by perni- cious results. The treatment of almost all diseases of the digestive organs in children requires the special 9 10 HOW TO FEED CHILDREN. study of foods and of hygiene, and many of them may be ayoided by care in this direction. Any mother who will study the nature of food products, whether nitrogenous, carbonaceous, or mineral, their proj)or- tions of waste and water, those needed to build tissue, furnish heat, purify the blood, etc., will comprehend at once the value of dietetic knowledge in the selection and preparation of wholesome food for her family. This knowledge is the foundation of sound practical dietetics (Burnet), and the subject is one of universal importance. A nourishing diet must be supplied during the entire season of youth, and at the same time be supplemented by favorable hygienic surround- ings and by plenty of exercise of various kinds to call every set of muscles into play ; want of sufficient exer- cise diminishes tissue-change. During this early period of life larger supplies of certain food elements are required than in adult life, when physical growth has ceased and bodily activity has grown less. It must also be understood that under various conditions in the life of the same child diflPerent foods and quantities will be required. The diet must be adapted to the power of the constitution at the time, and it must be of the highest nutritive value possible for present digestiye power. If the child's digestion is normal, and its life an active and out-of-door one, it can as- similate more and stronger food than if, from variations in climate and other causes, it leads a more quiet life ; and if for any reason its digestion is not up to its normal standard, consideration must be given particu- larly to quantity. It must be remembered that through repair eating is intended to balance, not to increase, WHY MOTHERS SHOULD STUDY DIETETICS. 11 the waste caused by the constant action and change going on in the organs. This waste, if not fully coun- terbalanced, will soon cause suffering and illness, but the mistake so constantly met with of overfeeding must be absolutely avoided. A well-balanced diet must have the right ratio of protein, fats, and carbo- hydrates ; enough proteids (eggs, milk, meat, etc.) must be given for the building of tissue, and enough of the other constituents of food to give energy, to keep the body warm and to enable it to do its work. The amount of nutrition required in every instance must be carefully considered. One of the most important reasons for this is that energy must not be wasted in getting rid of superfluous material, as organic disease may result. A little food thoroughly digested is far better than much that is half digested. It is always necessary to understand how to supply as nearly as possible the same materials that the body is regularly losing, as, for instance, when we give heat- forming food in cold weather and liquid in hot weather. Drink constitutes food as well as what we eat. As each nutritive ingredient serves its own peculiar purpose, it can readily be seen why it is necessary for a mother to understand something of the elements of food and their action. She should also be able to detect immediate needs in individual cases, as, on account of proximity, she is generally the only one who notices the daily variations in conditions requiring daily modifications of diet. Whilst a mother need not actually cook the food re- quired, she should know just what to select under certain conditions, and exactly how to have it prepared. 12 HOW TO FEED CHILDREN. Further, she should not only be able to note by results that her directions have been carried out^ but also be willing, if necessary, to see to it personally that this is done. A little supervision, judiciously applied, will frequently prevent difficulties that are likely to occur as a result of carelessness upon the part of servants. She should understand the changes needed in health, illness, and intermediary stages. In illness, this knowl- edge would allow her ably to supplement the efforts of the physician, and in cases of slight indisposition she would frequently seize the opportunity for overcoming ailments which, uncared for, might prove serious. For instance, if she recognized the fact that the eliminative processes were hampered, she would cut down albu- minoids : thus, in cases of constipation the supply of fruit, vegetables, cereals, etc., would be relatively greater in menus than that of milk, eggs, meat, etc. (proteids). Again, as the preparation, intervals, and amounts in feeding children are of equal importance, she would know that with ailing children she must feed more frequently and less at a time ; that the food must be more damtily prepared and be more as- similable than that required in health ; and she would, consequently, pay particular attention to these require- ments. In cases of illness she would realize that success in treatment depends very largely upon the trouble taken in the combination and preparation of the foods that are allowable, so as to give as varied a diet as the necessary limitations will permit. Tem- perament would be considered, and tastes and likings consulted, all of which are of great importance in the digestion of food. ISTaturally following as a result of WHF MOTHERS SHOULD STUDY DIETETICS 13 such study, the fact would be discovered that more liquid food should be used than is common, and less solid. The giving of water is one of the most im- portant features in infant feeding. Many conditions require it, and it is healthful at all times, unless in rare stages of illness, when it might be forbidden by medical authority. It is not unusual to deprive in- fants almost entirely of water because they drink milk. The fact is overlooked that milk, though a liquid out of the body, becomes in the stomach a solid food containing all the nutriment required for an infant's normal growth. Irregular action of natural laws is not infrequently a result of this deprivation, and can easily be corrected by the use of what appears to many to be an excess of water. Among the uneducated, strong in the old theory of teething being the necessary cause, it is a very common custom to look tolerantly upon serious infantile ail- ments. " Errors in diet, and consequent disorders of digestion, which frequently give rise to violent con- vulsions in infancy, would occur less frequently if," as has been aptly said by a physician, " for ^ teething' we would read ' stomach and feeding,' and if we would always consider whether these are at fault, we might, although proving disagreeable and troublesome at times to the mothers and nurses, do more good to the suffering infants." If food is not such as the digestion can master, it is useless and can only do harm. Not being turned to proper account, the blood receives no new supply, and is impoverished ; there is no nourishment given for de- velopment of body, and inherited tendencies to various 2 14 sow TO FEED CHILDREN. diseases are encouraged by those whose duty it is to provide food of nutritious quality and to see that it is carefully administered. Many of the diseases to which children are liable would disaj^pear under strict supervision of hygiene and diet, especially the various intestinal disorders, incladmg many resultant throat, catarrhal, and nervous troubles. ^N^ature resents care- lessness, and is relentless in her punishments. What the doctor calls cholera infantum, rickets, or marasmus, etc., and the mother is inclined to consider a dispensa- tion of Providence, is only too frequently the direct result of violations of the most common laws of domestic science. This problem is always before the physician. Food and hygiene have entered so largely into the study of medicine that preventive medicine has become one of the features of the day, and departments for this study have been, and are being, opened in the most promi- nent universities in all countries. The truly success- ful physician is he who carefLilly studies the chemical properties of different foods and their application, and who not only understands but makes use of this knowl- edge in his practice. Much of his effort may be wasted, however, owing to lack of knowledge upon the part of those directly interested. Directions may be given with precision, but the untrained mother or nurse mil fre- quently err by not carrying out instructions exactly as given, and thus oflen retard the recovery and pos- sibly endanger the life of the patient. The whole study of nursery dietetics appears to be a vast one, yet it resolves itself into a few simple and generally acknowledged facts. For an infant, whatever WHY MOTHERS SHOULD STUDY DIETETICS. 15 is given as a substitute must resemble its natural food as closely as possible. That this can be done has been shown by expert analyses, and this fact is conceded by all leading specialists upon the subject. A legal enactment in France prohibits the giving of any form of solid food to infants under one year of age without the authority of a prescription from a qualified medical man. The employment of the rub- ber tube for nursing-bottles is also forbidden, as it is almost impossible to keep it clean. The passage of this law is due in great measure to the efforts of the Society for the Protection of Children, of which Dr. Bouchard is founder. The United States Department of Agriculture at Washington has also taken up the matter of infant foods in connection with reports upon tuberculosis. A circular is issued by this department, giving simple directions for the treatment by heat necessary to make milk a safe food for infants. The establishment in Boston, in 1891, and later in New York and Philadelphia, of the Walker- Gordon Milk Laboratories, opened a new field in the province of infant feeding, and results, as stated elsewhere, show conclusively the advantages that have been gained thus far. These and similar movements are important and practical, and they should fully demonstrate to the thinking mother the necessity for her study in this direction. Following infancy comes the more difficult period of childhood, although not usually considered so, when necessary supplies of nutriment must be furnished to repair the constant waste caused by the active growth of the child. It frequently happens that a plump, 16 HOW TO FEED CHILDREN. vigorous-looking infant develops into a thin, unhealtliy- looking child. It is at this time that the constituents of various foods for practical results should be thor- oughly understood, the amounts necessary for various periods should be comprehended, and methods of ad- ministration and preparation should be closely studied. No amount of general kaowledge will be of service at this period ; special study is required. The laws of heat and change of tissue by applied heat must be learned. The proper proportion of albuminoids, salts, starches, and sugar must be considered under different conditions. The relation of fat to food as an aid to digestion, under what conditions to use it, and in what form and quantity to apply it, whether as cream or butter, olive or cod-liver oil, must all be carefully studied. In selecting the food for a growing child special diet lists must be consulted, and they must be reliable. It is in this connection principally that the mother will find of value her knowledge of the chemistry of foods, the science that tells us what things are made of, and how their elements combine with others to produce certain fixed results. Knowing the chemical composition of foods, she can use her knowl- edge to provide palatable dishes with no loss of nutri- ment. Indeed, possessing the elementary knowledge only, she can economize time, labor, and money. Constant suggestion in this field may prove of un- told value when sufficiently practical to guide the mother in her selection of menus from lists of foods that have been dietetically considered and given as suitable for the requirements of a child in average health and condition. Foods that are especially suita- WHF MOTHERS SHOULD STUDY DIETETICS. 17 ble for various forms of illness should be included in these lists, and recipes allowed should be only those that have been tried and found advisable, considered in every way, from a practical as well as a dietetic point of view. Such specific knowledge, if thoroughly comprehended and followed with intelligence^ would aid physicians materially in their efforts to lay for children a firm foundation for the future. Following the period of childhood comes the time for the study of estimating correct quantities and proper selections of food to be used in regulating the diet suited to the individual needs of girls and boys approaching maturity, the excesses to be avoided by those of sedentary habits, and questions of similar import. Relative to this whole subject Sir Henry Thomp- son, a noted English physician, and an authority upon dietetics, says, " I have come to the conclusion that more than half the disease which embitters the middle and latter half of life is due to avoidable errors in diet (to which might be added, ^more particularly in early years'), . . . and that more mischief in the form of actual disease, of impaired vigor, and of shortened life accrues to civilized man . . . from erroneous habits of eating than from the habitual use of alcoholic drink, considerable as I know that evil to be.'' General knowledge is of very little use in this study beyond directing attention to the need existing for special knowledge. What appears to be one of the most practical phases of this many-sided subject is that this special knowledge must be supplied to b 2* 18 HOW TO FEED CHILDREN. mothers by scientists, by physicians, and by those among the laity who are sufficiently interested in the subject to assist by giving data secured through per- sonal experience. The science of household affairs must be understood if reform is to be looked for. Endowments must be made to enable scientists to make researches of the highest order. Simplified re- sults may then be given to the public in such a manner that they will be assimilable and readily comprehended by the average intellect. Schools, public and private, should not overlook the importance of this study. Then all mothers and home-makers in the land, those indirect nation-makers, will easily come to understand the underlying principles involved, and will apply this knowledge in such a way as to benefit all who are dependent upon their efforts. Herbert Spencer says, " Perhaps nothing will so much hasten the time when body and mind will both be adequately cared for as a diffusion of the belief that the preservation of health is a duts'^. Few seem conscious that there is such a thing as physical morality. Men's habitual words and acts imply that they are at liberty to treat their bodies as they please. The fact is, all breaches of the law of health are physical sins. When this is generally seen, then, and perhaps not till then, will the physical training of the young receive all the attention it deserves.^' CHAPTEE 11. Infant Feeding. Natural Feeding — Food for Mothers — Wet-Nurse — Substitute Feeding — Modification of Milk — Purpose of Milk Laboratories — Weaning. T. M. EoTCH, M.D., of Boston, Professor of Dis- eases of Children at Harvard University, President of the Pediatric Society, etc., says, ^^ Just as the highest aim of medical art should be directed to the province of preventive medicine, so the highest and most prac- tical branch of preventive medicine should consist of the study of the best means for starting young human beings in life. . . . It is a proper or an improper nutri- ment which makes or mars the perfection of the coming generation. . . . We should be guided by what nature has taught us throughout many ages in studying the form of nutriment suitable for an especial period of life.'' Because of Dr. Botch's high standing and vast experience, his statements command recognition every- where, and such of his most recently expressed views as are likely to be of interest to those in charge of children are embodied in the present chapter. The superiority of human milk to all other kinds of infant food is universally acknowledged. Dr. Botch has divided the nutrition of young human beings into three distinct nutritive periods, corresponding to the stages of their development. The first period consists of the first ten or twelve months of life, and it is at this 19 20 BOW TO FEED CHILDREN. I time that human milk must be considered. Mother's milk, when of good quality, which must be determined by results, is conceded by all to be the most desirable food for infants. The younger the infant the more important the breast nursing, as it is extremely difficult to prejDare a food that will agree at this age. Every effort should be made to nurse a child for at least three or four months. A large number of infants are de- prived unnecessarily of their natural food. As knowl- edge increases this will, undoubtedly, occur less fre- quently. Mothers do not err usually from lack of feeling, but from want of knowledge as to ways and means. In no respect is there seen more lamentable ignorance, and maybe carelessness, than in this direc- tion. Mothers rarely know the conditions requisite for the satisfactory nursing of a child. To nurse a child normally, a mother should be strong and healthy, of an even, happy temperament, desirous of nursing her infant, and she should have time to devote herself to this SjDecial duty during the whole period of her lac- tation. She should have a sufficient supply of milk, and should be willing to regulate her diet, her exer- cise, and her sleep according to the rules which will best fit her for her task. These may be said to be the ideal conditions for the nursing of an infant. It is true that women who are far from vigorous nurse their infants with seemingly good results, and that a frail, delicate-looking mother may have an abundant supply of good milk. These are exceptions, however, which make the principles just stated all the more true. Emotional mothers do not make good nurses. With few exceptions, the mothers who have uncon- INFANT FEEDING. 21 trollable temperaments^ who are unhappy, who are unwilling to nurse their infants, who are hurried in the details of their life, who are irregular in their periods of rest and in their diet and exercise, are unfit to act as the source of food-supply for their in- fants. Even if their milk happens to be sufficient in quantity, it will probably be so changeable in quality as to be a source of discomfort, and even of danger, rather than the best nutriment for their offspring. The influence of emotion on mother's milk is very great : in some cases it acts as a direct poison. It is far better for such mothers not to attempt to nurse if they cannot regulate their lives, but to adopt some other method of feeding. It is of still greater importance that mothers who are suffering from some chronic disease, or one which their infants may directly inherit, should give up all thought of nursing. A nursing diet should not include too much meat and solid food ; an abundant light diet should be given at first, — milk gruels, soups, vegetables, bread and butter, and after the first week a small amount of meat once a day. Increase the diet with exercise, using plain but nutritious foods, taking regular meals, and frequently additional ones of milk, cocoa, etc. Use no stimulants ; malt extracts are useful; drink milk at night. The food of a nursing woman is closely connected with that of her infant. Idiosyncrasies must be looked for, and if cer- tain articles disagree with certain women, and con- sequently with their children, they should be omitted from their dietaries, but they need not be forbidden to all women on this account. " For the average woman, a plain mixed diet, with 22 HOW TO FEED CHILDREN. a moderate excess of fluids and proteids oyer what she is normally accustomed to, will, as a rule, give the best results.^^ (Rotch.) Exercise is important in regulating the constituents of human milk. It is to be taken according to the strength of the woman in question. A walk of one or two miles daily, or an equal amount of similar exertion, is necessary in almost all instances to reduce the proteids in human milk to the proper proportion. Mothers frequently wonder why their children have colic, when the reason is to be found in their own sedentary lives. This is very well illustrated in a case cited by Dr. Rotch, of an infant that was being nursed by its mother, who was healthy, and who had an abundance of breast-milk. The infant during the first two months of its life nursed well, throve, and was perfectly quiescent in its daily life. When it was three months old the mother was very much worried by some trivial family matters, and did not take much exercise. The infant now began to have colic, and, although it gained in weight, it was very restless, and cried continuously. The indications for treatment, as shown by an analysis of the mother's milk, were to lessen the amount of mental disturbance in the mother and to make her exercise more. The mother followed directions, and the infant improved. After a few days the unfavorable symptoms returned, and it was found that the mother had not been exercising, and was again mentally disturbed. Suitably modified labo- ratory milk, containing a very much smaller percent- age of proteids than the analysis of the mother's milk showed, was then used, and the child digested the food INFANT FEEDING. 23 perfectly, had no colic, and gained in weight. Later, a change to a wet-nurse was made, with ensuing diffi- culty, as her milk had too high a percentage of proteids. The child became ill, lost weight, and its bowels were affected. Ai last the mother decided to return to the use of the laboratory milk, which was given low in proteids ; in twenty-four hours improvement was marked, and from that time on gain was steadily made. This is only one of the many interesting accounts of the work being done by physicians with the aid of milk laboratories. Mother's milk may vary in quality and quantity. Frequent analyses should be made ; this can be done by any physician, approximately, by the use of the method devised by Dr. Holt. The apparatus is inex- pensive and of assistance to those physicians who are endeavoring to solve the problem of infant feeding, but who may be beyond the reach of laboratories and the opportunities afforded in large cities. It is of the utmost importance for any nursing mother to have an analysis made of her milk when the child is thriving, that in the event of her sudden death, illness, or ab- sence the same constituents of food may be provided, thus avoiding all risk of illness to the child from a change to an unsuitable substitute food. It should be the duty of every family physician to see that this is done. Human milk may be considered as representing a combination of foods. Experience shows that the digestive capabilities of infants differ just as do those of adults, and that nature provides a number of varie- ties of good liuman milk adapted to the various idio- syncrasies of infants. 24 sow TO FEED CHILDREN. "Young animals at birth begin to receive their nourishment immediately, and a corresponding increase in their weight takes place from the first day of life. The human infant, in like manner, should begin with its nursing early, getting what it can from the breast until the full supply of milk has come. In this way it will not be likely to have a large initial loss of weight to regain. . . . Every hour, every day, is of the utmost importance in the early days of life, and, provided it can be done without detriment to the condition of the mother, the sooner the infant is put to the breast the better. If, during the first two or three days of life, it is restless and evidently hungry, on account of the mother's inability to supply milk, one to two drachms of a five per cent, milk-sugar solution, made by dis- solving milk-sugar in sterilized water, should be given at intervals of two or three hours.'' If the mother's milk is delayed still longer, something additional must be given to the infant, and if the food cannot be ob- tained from a milk laboratory, the proportions for home preparation should be exactly specified by the physician in charge. The intervals constitute a very important part of the management of breast feeding where the quantity is regulated by the breast itself They should be defi- nitely stated to the mother at different times through- out the nursing period, and should be adhered to. The table given by Dr. Rotch as an average rule, with the caution that the intervals of feeding be made to correspond to the stage of development of the indi- vidual, is as follows ; INFANT FEEDING. 25 The day feedings are supposed to begin with the 6 a.m. feeding and to end with the 10 p.m. feeding. Age. From birth to 4 weeks From 4 to 6 weeks From 6 to 8 weeks . From 2 to 4 months . From 4 to 10 months From 10 to 12 months Intervals. hours hours hours 2J hours hours hours Number of Feedings in 24 Hours. 10 9 8 7 6 5 Number of Night Feed- ings. 1 ' 1 1 Note that night feedings are omitted at two to four months. The mother may thus have continu- ous sleep at night and get the rest necessary for condi- tions requiring it. Too frequent nursing renders milk too solid, lessens the water, and gives the child colic ; too long intervals make the milk too watery to give nutrition. The importance of regularity at proper intervals cannot be overestimated for the comfort alike of mother and child. An infant should nurse about fifteen minutes ; this will be found to be usually long enough to empty one breast, which should be sufficient for one feeding. A period of nursing longer than the usual fifteen or twenty minutes before the child is satisfied should make us suspicious that the milk is lacking in quantity, which can be determined by weighing the child before and after nursing, at dif- ferent nursings in the day, before reaching conclu- sions. Increase of weight is the best evidence as to nutrition. Dr. Edward P. Davis says a child may gain by proper food from a half-ounce to an ounce daily for the first four or five months, and half the amount for the rest of the year. The appearance of 26 HOW TO FEED CHILDREN. the stool is also an evidence of nutrition. In an in- fant it should be half solid, bright yellow, and free from partially digested milk. In certain cases the mother's nipple is so small or depressed as to give trouble in nursing. Nipple shields will sometimes be of assistance. In cases of extreme pain a little patience for a fcAv days will bridge the difficulty and prevent the loss of the child's greatest blessing. Bathing with cold water before and after nursing keeps the tissues in healthy condition. In cases where the child cannot obtain its food through a shield or from the breast from lack of suction power, the breast-pump becomes of value. The practical deductions to be drawn from known experiments demonstrate that in cases of illness of the mother or unavoidable absence from an infant the breast-pump may be used regularly to relieve the breast of the mother until such time as she may resume nursing, w^hilst the babe may be fed according to the analysis which the physician should have made beforehand and kept in readiness for reference under the possibility of just such circumstance arising. Drugs must be used very carefully. Laxative med- icines will frequently affect a child, and they should always be given with caution. Dr. Rotch speaks of one instance of a mother's drinking porter every day, which caused her nursing child to vomit for weeks. She stopped taking it, and the vomiting of the infant ceased. The return of menstruation does not necessarily in- dicate that there should be cessation of nursing. The only disturbance which is likely to arise is a slight Breast-pump. INFANT FEEDING. 27 attack of indigestion, whicli will in all probability dis- appear under normal conditions in a day or two. If this is not the case and the milk appears to disturb the chikPs nutrition continuously, a physician should de- cide whether weaning is necessary. Pregnancy is not compatible with nursing; hence weaning is imperative, but if a child is delicate or ill, it must not be done suddenly. Five or six weeks should be taken to do it, using modified milk prepared according to an analysis of the mother's milk that should have been made before the disturbance arose. If at any time the mother's milk seems insufficient, it may be supplemented with properly modified milk by one or two feedings a day at any age, from six weeks up, it necessary. So long as a child gains in weight, nursing may be continued up to eight or ten months, according to the season of the year; if, how- ever, the child does not gain, substitute feeding may be used at any age, but the substitute food must be made to resemble the mother's milk as closely as possible. If teething is delayed, it is an evidence of poor breast- milk, and substitute feeding should then be begun. A well-nourished child should grow about eight inches the first year (or nearly three-quarters of an inch every month) and four inches the second year (not quite half an inch a month). An infant should double its weight in six months, and treble it in a year. It should be weighed and measured monthly. If it does not increase at the rate of about one pound a month the first year, and about twelve ounces a month the second, it is advisable to see to its nutrition, which will, in all probability, be found to be at fault. A 28 HOW TO FEED CHILDREN. nurse should cease nursing if these conditions are not present. Premature children should increase in the same ratio. The employment of a wet-nurse requires careful consideration, and should be done under a physician's advice only. All the points which have been referred to for successful maternal nursing are of equal signifi- cance in the case of a wet-nurse. For many reasons, such as expense, difficulty in securing one whose milk will agree, hereditary taint, ungovernable temper, etc., this method of feeding is usually out of the question ; hence indirect substitute feeding must be instituted in the majority of cases. If a v/et-nurse is employed, her diet and habit of life should remain as nearly as possible like what she has been accustomed to. Under all circumstances, even if a mother is healthy and the milk good, by the end of the first year wean- ing should have been accomplished. Unmodified cow's milk and starch in some form are much better adapted to the child at this time, and should be substituted for mother's milk. If a child has been properly weaned, it can easily digest them at this age. The presence of six or eight incisor teeth allows a change to be made in the food, and the use of starchy foods follows, but it is usual for children to be unable to digest these foods to any extent until the last two or three months of the first year. The period of nursing may be shortened or lengthened by a month or two, according to the season of the year, the comiug of the teeth, or the condition of the child from illness or convalescence. Under such circumstances it may be wiser to feed the infant from the breast during summer, and to wean it INFANT FEEDING. 29 in cool weather, before or after the hot season, accord- ing to the individual case. It is also preferable to wean when the child is not cutting teeth, as disturb- ances may arise. Sudden weaning should never occur ; sufficient time should be taken, and the food substi- tuted must be gradually given. If home modification of milk is depended upon, give one bottle in place of a nursing for a few days, watching the child carefully to see if the new food agrees ; then two bottle feedings, replacing two nursings, preferably one in the morn- ing and one in the afternoon ; after a few days three ; and so on until every meal is given from the bottle. If the milk is properly modified, weaning should be a very simple matter in ordinary cases. Dr. Rotch says the method he finds safest and best is used in connection with the milk laboratory. If an infant is thriving upon its mother's milk, he has the milk analyzed, and sends for the same percentage of the elements in the substitute food to be used. After using this for a few days, if he finds the milk agree- ing with the infant, he changes the constituents grad- ually, with the object of gradually combining these percentages in such a way as to correspond to the percentages of the elements of unmodified cow's milk. He shows how this is easily and precisely accomplished, and fully explains the use of milk laboratories where such exact methods are followed. At the tenth or eleventh month, before the breast-milk has been en- tirely withdrawn, starch in some form, as advised by the physician, should be added to the milk, and, if it agrees, the breast can be altogether replaced by substi- tute feeding. 3* INFANT FEEDING. 31 who knows, instead of presuming to know it all her- self. Too much stress cannot be laid upon the necessity in infant feeding for mothers to consult physicians in regard to substitute feeding, and all important changes to be made, and equally upon a strict following to the letter of all directions given, not relying too implicitly upon others for supervision where personal attention is necessary. If this be done, the physician will be aided, not hindered, as he now so frequently is, in his efforts to reduce infant mortality and increase the strength of those who survive. Proprietary artificial foods are entirely unnecessary when cow^s milk and cereals may, with the requisite knowledge, be prepared at home. They are a useless expense for older children, unsuitable for infants, and altogether the weight of opinion is against their use. If in weaning a child the laboratory method or home modification cannot be followed, on account of care- less servants, nurses, etc., the Fairchild process will be found satisfac^tory at any age or season, one bottle taking the place of a nursing at first, two in a few days, and so on. For infants hand-fed from the first, in cases where a physician or laboratory methods are not available, this process should be tried before resort- ing to the mixtures advised on labels and advertising pages as "the only food for infants," or "just like mother's milk," etc. Ideal weaning should be completed at twelve months if gradually done. If, on account of illness of the mother, or for any other imperative reason, it must be done in summer, the process mentioned above will, in 32 JSOW TO FEED CHILDREN. all probability, meet all requirements if a physician's advice cannot be had. After the change from breast- milk has been entirely made to modified milk, the advance to clear milk must be graduated with equal care by substituting one bottle only in place of the modified milk, in a week another, and so on ; then when the change is completely made, cereal foods must be used just as gradually, the undiluted milk being kept for the base of the child's food throughout the second year, as indicated elsewhere. The fat necessary for an infant's food is in the cream. Constipation is a frequent result of lack of fat in both nursing infants and those fed by substi- tute feeding. A nursing mother may correct such constipation by eating more meat and taking more exercise. A bottle-fed baby needs more fat (cream) in its food. Condensed milk and malted milk are both lacking; in fat, and when children are said to thrive upon these foods it will usually be found upon inves- tio^ation that cream has been added. I remember one instance in which this was particularly noticeable, as the child's parents told me, in refutation of my state- ment that modified cow's milk was best, of the ex- ceptional weight and condition of their child, who had, as they said, been fed altogether upon condensed milk. Upon close questioning I discovered that cream had been used generously, which explained to me very satisfactorily the causes at work in this instance. The test of a child's condition does not always reveal itself upon casual observation. The true test is shown in its resistance to the various forms of disease so generally supposed to be children's necessary ailments. Many INFANT FEEDING. 33 of them result from carelessness, and are called chil- dren's diseases only because at this period of slight resistance the greatest amount of ignorance and care- lessness is usually displayed, with consequent disas- ter to the little ones. As the knowledge of hygiene and dietetics in the nursery becomes more general, the infant's chances of life will outweigh those of death. Some modification of cow's milk is necessary for substitute feeding. It is the universal source of sup- ply for this purpose, and, as Dr. Rotch says, the various foods used are merely adjuvants of cow's milk, which does away with much misapprehension concerning the apparently successful results of in- numerable foods. What he says further upon this subject might be studied with profit by every one interested in the welfare of children : " It would seem hardly necessary to suggest that the . proper authority for establishing rules for substi- tute feeding should emanate from the medical pro- fession, and not from non-medical capitalists. Yet, when we study the history of artificial feeding as it is represented all over the world, the position which the family physician occupies, in comparison with that of the venders of the numberless patent and proprietary artificial foods administered by the nurses, is a humili- ating one, and should no longer be tolerated. " If we are abreast of the times, if we but recognize and do justice to the work which has lately been done by our own profession, we surely will not hesitate to relegate to oblivion the statements of the food proprie- tors, which on box and can, on bottle and printed circu- 34 HOW TO FEED CHILDREN. lar, attempt to stem the slow but inevitably progressing wave of scientific investigation. " It may be well to bear in mind that the attempts which in the past have been made to manufacture cheap foods have been markedly failures. We must first, regardless of expense^ learn to produce by modi- fication a perfected substitute food^ and not endanger the success of our undertaking by allowing the mer- cantile side of the question to cripple us in the use of costly methods^ which, however, Ave know to be the best. We should, in fact, remember that the human milk, which we are endeavoring to copy, far from being a cheap product, is a very expensive one. "^ly own opinion in regard to patent foods, as a whole, is that they must necessarily be unreliable. They are thrown on a market where the competition is extreme, and when once they have been advertised into public notice I cannot but feel that irregularities and changes — slight, perhaps, in the eyes of the makers — may unintentionally creep in and carry their composi- tion still fui'ther from that of the standard, human milk. " Analyses show that there is a lack of uniformity in these foods from year to year, and that original claims are apparently forgotten or allowed to give way to cheaper production. In fact, as my experience in the feeding of infants increases, and as I examine year by year the effects of the different foods on in- fants, I am strongly impressed with the belief that with our present physiological, chemical, and clinical knowledge all the patent foods are entirely imneces- sary. The claims made for them are not supported by intelligent and unprejudiced investigation. Those who INFANT FEEDING. 35 manufacture them are not in a position to judge cor- rectly concerning them. The merit at times of their apparent success does not belong to them^ but to ac- companying circumstances. They do great harm by impressing upon tlie public the false idea that a cheap, easily prepared food is for the good of the infant and is better than anything that can be procured elsewhere. They vary too greatly in their analyses to keep even within the acknowledged varying limits of human milk. It is therefore high time for physicians to ap- preciate exactly how inefficient in themselves and how misleading in their claims are these artificial foods, and also in what a false position, as the protector and adviser to the public, our profession is placed whenever it lends itself to even a toleration of their use. I speak of them here simply because there is no doubt that they are kept in the market by the physician rather than by the manufacturer. The latter is only doing what any capitalist interested in a business ven- ture would do. The former, it seems to me, is, per- haps unintentionally, aiding the business interests of others at the expense of his own future reputation as a scientist. It makes little difference to physicians as to what is claimed for these foods w^hen they are placed in the market. It makes a great difference what the mixture contains when given by the mother to the infant according to the directions on the label. For instance, a food may show by its published and certi- fied analysis a fair percentage of fat or sugar, and yet this same food when diluted for the infant's feeding may have these constituents reduced far below the reasonable limits of nutrition." 36 sow TO FEED CHILDREN. It is not generally known that every year in the United States alone thousands of children die for want of care in the preparation and administration of their food. Until within the past few years very little attention was given to the purity of milk or to the possibility of keeping it sweet for any length of time. Infected milk is one of the chief sources of con- tagion in consumption, scarlet fever, diphtheria, and kindred diseases. The application of sufficient heat I (167° r.) to kill the germs which are dangerous to the child without destroying the quality of the milk as a food, is the only practical w^ay known of pre- venting contagion and keeping milk sweet for the time required in infant feeding. Tlie proper care of milk demands purity of source, cleanliness in handling, and quick and careful transportation. Failing these, the application of heat is the only safeguard left to the mother to protect her child. Statistics show" that in hospitals wdiere this method has been introduced the death-rate of children, particularly of infants, has wonderfully decreased. This is not surprising when one hears that a single microbe, like the hay bacillus, found in all stables, is so prolific that at the end of twenty-four hours its descendants will be more than ten billions in number. This fact alone shows one immense advantage to be gained by the application of a sufficient degree of heat to kill all dangerous germs. The fact is generally conceded that pure milk will prevent much infant disease and mortality, and bacteriologists have fully demonstrated the necessity for this process by showing that milk is rarely 23ure. Dr. Chapin says that in six hundred infants whose INFANT FEEDING. 37 cases were studied, nearly all the troubles were acquired and not hereditary. ^' While a tendency to constitu- tional disease may be inherited, it is the bad surround- ings and the faulty conditions of life that powerfully predispose to illness/^ the chief sources of difficulty being poverty and ignorance. He says the waste of child-life in densely populated centres, especially in New York, is enormous. In the year 1893 the bodies of three thousand and forty-two children under five years of age were received at the morgue, and nearly all were buried in Potter's Field, killed by poverty and ignorance, want of proper diet and care. In France, out of two hundred and fifty thousand infants that die annually, one hundred thousand might be saved by careful nursing, says M. Rouchard, President of the Society for the Protection of Children. This knowledge caused the passage of the bill forbidding the use of solid food for infants under one year of age, unless advised by a physician. A few facts like these will show to the educated and thoughtful woman why this particular branch of knowledge should spread until its influence takes effect in a marked degree upon the health of the children of the poor in large cities, who now have to struggle as best they can against sour milk, heat, dust, tenement-life, and all the evils and discomforts that attend the very poor, absence of cleanliness being generally the greatest evil. Those engaged in visiting the poor in cities where ignorance reigns supreme, reveal pitiful cases of poverty, care- lessness, and ignorance. Baby's milk is left uncovered all day long in the stifling atmosphere of one living- room, or is placed with other food in a sink, which 4 38 HOW TO FEED CHILDREN. becomes the refrigerator for those who cannot afford ice, and here absorbs germs by the million. The underlying truth of all the past and present agitation concerning the purity of the milk-supply and the problem of substitute infant feeding is that both have been sadly neglected for many years, with the pitiful result of a vast amount of suffering and many premature deaths of children from one to ^ye years of age, especially during the hot summer months, when it is so difficult not only to secure a pure supply, but also to protect the milk upon which these little ones depend. Comparatively few people stop to consider how quickly dangerous changes take place in this important article of food, and how readily it becomes contaminated by absorption of various volatile substances. This is par- ticularly true of those who have the immediate charge of milk. It is appalling to any one understanding the subject and its bearings to see the carelessness that is frequently displayed by the milkmen, maids, and nurses, all of whom play so important a part in infant dietetics. Is it any wonder that philanthropists, scien- tists, and physicians have combined in solicitous effort to provide a pure supply of milk and to show how it should be properly administered to save helpless and suffering infants? The subject is of infinite impor- tance, and the truths concerning it should be iterated and reiterated until satisfactory evidence has been given that persistence has been of some avail in changing existing conditions that are a reproach to our people and a menace to our health as a nation. Medical science has made important and rapid prog- ress in this direction, as is evidenced by the work INFANT FEEDING. 39 done by Drs. Rotch, Jacobi, Holt, and many others, and by the establishment of milk laboratories where a child^s food may be called for by prescription and be prepared with the same care as is ordinarily sup- posed necessary for medicines only. A brief outline of the work possible to be done with the assistance of these laboratories is as follows : the cows supplying the milk receive the care required to provide as pure a milk as it is possible to procure ; the milk is properly handled and cared for ; the cream is separated from the milk by a sej^arator specially adapted to the purpose; other ingredients, such as cereal jellies, lime water, boiled water, etc., required for the modification of milk, are held in readiness, and .all the materials used are clean, sterile, and exact in theii percentages ; the physician making use of labora- tory methods calls for certain percentages of foods re- quired in the especial case he has in charge ; the milk modifier simply follows directions. Dr. Rotch says, " An opportunity has for the first time in the history of medicine been presented for the physician to carry out his own methods, for the first time to be judged on a fair basis. In this way only can each clinical observer, when lacking in success, be sure that it is the fault of the food he is giving, and not because the food has varied from what he supposed he had ordered." Each day's feeding of each individual infant is re- corded. During the last three years Dr. Rotch has been able to test the value of this method by the feed- ing of nearly three thousand infants, and his data in the practical use of this system have been gathered by about four hundred physicians. He says he believes 40 HOW TO FEED CHILDREN. a new era has been entered upon in the province of infant feeding which will enable physicians to produce results that have never before been obtained. The first milk laboratory for the exact modification of milk that has been established in the world is the one that was opened to the public in 1891 in Boston under the name of the Walker-Gordon Laboratory. Since that time Kew York has had one, and one is now being established in Philadelphia. For those who are beyond the reach of these labora- tories, except by correspondence, Dr. Rotch, in con- junction with Mr. Gordon, has formulated a plan for the modification of milk at home. If mothers will study this plan practically they may materially aid physicians who are away from labora- tories in arranging a substitute food that will be likely to agree with the infant in question. It would be a very simple matter for any mother (relying upon her family physician for assistance in regulating ingre- dients) to follow these directions, if only in a general way, with advantage to her child, as they are based upon purity of source and handling of an infant's food, and caution and exactness in preparing, administering, and changing from one kind of food to another. Dr. Jacobi says a good food for a baby does not mean one which simply does not kill. It is one which j)ermits a child to grow up healthy and strong. To perfect a substitute food exactness is required. This is made possible by laboratory methods. The apparatus re- quired for home modification can be procured from the original laboratory in Boston, or from those in ISTew York and Philadelphia. It consists of a home steril- INFANT FEEDING. 41 izer, a thermometer to indicate the heat within the can, tubes for the milk, a roll of aseptic, non-absorbent cotton for stoppers, a cozy, an 8J-ounce glass graduate divided into half-drachms, a milk-sugar measure, hold- ing 3f drachms, which obviates the expense of having Sugar-measure. the milk-sugar put up in packages by the apothecary, and is sufficiently exact to regulate the sugar per- centages in the mixtures likely to be directed by the physician (if preferred, one pound may be divided into thirty-five packages, one package to be used instead of a measureful), and, finally, a glass siphon, which is a very necessary adjunct in preparing an infant's food. "It should be a glass tube one-quarter to one-half inch in diameter, and it can be bent in a gas-flame. The end out of which the milk is to flow should be at least six inches longer than that which is to be inserted in the jar. To operate the siphon, fill with boiled water, close the longer end with the finger, invert the siphon, and place the shorter end in the milk (at the bottom of the jar). Then withdraw the finger, and the water, followed by the milk, will run out of the long arm of the siphon. Do not use the mouth to start the flow of the milk through the siphon under any circumstances." (Rotch.) Every direction must be followed with care as to the minutest detail. Herd milk is preferable to that of 4* 42 HOW TO FEED CHILDREN. one cow ; the cows should be of common breed, and such as give a moderately rich milk ; the milk should be drawn with clean hands ; the udders and teats of the cows should be cleansed, and the cows should be milked in as clean a place as possible ; the milk should be thoroughly strained. The milk should then be set in a vessel containing ice and water with some salt in the proportion of one teaspoonful to a quart of water, and the vessel be set in some clean place. A clean, freshly boiled cotton cloth is next to be thrown over the uncovered quart jar. The mouth of the jar is to be kept open for about fifteen minutes, to dispose of animal heat. The jar is then sealed tightly, as you would for preserving, and is left in the ice water for six hours, care being taken that the water does not fall below 1.66° C. (35° F.). City milk as delivered in jars is supposed to have gone through the cooling process, and if it must be used for children's food it should be siphoned, in the manner already described, after the cream has risen. It is possible in some cities — i.e., New York, Boston, and Philadelphia — to secure milk, in limited quantity, that is only a few hours old ; this should be used in pref- erence to ordinary city milk, which is usually twenty hours old by the time it reaches the consumer. At the end of the time required for the rising of the cream, siphon out carefully from the bottom of the jar with the siphon described three-quarters of the milk into a clean glass vessel, leaving half a pint of cream containing ten per cent, of fating the jar. You now have in a separate vessel the milk necessary for dilu- tion, containing the proteids. Some clean drinking INFANT FEEDING. 43 water should then be boiled for five minutes, which, with some fresh lime water and the milk-sugar in packages or measure, prepares you for following your physician's advice as to percentages. Inasmuch as every child requires different percent- ages in the same way that every adult needs food suited Jar containing millr, cream, and siphon. C, cream; M, milk; S, siphon. to his capabilities in various directions, it is manifestly impossible to give a routine mixture, and this part of infant feeding should always devolve upon the family physician, who is much better able than the mother to decide as to the constituents required for various ages and conditions of health and illness. The above di- rections are given in the hope that mothers and others 44 HOW TO FEED CHILDREN. of the laity wlio are in charge of children will realize the necessity of going hand in hand with physicians who are working faithfully to reach a safe basis for infant feeding. Mothers and nurses can aid materially in this work if they will only take the initiatory steps and make themselves competent assistants in work of this kind. Dr. Seibert, of K^ew York, has recommended a system of filtering through a thin layer of clean ab- Dr. Seibert's funnel. sorbent cotton, which plan is supposed partly to re- place in families the centrifugal method of large milk establishments. A writer on this subject in the jS"ew York Iledical Journal speaks of the gross filth that is removed by this process, and says, "It not only keeps dirt out of the nursing-bottle but also out of the alimentary canal of the infant, where, not being digestible, it is reinfected and can only do harm." It is said that the bacteria in milk are reduced in num- INFANT FEEDING. ' 45 bers one-half by this method of filtering. Dr. Seibert has had made for the purpose carefully prepared cotton disks and funnels. Taking it for granted that the above directions have been followed, and that the physician has given the formula required for immediate use in the case of whatever infant is being fed, the next point to be con- sidered is the purity of the milk that is to be used. In some exceptional places, and under some exceptional circumstances, milk may be so well cared for as to be comparatively free from bacteria, and the cows riiay be known by test to be free from tuberculosis, but in the majority of instances this cannot be relied upon ; hence the better plan is to heat the milk to 75° C (167° F.), a temperature sufficiently high to kill those developed bacteria which would be of any harm to the digestion of the infant, and at the same time low enough to prevent changes that are now acknowledged by nearly all physicians to be undesirable in an in- fant's food, — changes that are caused by the tempera- ture (212° F.) formerly advised for the destruction of germs existing in milk. The temperature of 75° C. (167° F.) allows the milk to remain practically fresh, uncooked, and sterile. The higher degree of 100° C (212° F.) may be used in case of journeys, and when the milk, for unavoidable reasons, must be kept for a period longer than twenty-four hours ; but for ordinary usage in the family this temperature need not be con- sidered, unless under a physician's advice ; as, for ex- ample, in cases of summer complaint in early infancy, when the higher temperature might be desirable. The degree of 167° F. may be applied to the entire mixture 46 sow TO FEED CHILDREN. of ingredients called for, including the lime water, which is changed by the higher temperature of 21 2° F. ; hence, in the event of 21 2° F. being used, the lime water must be added to each feeding when it is given to the child. There are various devices offered for the application of an exact degree of heat to milk, notably the Walker- Gordon laboratory sterilizer, the Arnold steamer. Dr. Freeman's pasteurizer, and one designed by Dr. Decker, of Kingston, New York. Exact directions are given with each, and any one of them may be readily pro- cured by any druggist. The Walker-Gordon sterilizer is constructed upon scientific j^rinciples, and is to be used with a thermometer. Dr. Rotch's directions in " Pediatrics'' for the use of this apparatus are as fol- lows : " The recjuisite amount of food for one feeding is poured into each of the tubes. They are stoppled with cotton- wool, care being taken to have a reasonably tight stopple in and a dry neck to the tubes. The tubes are then placed in the rack and lowered into the sterilizer, and the water in the sterilizer is adjusted to the level of the milk in the tubes. Heat, by means of a lamp or stove, is then applied to the sterilizer, which is watched, with the cover off, until the ther- mometer shows that the water-bath has reached a point of 77.2° C. (171° F.). The lamp is removed as soon as this temperature is reached, the cover put in place, and the cozy over it. The thermometer should mark a temperature of between 75° C. (167° F.) and 77.6° C. (170° F.) for thirty minutes, at the expiration of which time the tubes are to be removed from the steril- izer and are to be kept in a cool place, preferably the ice-chest, until needed.^' INFANT FEEDING. 4=? The Freeman pasteurizer was designed very accu- rately for household convenience by Eowland Godtrey Freeman, M.D., of ISTew York, and is said not to require the use of a thermometer, as a definite tem- perature of about 75° C. (167° F.) is reached by the process. (Patent applied for.) R, reservoir; C, cover; W, water-gauge; S, support for rack; T, ther- mometer; K, water-cup for thermometer; Z, water-tap; X, rack; H, handle ; B, cell; A, sterilizing-cap for cell ; P, the same corked with cotton. The Hygeia sterilizer is arranged so that the ther- mometer can be watched without taking off the cover, and it is made to hold the bottles mentioned elsewhere. 48 HOW TO FEED CHILDREN. The Arnold steamer has several improvements. It is to be used with a thermometer, thi'ough a perfora- tion in the lid. A book of instructions is soon to be issued, which is said to give exphcit directions for INFANT FEEDING. 49 ■^? reaching the required degree both with the old and the new style steamer. The care of bottles, nippies, etc., is naturally an important part of infant feeding. The seamless nip- ples made in Philadelphia, and described by me some years ago in " Babyhood,^^ are remarkably easy to keep clean. They are very smooth, care- fully punctured (a very tiny hole being necessary, that the infant may not receive its food too fast), easily cleaned, and they never collapse. When clean and dry they should be kept in a covered box or dish, or wrapped up in a clean napkin, and just before using them they should be dipped in boiling water. This must not be omitted. The usual plan is to keep them in a tumbler of water contain- ing soda, etc. I have tried both ways, and am convinced that the former method is preferable. The ^^ Hygeia'^ nursing device marks a step in ad- vance in nursery bottles and nipples, as may readily be seen from the accompanying illustration. It was designed by a physician * to resemble in every possi- ble respect the natural source of an infant's food, and the greatest evident advantages are the ease with which both tip and bottle may be cleansed, the doing away with both funnel and brush, the resemblance to the mother's breast (as a child frequently refuses the bottle, when being weaned, on account of the size of the PAT.JUNEig^l894j * William More Decker, M.D., Kingston, New Yors. d 5 50 S:OW TO FEED CHILDREN. nipple), and the slow feeding resulting from the care- fully punctured holes. Milk-bottles can be thoroughly cleaned by rinsing first with cold water, then washing with hot soapsuds and a bottle-brush that is clean. The brush requires as much care as the bottles, a fact that is sometimes overlooked. Rinse the bottles, both inside and out, in an abundance of flowing clean water, preferably under the cold-water faucet, and examine each bottle care- fully to see that there is no cloudiness or speck of milk remaining. They may then be placed in the rack and set in a moderately hot oven for an hour, when they will be sterile and ready for use, or they may be put over a fire in a boiler filled with cold water, to boil for half an hour, when they should be carefully drained and kept free from dust. Experiment will show that the oven method is preferable, as the bottles are dry and ready to be put away when removed from the oven. Care should be taken to cool the oven slightly by opening the door a few minutes before re- moving the hot bottles. This will prevent the cracking that might result upon sudden exposure to the colder air of the room. After an infant has been fed, the empty or half- empty bottle of milk should not be allowed to stand for any length of time. It should be emptied directly, or as soon as possible, and be rinsed with cold water. It may then await a convenient time for washing the entire number used that day. A careful nursery-maid will, however, wash and heat the bottles as fast as they are emptied, which is decidedly the best plan. Phy- sicians and fathers know, if no one else does, how INFANT FEEDING. 61 frequently the presence of a baby in the house insures the appearance at all times and in all places of half- empty or unclean-looking milk-bottles, which un- doubtedly cause much of the illness usually ascribed either to the visitation of Providence or to a sup- posedly impure supply of milk. Careful observation will convince many that not one cause alone is the source of evils met with constantly in infant feeding. The intervals in substitute feeding must be care- fully considered. Dr. Rotch's table for intervals in breast-feeding (p. 25) applies equally to substitute feed- ing. His table for amounts is as follows : GENERAL RULES FOR FEEDING DURING THE FIRST YEAR. The day feedings are supposed to begin with the 6 A.M. feeding and to end with the 10 P.M. feeding. <« a . «M to ■ ~ ■" r^ o to Age. 1% 0) o umber ediugs 4 Hour umber Night 'eediug Amount at each Feeding. Total Amount in 24 Hours. 1— 1 ;zi^=^ ^ « CO. Oz. C. C. Oz. 1 week 2 10 80 1 300 10 2 weeks 2 10 45 n 450 15 4 weeks 2 9 75 ^ 675 22^ 6 weeks 'Ih 8 90 3 720 24 8 weeks 2h 8 100 H 840 28 3 months 2h 7 120 4 840 28 4 months 2i 7 135 H ' 945 3U 5 months .... 3 6 165 5i 990 33 6 months 3 6 175 5| 1035 34J 7 months 3 6 190 H 1125 37^ 8 months 3 6 210 7 1260 42 9 months 3 6 210 7 1260 42 10 months 3 5 255 H 1275 42i 11 months 3 5 265 8| 1312 43J 12 months 3 5 270 9 1350 45 The above table is given as a safe average to begin with. Dr. Rotch says it is so important to avoid stretch- 52 HOW TO FEED CHILDREN. ing an organ so easily distensible as the stomach that it is wiser to give too little lather than too much food in the early days of life. An unusually heavy child might require a little more ; for instance, a child weigh- ^ Cv^ r ^ z— — oo 0^ ing ten pounds at birth would, according to tables regulated by weight, require IJ ounces instead of 1 ounce at a feeding, if in a healthy condition ; but this the attending physician should determine. Dr. Rotch advises the use of a set of graduated feeding-tubes INFANT FEEDING. 53 during the more important periods of growth, for the purpose of continually impressing upon the mother and the nurse what the physician often has the opportunity of telling them only at the beginning of the nursing period, — namely, that the error is in giving too much food rather than too little. This error naturally re- sults when, as is commonly the case, the usual eight- ounce nursing-bottle is used at the very beginning of infantile life. He says he has found that he can easily convince most mothers of the mistaken zeal of nurses who advocate giving the young infant large amounts of food, by showing them the size of the infant's stomach at birth (A) and comparing this small tube (B) which corresponds to the stomach's capacity with an eight- ounce nursing-bottle. If my readers still think they can decide for them- selves upon " what to feed the baby/' in defiance 5* 54 HOW TO FEED CHILDREN. of well-established principles in infant dietetics, and ignoring the fact entirely that it is unsafe for the laity to decide upon so important a question, it is to be hoped that they will at least bear in mind the follow- ing facts : that it is at all times advisable (1) to insure purity of milk by heating to about 167° F. for tenor B i:^ fifteen minutes, (2) to dilute milk with boiled water, for the first nine or ten months of the first year of an infant's life, beginning with at least half water to half milk for an infant one month old, (3) to add cream to each bottle of diluted milk in order to supply the fat lost by dilution, (4) to add milk-sugar and a little lime water, according to some reputable physician's INFANT FEEDING. 55 formula, or that of a milk-laboratory, and (5) to add carefully prepared cereal foods very gradually at the proper time, not before eight months under any cir- cumstances, and preferably not until the end of the first year. If, however, the whole duty owed to chil- dren is fully appreciated by those in charge of their welfare, all uncertain methods will be avoided and every point relating to the feeding of a child, from in- fancy to adolescence, will be carefully considered and its importance be fully estimated. Dr. Rotch says truly that the subject is a great one, worthy of the attention of the greatest minds of the age, and that the responsibility of discussing so serious a question is a grave one, that should be taken up carefully and dealt with broadly. He says 'Hhe preventive medi- cine of early life becomes pre-eminently the intelligent management of the nutriment which enables young human beings to breathe and grow and live.^^ CHAPTEE III. Cereals, Bread, Crackers, and Cake. CEREALS. Cereals are a necessary food for growing children, as they are rich in the constituents required for energy and for tissue-building, and promote fine muscular de- velopment. As more of tissue food is needed when the body is growing rapidly than in adult life when repair alone is called for, cereal foods must not be neglected at the proper time. Starch being the pre- dominant constituent, it is evident that great care must be exercised in cooking the various grains allowable in the nursery, always keeping in view the fact that a double boiler of agate or porcelain is necessary, and that long cooking increases digestibility. It is im- portant to know what you want to accomplish when cooking cereals. All starchy foods shonld be cooked long enough to be jDut in a condition to be easily acted upon by the digestive juices. The purpose in pre- paring them is to secure the bursting of the granules and the liberation of the starch by the highest tem- perature it is possible to reach, that it may be acted upon by the beat and be partially changed into a sub- stance called dextrine, which is easily digested. An extremely high and prolonged temperature is required for this change, without w^hich cereals are not nu- tritious and are likely to cause digestive troubles, 56 CEREALS. 57 Starch foods imperfectly cooked undergo fermentation, therefore it is necessary that this method of cooking grains be followed for the nursery. Diastase, a sub- stance found in growing grains and used in malt ex- tracts, is sometimes used for this purpose, especially for children who are ill or convalescent, as it effects a more complete change of the starch, thereby saving an appreciable amount of force in the alimentary tract, but it should be used by medical advice only, as a healthy child, if properly fed from the first, should not need it. The following cereals are all suitable for nursery use: granulated or crushed wheat, which is an all- year-round food, possessing no fat, and requiring cream to make it a perfect winter food ; cornmeal, a winter food, which builds up strong tissues and is useful in constipation; purified or cooked gluten, the latter of which is always ready for use; oat flour, from which a delicious blanc-mange can be made ; crushed barley, which, when properly cooked in milk or water, is an easily digested nursery food, and when mixed with gluten, half and half, stirred into cold water, and afterwards well cooked, is extremely palatable ; farina, which when subjected to high heat in preparation be- comes a desirable and nutritious nursery food, used either as a gruel, a porridge, or in desserts. The list of cereal preparations to be found for sale is endless, but for nursery use one need not go far to find a few perfectly prepared foods of this class that are assimilable when properly cooked, and Avhich will supply the needs of growing children in variety as well as in constituents. Being heat-producers, they 58 sow TO FEED CHILDREN. should be used carefully in warm weather ; white hominy, rice, gluten, barley, rye, and wheat prepara- tions are the most desirable, as they possess little or no fat. Farinaceous foods should not be used at all during the first year, unless by medical advice, and they must be used very cautiously even in the second year, when milk should still predominate as a food. Oatmeal is the usual cereal to begin with in the nursery, as it contains all the necessary elements for growth, including fat, but for this very reason, if the use of cereals is begun in warm weather, wheat is pref- erable. When cereals are first given to children after an exclusive milk diet, difficulty in digesting them is sometimes experienced. The change must be made very gradually. Fairchild's peptogenic powder may be used in a very simple and satisfactory way with cereals if any trouble is manifest, by sprinkling it lightly upon porridge or any starchy food, using care to have the food warm — not hot. AVhen used in this way it should not be relied upon for any length of time, but should be gradually discontinued as strength for digest- ing starchy foods increases. A little observation will soon show whether it is advisable or necessary. Where there is doubt the child's physician should be consulted. When used in this way it should be considered a tem- porary aid only. For preparing cereals the proportions of water, milk, salt, etc., may readily be learned from any cook- book, or from a little experience, individual preferences requiring various amounts for the consistency desired. Personally, I prefer the use of a larger proportion of BREAD AND CRACKERS. 59 water than Is usually given. They should be served preferably with salt and cream ; however, in cases of particularly active digestion and where dietaries are well regulated a little pure sugar (granulated) may be allowed. BREAD AND CE ACKERS. The government reports of the adulteration of bread with alum, sulphate of copper, ammonia, flours other than wheat, inferior grades of flour, damaged pease, ground rice, cornmeal, etc., should be sufficient to con- vince the most sceptical mother that for nursery use well-made home-made bread is infinitely preferable to ordinary baker's bread. According to these same re- ports, flour is rarely adulterated. For many years the white flour of commerce was considered the most de- sirable, but during recent years, with the advances made in the study of dietetics, the nutrient value of the gluten of the wheat grain has become appreciated, ana improved methods of milling have been adopted, which prepare wheat in such a way as to preserve the dark layer of gluten which, when remaining in the flour, changes its color from white to brownish yellow. This gluten is a necessary constituent for the perfect food that wheat should be, containing as it does all the elements that form muscle, blood, and brain, being de- ficient only in fat, which may be supplied, if desired, by the use of oat flour, in the proportion of one-third, but for general use for bread in the nursery there is little necessity for any meal beyond a good wheat flour, as the necessary fat may be supplied by the use of good butter spread upon the bread. For growing 60 HOW TO FEED CHILDREN. children who are restricted in a mixed diet whole meal bread is vastly to be preferred to that made from the whiter flours of less nutrition, as it supplies nutrients usually received by adults through other articles of food. Well-baked cornmeal bread or muffins may be used, at certain ages, in fall and winter, as an occa- sional variation, as cornmeal is heating, nourishing, and easily digested, but care must be taken to have the meal fresh, and not to use the bread when freshly baked ; in fact, all bread for the nursery should be at least one day old, and should be thoroughly baked. Very few people of the present day realize or will ac- knowledge how many intestinal disorders are caused by the use of new bread, hot biscuit, etc. Their use should be strictly forbidden in the nursery, and well- made bread or cake is always improved by being kept a day before using, care being taken to keep it — not wrapped in a cloth — in a perfectly dry covered box: tin being better than wood, as it does not grow musty. Good bread should possess moisture, but not noticeably so. It should be of a yellowish-white color, and have a sweet, nutty flavor. It should also be of such a con- sistency as to crumble very easily. Practical experi- ence is the best teacher when one is endeavoring to reach these conditions. The gluten flour advised above absorbs more water than ordinary starchy flours, and needs less yeast. Brewer's yeast, which gives a good flavor on account of the hops used, or good home-made yeast, is not undesirable, but in these busy days no one need hesi- tate to save time and trouble by using the commercial compressed yeast of deservedly good repute, as it an- BREAD AND CRACKERS. 61 swers every purpose. Heated railk may be used for mixing instead of water^ if preferred, but a very good bread may be made very easily as follo^YS, according to a recipe given by a cook who learned her art in Ireland. Her method reverses the usual directions in regard to the temperature of the oven, which, judging from the delicious results, is a very sensible procedure. The ease with which the bread is made will commend it to the busy housewife. Begin in the morning : Flour, three quarts, sifted in a large bowl ; Salt, two heaping tablespoonfuls ; Sugar, four heaping tablespoonfuls ; Water, or milk and water, two quarts, lukewarm ; Yeast, one cake ; Lard, three heaping tablespoonfuls. Put the salt, sugar, and lard into the flour, and rub the lard fine by crumbling it lightly between the hands. Use warmed flour, especially in winter. Flour should always be warm for best results in baking. A good plan is to keep constantly on hand near the fire a bag or covered pan of well-dried flour for bread, cake, or biscuit. Dissolve the yeast in the warm water, and pour it over the flour, mixing with the hands ; then sift in gradually a quart or more of flour, adding until the dough can be turned out on the board. Knead lightly from ten to fifteen minutes, adding flour until the loaf does not stick to the board. Put it back in the bowl, cover lightly, and let it rise in a temperature of about 75° F. for three hours. Cut into loaves and put into buttered pans, letting them rise on the rack above the range, or in a place of equal tempera- ture, for half an hour, when they will be ready to be 6 62 HOW TO FEED CHILDREN. placed in a moderately quick oven. After half an hour, as the bread rises in the oven, increase the heat slowlv to the end of the time required to bake the loaves. The time to be allowed for baking an aver- age-sized loaf is one and a quarter hours. The usual plan in baking bread is to begin vrith a temperature of 400° F., gradually lowering to 250° F., with the frequent result of a loaf of bread that is soggy in the inside and very hard on the outside. In the above method the reverse is the case. The result should be dry, well-baked, evenly browned loaves of bread, that still retain enough moisture to keep them as they should be. The use of an oven thermometer is advised. The art of making good bread is certainly one of the most important cooking processes to which atten- tion should be directed in the present era of reform in dietetics and household science. The digestibility of bread and its nutritive properties depend very largely upon the mode of preparation and the kind of flour employed. (Yeo.) Coarse meal breads are unfit for the nursery, as they are usually heavy and indigestible. Bauer observes of bread made of coarse, adhesive meal, ^' Such adhesive breads are very imperfectly utilized by the human organs of digestion, since the irritation they cause to the mucous membrane of the alimentary canal leads to a rapid progress and early evacuation of its contents.'^ This explains the occa- sional use of such bread for adults, but other methods should be employed in the nursery for a difficulty which need not exist with the proper care of diet. The use of bread made from the whole grain meal should be encouraged for children, for the following BREAD AND CRACKERS. 63 reasons : they must be restricted in a meat diet, there- fore such bread supplies a much-needed addition; it contains forty instead of twenty per cent, of gluten, and contains twice as large a proportion of certain salts — chiefly phosphates — as white bread ; it con- tains also the laxative fatty matter upon which great dependence is placed when arranging a dietary for children. Some idea of the proportions of nutrients in beef, oysterSj and flour may be gained from the reports of the Storrs^ School Agricultural Experiment Station, Connecticut, where Professor Atwater, whose diet articles have explained much that has hitherto been but vaguely understood, is conducting experiments that will mark this era as an important one in domestic science in its relation to dietetics. He says that a quarter of a dollar invested in the sirloin of beef at twenty-two cents per pound pays for one and one- seventh pounds of the meat with three-eighths of a pound of actually nutritive material, which Avould supply 1120 calories of energy — i.e., heat — to keep the body warm and give muscular power for work. The same amount of money paid for oysters at the rate of fifty cents per quart secures but two ounces of actual nutrients, 250 calories of energy. But in buying wheat flour at seven dollars a barrel, the twenty-five cents pay for six and a quarter pounds of nutrients and 11,755 calories of energy. 3500 calories are said by Professor Atwater to represent the American standard for the fuel value to be derived from a proper dietary for a man with moderate muscular work. It is of importance that facts like these should be gen- 64 HOW TO FEED CHILDREN. erally known^ as this knowledge is one of the first steps towards dietary reform. Points to remember in buying flour and baking bread are that a good bread flour does not cake in the hand when squeezed, that kneading must be done lightly to keep the bread porous, and that the temper- ature for the rising of the sponge should be from 70° to 80° F., not higher. The use of bread in the nursery may begin as early as twelve months if a suflicient number of teeth are present, which should be the case at this age. Dr. Rotch says, ^' Good butter on the bread may usually be allowed at sixteen months.^^ In some form, at the ages indicated, bread or crackers should be given at each meal, — -i.e., stale bread or crust of French bread, zwieback, toast, and Graham bread, or soda, oatmeal, Graham, gluten, or educator crackers. These are all permissible when they can be chewed thoroughly. Oatmeal and Graham crackers belong to laxative foods, and should be used accordingly. Jerome Walker, M.D., pertinently says, in regard to this subject,* that ^^ probably, with the exception of candy, no article that is eaten is so much abused as the animal-cracker. Before these crackers were introduced children w^ere content w^ith a few butter, soda, milk, or even ordinary sweet crackers at one time, but now the child is anxious to eat a number of animals. The cracker-maker, detecting this propensity in children, furnishes a wonderful assortment of animals, and the child is eager to eat one, at least, of each kind pur= * Babyhood. MORAVIAN CAKE. 65 chased. The mother thinks these animals are so nice for the children to play with that frequently she sends out for a half-pound or a pound, and gives them to the child to keep him quiet as he is trundled along in his carriage. What is the consequence of so much sugar and starch? It perverts the appetite, teaches the child to reject soups, broths, bread and butter, and milk, and to prefer sweets and pastries, and also in- duces starchy dyspepsia.^' The use of zwieback (twice-baked bread) can be thoroughly recommended. It possesses the advantage of being more easily digested than ordinary bread on account of the complete conversion of the starch into dextrine as the result of the double baking. The following recipe may be used for zwieback, for a change from that made from ordinary home-made bread : MORAVIAN CAKE. This is best when started in the morning, unless the last rising can be attended to very early in the morning. If this can be done, set the sponge about five o'clock in the evening, using one cup of potatoes mashed in one cup of the water in which they were boiled, one cap of sugar, one-half cake of yeast dissolved in a little warm water, with flour enough to make a thick batter. Cover and keep in a warm place (about 80° F.); beat oc- casionally during the evening, and at ten or eleven o'clock mix in the batter one cup of sugar, three eggs, and three-quarters of a cup of lard and butter, a pinch of cinnamon, and enough flour to stiffen, kneading it well into a dough that will not stick to the sides of the e 6* Q6 HOW TO FEED CHILDREN. bowl. Leave it well covered, in a temperature of 70° to 75° F., until early in the morning, shape into loaves or any form desired, let rise for half an hour, spread the cake wdth a sauce made of a cup of sugar, one tablespoonful of hot water, a small piece of butter, and enough cinnamon to darken the sauce, and bake in a moderate oven. The above may be used as sweet bread, cake, or toast. By cutting it into thin slices, buttering it lightly, and browning delicately in the oven, you have a deli- cious change for the frequently stereotyped nursery menu. A word of caution should be heeded when making toast. It should be done in such a manner as to dry it thoroughly in the middle before browning takes place. Soggy, quickly made toast is decidedly not allowable in the nursery. A simple sponge or tea cake may be used occasion- ally, when given with moderation to children over five, either in the form of lady-fingers, or as the ordi- nary sponge or tea cake made by the average cook. It must be w^ell baked, not fresh, and should be just as light and porous as good bread should be, not notice- ably moist, nor rich, nor full of fruit. CHAPTER IV. Broths and Soups. The first point to impress well upon the mind in making broths and soups for the nursery is that good material must be used^ and that the meat must be treated in such a manner as to extract the nutritious juices. This cannot be done by using hot or boiling e given by the physician, as each case must be individualized, and he should be able to select the kind of food re- quired and the form in which to give it, and also to direct how it should be prepared. Inasmuch as children are frequently poisoned by eating sweets improperly prepared, or berries, or seeds, or by sucking painted toys, their treatment under such conditions becomes a matter very closely related to dietetics. Jane H. Walker, M.D., says,* "The first and most important thing is to make the child vomit as speedily as possible, ... to tickle the back of the throat with a feather, and give large drinks of luke- warm water, or of mustard and warm water. A tea- spoonful of mustard in a tumbler of warm water is very efficacious. Greasy or soapy water, if it is the readiest obtainable, does perfectly ; soapy water has the advantage that if the poisonous substance taken be an acid, it is an excellent antidote. See that the child is repeatedly nauseated, and then give it bland sooth- ing substances, such as white of egg beaten up, milk, barley water, or oil. These help if the poison has been of an irritating character, such as carbolic acid. " If there is great depression, stimulants must be given and hot-water bottles applied. The best stimu- lant is strong hot tea, because it is an antidote to many poisons. " If there is great tendency to sleep, it must be pre- vented at all cost. This tendency generally shows that * A Book for Every "Woman, Longmans, Green & Co. 188 HOW TO FEED CHILDREN. opium in one of its numerous preparations lias been taken^ and sleep indulged in at this time will probably be the sleep that knows no waking. When the poison- ous substance that has been taken is known, the method of procedure differs with the particular poison." ANTIDOTES FOE POISONS. Useful hints for emergencies. In cases where the other articles to be used as anti- dotes are not in the house, give two tablespoonfuls of made mustard in a pint of warm water. Also give large draughts of warm milk or water mixed with oil, butter, or lard. If possible, give as follows : For bedbug poison, blue vitriol, corrosive sublimate, lead water, saltpetre, |- sugar of lead, sulpbate of zinc, red precipitate, vermilion. Give milk or white of eggs in large quantities. For Fowler's solution, wbite precipitate, arsenic. For antimonial wine, tartar emetic, For oil of vitriol, aqua fortis, bicarbonate of potas- sium, hydrochloric acid, oxalic acid, "I Give prompt emetic of mustard 1- and salt, tablespoonful of each ; follow with sweet oil, butter, or milk. Drink warm water to encourage vomiting. If vomiting does not stop, give a grain of opium in water. Magnesia or soap dissolved I water, every two minutes. m DIET IN ILLNESS. 189 For caustic soda, caustic potash, volatile alkali, For carbolic acid, For chloral hydrate, chloroform, For carbonate of sodium, copperas, cobalt, For laudanum, morphine, opium (paregoric car- minatives), For nitrate of silver, For strychnine (rat and beetle paste), tincture of nux vomica, Drink freely of water with vin- egar or lemon juice in it. Give flour and water or glutinous drinks (olive oil in large quan- tities, then an emetic, is recom- mended by Dr. Walker). Pour cold water over the head and fiice, with artificial respiration, and galvanic battery. Prompt emetics ; soaps or muci- laginous drinks. Strong coflPee followed by ground mustard or grease in warm water to produce vomiting. Keep in motion. } Give common salt in water. 1 Emetic of mustard or sulphate of i zinc, aided by warm water.* J * American Analyist. GHAPTEE XV. Diet for School-Children. Yeo emphasizes the period of school-life as one of the most critical and important epochs in the life of children as regards adequate nutrition. He says that at this period there is not only continuous growth and development, but remarkable activity, which demands a complete and liberal dietary. Teachers in boarding- schools are apt to overlook this fact, and parents, as a rule, know little of the necessity for additional care at this time, with the result only too often of the founda- tion being laid for future disease, or of the undermining of strength that should be held in reserve for later life. Both body and mind are undergoing rapid development at this time, and the greatest care should be exercised. The food must be abundant, and must contain suffi- cient proteids, starches, sugars, and inorganic salts to meet the constant demand for these constituents of a perfect food. It must be remembered that this is a period when digestion and assimilation are active. It is a frequent custom among mothers of growing boys and girls going to school to jest about their immense appetites, and not only to jest, but actually to limit sup- plies of certain foods especially needed at this period. The custom of sending children to school upon a light breakfast or none at all, with a cold luncheon for the noon meal, is reprehensible to the last degree. Or, if 190 DIET FOR SCHOOL-CHILDREN. 191 a hot dinner is provided, the habit of rushing home at noon in a limited time to consume eagerly and rapidly the food which should be eaten leisurely and enjoyed, has a strong influence upon the integrity of the child's health, and it should not be allowed under any cir- cumstances. If school law^s are rigid, remember that parental autliority should be absolute, and insist upon different hours ; or, if nothing better can be done, keep the child away for the time required, irrespective of late- marks, etc. Such action, if concerted, would speedily bring authorities to the point of meeting existing needs in this direction. Do not forget that there is a lifetime for study and only part of one during which the physical building-up process can be regulated. To sum up the rules laid dowm by Yeo, Dukes, Thompson, and others, the foods required during this period are as follows : Well-made whole-meal bread ; as much butter as is desired; an abundant supply of milk all through adolescence; starches and sugars should be freely supplied (giving heat and force) ; meat twice a day ; fish for delicate feeders ; green vegetables in abun- dance, either alone or in vegetable soups (to prevent eczema) ; suppers should be light, not stimulating ; the craving for sweets should be satisfied with mod- eration and wisdom in selection ; a free use of salads should be made ; all cooking should be carefully looked after, and food should be made savory and appetizing ; in fact, the rules given by dietists for early life should be carried out through the entire period of childhood to adult life, and, indeed, many of the suggestions may be followed with benefit even then. 192 BOW TO FEED CHILDREN. Dr. Thompson says many children inherit feeble con- stitutions, such as the scrofulous, rachitic, and gouty, which must be combated through the whole period of childhood. He says such children are better at home, where they can be under constant observation and proper dietetic treatment, or country schools can be found for them where such matters are made the sub- ject of special consideration. He speaks of the large number of cases of anaemia and chlorosis seen in young girls during or shortly after the attainment of the con- dition of puberty, and which he says are directly trace- able to malnutrition from faulty diet. This fact may serve to show to some jDarents why Providence, as they say, has so frequently afflicted their growing daughters with delicate health, which is more frequently their lament than their shame. I think it was Shirley Dare who said that the day will come when many forms of illness will be considered a discredit to those involved. As the knowledge of causes increases there will certainly come a less ready willingness to credit everything to a hitherto much -abused Providence. The patience of physicians in dealing with this class of diseases is a constantly growing marvel. Inasmuch as Dr. Thomp- son * has covered the subject of school diet so thor- oughly, liberal quotations are made in the interest of our readers. " Girls take much less exercise than boys as a rule, and are more apt to become constipated. This diffi- culty may be increased by lack of sufficient fresh vege- tables or fruit in their diet, and if prolonged it is * Practical Dietetics, W. G-ilman Thompson, M.D. DIET FOR SCHOOL-CHILDREN. 193 enough in itself to cause anaemia. The latter (anaemia) may also be brought about by insufficient good animal food. It should be the imperative duty of every head master of a school for children to realize the responsi- bilities of rightly developing the physical constitution of those intrusted to his care, and to make a thorough study of the questions of dietetics involved. " An important consideration in school diet is to prevent monotony, which becomes so common from economic reasons, or more often from carelessness. It is much easier to yield to routine and force of habit or to leave the matter to the indiscretions of an un- intelligent cook. But a little study and thought ex- pended upon this subject can always result in furnishing variety in a wholesome diet without material increase of expense. " The hours for study and for meals should be so regulated that sufficient time should be allowed before each meal for children to wash and prepare themselves comfortably without going to the table excited by hurry, and they should be required to remain at the table throughout a fixed time, never being allowed to hastily swallow their food in order to complete an un- finished task or game. An interval of half an hour or more should intervene for recreation after meals, in order that digestion may be well under way before any mental exertion is required. Constant nibbling at food between meals should be forbidden ; it destroys the appetite, increases the saliva, and interferes with gastric digestion. The number of meals for children should be adapted to the age of the pupils. For young children from ten to twelve or thirteen years of age it in 17 194 BOW TO FEED CHILDREN. may be necessary to furnish food somewhat oftener than for the older ones. " If children live at a distance from their school^ or if they are weak and easily fatigued and inclined to sleep over in the mornings their hours for study should be so adjusted that they are never obliged to hurry their eating in order to be on time for school work. The teachers should consider themselves quite as re- sponsible for regulating this matter as are the parents. " Children should never be hurried off to school in the morning with an insufficient and rapidly eaten breakfast. Their appetites are often poor at this hour from the effects of an ill- ventilated sleeping apartment, and if they are subsequently kept at school for five hours without luncheon they will be very ill prepared for mental work. Or they ride to school without exercise after a hasty breakfast, take a hurried cold lunch at noon, and perhaps a warmed-over late dinner, and at six or seven o'clock a fourth meal, after which they are expected to study and go to bed. " It is being more and more realized by teachers and the public in general that the breaking down of health at school is quite as often, if not oftener, due to impoverished nutrition than to overwork. ^^A fact which is often overlooked in the dietetic treatment of growing chiklren is that their digestive processes are so active that the stomach is emptied somewhat sooner than in the case of adults, and, their meals being promptly absorbed, it is natural for them to become hungry if the intervals between the hours of eating are prolonged. In some schools, children are given their last meal of the day at six o^clock in DIET FOR SCHOOL-CHILDREN. 195 the evening, and they may not breakfast until seven or half-past seven or even later, leaving an interval of over thirteen hours during which they have no food at all. The evening meal is usually made light, on the ground that they can sleep better, and it is therefore sooner digested. Robust children can, perhaps, thrive on this treatment, but those less strong are injured by it. For some school-children of from ten to fourteen years of age it will be much better to give the es^ening meal later, at say seven o'clock, and the breakfast at half-past six or seven, and if they awaken hungry during the night there is no harm in their having a glass of milk and a cracker. "Very delicate children whose appetites are poor and who do not do justice to their regular meals should be given an extra allowance of hot broth or hot milk, or an occasional cup of chocolate, with bread and butter and rusk, between meals. " These general rules are applicable in cases of chil- dren who, during one or two years, seem to develop with extraordinary suddenness and rapidity, growing sometimes two inches or more in six months and at- taining a height quite disproportionate to their frames. The demands of this rapid growth must be met by proper nutrition, or serious subsequent impairment of vitality may result. Such children should have their meals made tempting by good cooking and pleasant variety as well as an agreeable appearance of the food. "Meat which is carved in unsightly masses, and vegetables which are sodden and tasteless, will be refused, and an ill attempt is made to supply the 196 HOW TO FEED CHILDREN. deficiency in proper food by eating indigestible candy, nuts^ etc. Children often have no natural liking for meat, and prefer puddings, pastry, or sweets when they can obtain them, and it is the more important that meat should be made attractive to them at the age when they need it. " It is unnecessary to discuss further questions which, after all, must be controlled by tact and circumstances of individual cases, and the line must be drawn with care between making a child too fastidious on the one hand in regard to the nature of its food, and, on the other hand, impairing its constitution by monotony of diet and ill-cooked viands. Children at school should especially be required to eat slowly, for the habit of fast eating is almost contagious, and, as it is much easier to acquire than to overcome, the foundation of dyspepsia and life-long discomfort may be laid in this way in childhood. A SAMPLE DIET. 'If early rising is insisted upon, a child should never be set any task before breakfast, especially in winter, and if it is not expedient to serve a full break- fast at half-past six or seven, the child should be given a bowl of hot milk and bread, or a cup of cocoa Avith a roll, or other light food ; breakfast may be served later after the first exercises of the morning, and should be a substantial meal with animal food in the form of either fish, or eggs, or cold meat of some sort, with porridge of wheaten grits, or hominy with milk or cream and abundant sugar, also bread and butter, with some sweets in the form of jam, or marmalade, or DIET FOR SCHOOL-CHILDREN. 197 stewed fruit. Dinner, which should always be served near the middle of the day, should comprise meat, potatoes, with one or two green vegetables, and some form of sweet pudding. The supper, it is generally admitted, should comprise only easily digested articles of food, and such substances as pastry, cheese, and meats are better omitted. It should consist of either a porridge with milk or cream, or a light farinaceous pudding of rice, tapioca, sago, and the like, with bread and butter, and some simple form of preserve, or stewed apples or prunes, or very light plain cake, or a good bowl of nutritious broth with bread or crackers may be substituted for the porridge or pudding. It will sometimes be found best to serve this meal at seven o'clock or half-past seven, and if hungry the child may be given a slice of bread and butter and a cup of weak tea or coffee, mostly hot milk, at half-past five or six o'clock. " Children need fat, but they do not digest meat fat well, as a rule, and are very apt to dislike it. They will often take suet pudding, however, when hot mutton fat wholly disagrees with them. "Milk should be freely supplied not only in the form of puddings and porridges, but as an occasional beverage, and children should be made to understand that when hungry they can obtain a glass of milk, or a bowl of crackers or bread and milk, for the asking. " Fresh fish, eggs, and bacon are all wholesome and serviceable foods for children, and meat, as a rule, may be given twice a day, but not oftener. It may some- times be advisable to give it but once a day when fish or eggs are supplied; it should, however, always be 17* 198 HOW TO FEED CHILDREN. given at least once daily ^ and better twice to rapidly growing children. Large, strong bovs require a great deal of meat, and its use should not be stinted. The larger boys may eat from seven to nine or even twelve ounces of cooked meat as a ration, although many children may not require so much, the smaller boys doing well with from five to six ounces, and the older boys with from seven to eight ounces daily. ^^ During midwinter, when fresh vegetables are almost unobtainable in severe climates, vigorous boys are apt to have too much meat given them, and Yeo calls atten- tion to the fact that eczema may be produced in them by a too exclusive animal diet. " Overeating should be guarded against. The habit of slow eating should be insisted upon. ^^ It is well to allow children to play but moderately immediately after eating and to require no mental w^ork of them at such times. '^ For some reason the diet in girls' schools is apt to be much less carefully regulated than in corresponding schools for boys. This applies not only in the United States, but it has been found the common experience in England and France ; it is the more unfortunate, since girls, from their greater delicacy of constitution, espe- cially at the period of puberty, require more careful nurture. Differences in habits and exercise and out- door recreation, no doubt, in part, are responsible for the comparative lack of proper development in some girls' schools as compared with boys', but this should be recognized and regulated with as much care as the diet. " During the establishment of puberty it is best for DIET FOR SCHOOL-CHILDREN. 199 children to avoid stimulating and highly seasoned food, and eating late at night. . . . Alcohol should be wholly forbidden." The British Medical Journal says, in commenting on an article in the St. Jameses Gazette, on the question whether " parents underfeed their children/' that ^' it is only too true that underfeeding prevails, — particularly in the girls' school ; not the underfeeding of necessity, but the semi-starvation due to ignorance or meanness. The facts would be revealed at once, and the greatest benefit be conferred upon the life, health, happiness, and growth of children, if we could impress upon parents and teachers the value of scales and meas- ure. Every age has its normal height and weight, and every season and every year its normal rate of growth. The diet may be inadequate in proportion to the work required to be done, especially where work is required before food, as in early morning lessons. . . . Insufficient care is taken at home, and still more at school, to provide an adequate variety in feeding. It is often the same, day after day, week after week, and year after year. The outcry against the feeding at schools, which arises from time to time, is frequently to be traced to this defect. Most of the causes of the underfeeding of children, both at home and at school, would disap- pear if the scales and measure were systematically resorted to, for they would instantly point out those children who were not thriving. Unnatural and im- reasonable restraints would be removed by parents and teachers, if hindrances to growth were so palpably presented to them.'' CHAPTER XVI. Recipes. The following list is a summary of the recipes given throughout the book, with pages specified. Others are added that have been tested and considered practically as well as dietetically : Meat broths . Vegetable soups Chicken broth Barley broth , Broiling meats Panning meats Boiling meats Meat stew . Koast beef . Sweetbreads Eggs, boiled rish, broiled creamed boiled baked Oysters Squabs Chicken . Turkey . Partridge Pheasant . Vegetable omelet Milk jelly Cereals Barley and gluten porrid Bread .... Moravian cake 200 PAGE 67 68 72 73 75 77 77 78 79 79 80 82 82 82 82 83 83 83 83 83 83 127 118 56 57 59 65 PAGE Zwieback ....... 65 Macaroni 96 Corn 93 Kice 94 Potatoes 95 Spinach 88 Stewed onions 89 Stewed celery 90 Cauliflower 90 Peas 91 Beans 91 Asparagus 92 Tomatoes 92 Beets 92 Apple sauce 93 Brussels sprouts .... 93 Pruit gelatin 117 Pruit corn starch, or blanc- mange 118 Junket 115 Baked apple 115 Yellow or white custards . 116 Soft custard ...... 116 Cup custard 116 Pruit-juice custards ... 116 Gelatin desserts . . . . 117 Irish-moss blanc-mange . 118 RECIPES. 201 BEEF JUICE. Remove all fat and tissue from a half-pound of lean beef; broil over a clear fire from six to eight minutes ; cut the meat into small pieces^ and squeeze out the juice with a meat-press or lemon squeezer. Add salt. When warming, put the juice into a cup and set it in hot water, that it may not coagulate, as it will do if heated in the ordinary manner. BEEF ESSENCE. Put one pound of chopped lean beef, with a little salt, in a glass fruit-jar or in one of the porcelain com- partments of an Arnold Nursery Cooker, and see that the cover is tight. If the jar is used, place it in the oven in a pan of water or in an ordinary Arnold steamer and cook four or five hours. Strain the essence through a very coarse strainer, one that will keep back the meat-pulp only. BEEF OE MUTTON TEA. This recipe is adapted from Burnet, and is efficacious in cases of anaemia. One pound of chopped beef or one and one-half pounds of lean mutton (chopped) ; no gristle or fat ; ten drops of hydrochloric acid, and a pint of water. Put the beef and acid in the water, and keep it covered in a cool place for at least six hours, or overnight if possible. Simmer for two hours, strain, and salt. Remove all fat when cool. It may be used cold, or, if desired, it may be heated in a cup in warm water. 202 HOW TO FEED CHILDREN. VEAL BROTH. Veal broth is nutritious, and is the only form in which to use veal in the nursery. Use one- half pound of minced lean veal to one pint of salted cold water. Let it stand four hours, then simmer slowly (it should not reach the boiling-point) for two hours, strain through a coarse sieve, and skim when cool. MUTTON AND VEAL BROTH. Use one pound of meat, half mutton and half veal, to a pint of cold salted water, and proceed as above. Bar- ley or rice may be added, a tablespoon ful of either, well boiled. Milk thickened with flour is a pleasant addi- tion to the above or to plain mutton broth. CHICKEN BROTH. Cut up a chicken, bones and all, into small pieces, put them over the fire in cold water, add a little salt, and simmer for six hours. Cool, remove the fat, and keep the jelly covered in a cool place. This yields a very strengthening soup, which may be made the base of many a delicate dish for children or invalids. CHICKEN CUSTARD. Use chicken broth instead of milk, with beaten eggs, in the same manner as when making cup custard, sea- souing with salt instead of sugar. Serve cold or warm, with or without thickened chicken broth. Burnet strongly advises the thickening of broths with arrowroot, boiled flour, etc. They may also be RECIPES. 203 thickened with gelatin. Chicken broth is especially nice when done in this way. OYSTER BROTH. Chop six fresh oysters and heat them in an agate saucepan, letting the liquor which exudes from the oysters come to a boil. Add a very little hot water, season, and serve after strainmg. This is very nice with buttered crackers. CLAM BROTH. Put a few well-washed clams in a clean pan in a hot oven, or in a steamer over a hot fire. When they open, drain oif the liquor and add an equal quantity of hot water. Season to taste and thicken with grated cracker, if desired, or serve plain with buttered crackers. POTATO SOUP. Peel one dozen potatoes and one onion and cut them into small pieces. Cook them tender in a quart and pint of beef-stock, plain water, or vegetable water (page 69), and rub the potato through a puree sieve. Add salt and a half-pint of hot cream. Beat lightly, and serve with bits of zwieback or dry toasted bread broken into small bits into the soup plate. SAVORY JELLY. (Adapted from Burnet.) Take half a chicken, one pound of neck of veal, one pound of lean beef (from under the shoulder is the best part for beef tea, etc.). Separate the joints of the chicken, then cut all the meat — beef, veal, and chicken 204 HOW TO FEED CHILDREN. — into very small pieces ; put the whole in an earthen covered vessel with two quarts of water and enough salt to season ; stew gently in the oven for five or six hours ; skim, strain, and keep cool. This is a very nutritious jelly, and it may be made very easily in the '^Nursery Cooker" mentioned before. EOAST BEEF GEAVY. The thick brown essence in the pan, called ozmazome, should be dissolved in a little water after the fat has been poured off. It may then be thickened and sea- soned in the usual manner. Gravy made from fried meats must not be used in the nursery. A HOME-MADE MEAT POWDEE. Dr. W. R. Huggard (Muenchener Medicinische Wo- chenschrift) gives a convenient method of preparing a powder from meat to be used as a nutrient. Lean meat is cut into small pieces ; these are dipped into boiling fat for a few minutes, until the surface is browned, then taken out and drained on a sieve. They are then cut into fine pieces and dried in an oven for twenty- four hours Avith a slow fire. The meat thereby becomes dry and brittle, and may be easily ground in a coffee- mill. By this process of roasting it has lost four-fifths of its weight. This meat powder has a pleasant taste, and may be used in various ways, as in hot water, mixed with mashed potato, on bread and butter, as a sandwich, in soup, milk broths, etc. It is very easily digested, is tolerated by the most delicate stomach, and may be kept, if dry and excluded from the air, for a long time. RECIPES. 205 EGG CUSTARDS WITHOUT MILK. • Ingredients required. — Four eggs, two tablespoonfuls of sugar, the juice of an orange or a lemon, or a tea- spoonful of vanilla. Beat the yolks well with the sugar, and pour them into a double boiler. Stir over the fire until the mix- ture thickens, then add the flavoring and the whites of the eggs, which should have been previously beaten to a froth. Stir a few minutes longer, and pour into a mould and cool. These custards may be made also with salt, meat juice, celery, or chicken broth for a pleasant variation. Inasmuch as there is always great demand for new dishes that are not sweet, it may be well to remember that this plan may be followed with tapioca, sago, rice, and many other farinaceous foods that are generally used in sweet puddings if used at all. It requires very little originality to make a palatable and wholesome dish of any of the above-mentioned articles without following the stereotyped plan of sweetening and flavoring. The following recipe is an illustration of this method : TAPIOCA WITH CHICKEN OR MEAT JELLY. Wash one-half cup of tapioca, and put it into a double boiler with one- half cup of cold water. Let it absorb the water, then add a pint of chicken broth, milk jelly, or any meat infusion, and cook until the tapioca is soft and clear. Season with salt, and mould. Serve hot or cold as preferred. For another change, a well-beaten egg may be stirred into the tapioca when it is taken from the fire. These moulds are very ap- 18 206 HOW TO FEED CHILDREN. petizing when served with a little of the same broth or essence that has been used in making the jelly if thickened and daintily seasoned. A SAVORY BREAKFAST CUSTARD. Fill a custard cup lightly with bread crumbs^ and, if convenient, add a little minced chicken. It is equally good without. Beat an egg, add a little milk, season, and ponr the mixture into the cup over the crumbs. Bake in the oven in a pan of hot water for but a few minutes, as eggs must be lightly cooked to be digestible. POACHED EGGS. To poach eggs for the nursery, drop them in steam- ing water that has just stopped boiling, having added sufficient salt to taste before putting the water on to boil. Set the water containing the eggs back upon the stove. From five to eight minutes will cook them sufficiently. Eggs poached in this way and served on toast are further improved by the addition of chicken broth slightly thickened. CEREALS. Malted Gruel. (Adapted from Thompson.) Gruel should be well boiled and kept free from lumps, using a strainer if necessary. When cool enough to sw^allow, add a tablespoonful of malt extract to a pint of gruel. In a few minutes the gruel will become thin from the conversion of the starch into maltose. All farinaceous foods can be treated in this way. RECIPES. 207 Oatmeal Gruel. Four tablespoonfuls of rolled oats, one-half tea- spoonful of salt, one teaspoonful of sugar (if directed by the physician), two cupfuls of boiling water, two cup- fuls of hot milk (or four cupfuls of water and no milk). Pour the boiling water on the oatmeal, salt, and sugar, if used, aud cook in a double boiler for three hours, or cook in an agate saucepan for one hour, stirring fre- quently, if a saucepan is used, and adding water to keep to the original quantity. Strain to remove the hulls, and add the hot milk, bringing all to the boiling- point. If no milk is used, add all the water in the beginning. Two tablespoonfuls of oatmeal and two of Graham flour, with salt, a pint of water, and a quart of milk, make a pleasant change in gruels. Cook the water, salt, and meal for one hour in a double boiler or steamer ; then add a quart of milk and scald or steam, according to the vessel used, for a few minutes only. Strain and keep cool. If gruels are to be malted they need not be cooked so long as for ordinary use. One hour in a double boiler, or half an hour in a saucepan, is sufficient. Barley Gh^uel may be made in the same way as oat- meal gruel, using barley that has been ground fine in a coffee-mill. Farina Gruel is made in the proportion of two tablespoonfuls of farina to two cupfuls of water and two of milk, with salt to season ; but it does not need long cooking, as it is partly prepared. Half an hour is enough for the whole process. 208 SOW TO FEED CHILDREN. ' Arrowroot Gruel. — One tablespoonfnl of arrowroot, one-half teaspoonfnl of salt, one cupful of milk. Wet the arrowroot with a little cold water, add a cupful of boiling water, and boil ten minutes ; then add the milk and bring again to the boiling-point. Strain and keep cool. Oatmeal Porridge. Three tablespoonfuls of rolled, ground, or crushed oats, one pint of boiling water, one-quarter teaspoon- fnl of salt. Steam for two hours or longer in a double boiler or ^^ Nursery Cooker," which is desirable for all preparations of cereals, and is especially designed for nursery cooking. The vessels in the ^' Cooker" are porcelain-lined, which is a great advantage. Oatmeal porridge is very appetizing when served cold in mould shapes, and it will frequently be eaten in this way when it would be refused if served in any other form. Variations may be made by using farina, cracked wheat, browned rice (browned in the oven before steaming and moulding), hominy, arrowroot, etc., giving further change for older children by serving occasionally with fruit juice instead of cream or milk. Wheat Porridge requires two tablespoonfuls of wheat to a pint of salted water, and it should be thoroughly boiled or steamed in a double boiler or a " Cooker," two hours being the shortest time to be allowed for the cookiug of any porridge. Hominy requires the same proportions, and should be cooked for the same length of time. Cornmeal Ifush (to be used warm or moulded, for RECIPES. 209 supper or breakfast, with milk or a little good syrup) should be cooked very carefully m a double boiler or steamer for the time giveu for the cooking of all cereal porridges, and it should be free from lumps when done. A very good plan to follow when cooking cornmeal or bran mush is to sprinkle the meal into a saucepan of boiling water from a fine sifter, stirring all the time, before putting it into the steamer, as freedom from lum])s depends upon the even admixture of the water and the meal. Farina Porridge requires three tablespoonfuls of farina to a pint of hot salted water, and it should be cooked at least an hour in the steamer or double boiler. Oat Jelly, (Rotch.) Four ounces of coarse oatmeal are allowed to soak in a quart of cold water for twelve hours. The mix- ture is then boiled down so as to make a pint, and is strained through a fine cloth while it is hot. When it cools a jelly is formed, which is to be kept on ice until needed. Different proportions of this jelly can be used, but usually it is best to begin with equal parts of jelly and cow's milk. When needed, this mixture is warmed and a little salt is added. CREAM MUFFINS. To make one dozen, beat up one egg very light; mix it with four tablespoonfuls of rich sweet cream, a little salt, and a scant half-cupful of milk. Sift in slowly one and a quarter cupfuls of whole-meal flour and two teaspoonfuls of a well-selected baking-powder, o 18* 210 HOW TO FEED CHILDREN. Bake in a very quick oven (about fifteen minutes should suffice), putting very little batter into each muffin-pan, that the muffins may puff up and be nearly all crust, as they should undoubtedly be for nursery use. Graham and Cornmeal Muffins may be made in the same way, using Graham or corn flour in the place of whole-meal flour. Cornmeal Muffins are delicious when made with half cornmeal and half hominy (breakfast hominy, well cooked). Stir a teaspoonful of sweet butter into three-quarters of a cup of hot hominy ; add the e^, salt, cream, and milk ; then stir in three-quarters of a cupful of corn flour and the baking-powder, and bake as directed above, remembering to keep the mixture of a consistency to pour easily, as in this way the muffins will be light and crusty instead of heavy and indigestible. APPLE BREAD. A very light, wholesome, and palatable bread is made of apple-pulp and flour. The apples are pared, boiled, and beaten to a pulp. The usual quantity of yeast is employed as in making ordinary bread, and is beaten with flour and the warm apple-pulp. It is allowed to rise, and in fact the process is the same as usual. Very little water is requisite. This bread is highly relished by children. {Household, of Boston.) MAPLE MOLASSES GINGERBREAD. One cupful of boiling water, a piece of butter the size of an egg, one cupful of maple molasses, one-half RECIPES. 211 teaspoonful of soda, one-half teaspoonful of ginger, two cupfuls of flour. Common molasses may be sul)- stitiited for the maple molasses, but the flavor will not be the same. {Household.) A WHOLESOME SPONGE-CAKE. First sift the flour and sugar. Whisk the whites of the eggs stifl". Beat the yoll^s of the eggs very light in a large bowl, then stir in very gradually the sugar and a tablespoonful of milk ; add the whites, blending all well before gently stirring in the flour and a heaping teaspoonful of baking-powder. Bake iu a well-but- tered mould for one hour in a moderately quick oven. The proportions for a small cake are three eggs, one and a half cupfuls of flour, and one cup of pulverized sugar. The batter should pour easily. EICE PUDDING WITH EGGS. As eggs should be cooked lightly to be digestible, they should not be added to farinaceous or milk pud- dings when first mixing, as is the usual custom. For rice pudding steam the rice tender in milk, using four teaspoonfuls of rice to a pint of milk ; allow it to cool for a few minutes before stirring in two well-beaten eggs, which should not curdle, but should be partly cooked by the hot rice. Sweeten to tavSte, and add vanilla, lemon, or any flavor desired. Grated nutmeg is very nice. Brown lightly and very quickly in a very hot oven. The above may be varied by pressing the rice through a puree sieve when hot. Add the eggs and flavoring, omit browning, and steam the whole mixture for only a few minutes in a double boiler. 212 sow TO FEED CHILDREN. The yolks also may be omitted if a white pudding is desired, using four whites in place of two whole eggs. This need not be steamed after mixing if the whites have been beaten stiflF. EICE PUDDING WITHOUT EGGS. Put two tablespoonfuls of rice into two cupfuls of sweetened and flavored milk, and set it in a moderately hot oven. Stir every fifteen minutes at first, and every half-hour while the top forms. Any good cook under- stands the process, which, if carefully followed for two hours, produces a creamy, slightly brown pudding that is invariably relished by children. A few raisins may sometimes be added for children over five years old. SNOW PUDDING. (Bumet.) Put into half a pint of cold water half a package of gelatin ; let it stand one hour ; then add one pint of boiling water, half a pound of sugar, and the juice of two lemons. Stir and strain, and let it stand, covered, in a cool place all night. Beat the whites of two eggs very stiff, and then beat them well into the mixture. Pour into a mould. BREAD PUDDING. Soak one pint of fine bread crumbs in a pint of milk until soft, add three tablespoonfuls of cocoa dissolved in a little water or a dessertspoonful of vanilla for flavoring, three w^ell-beaten eggs, a cupful of granulated sugar, and another pint of milk. Either plain or whipped cream is very good with this pudding. RECIPES. 213 BROWN BETTY. Alternate layers of sliced apples and dry bread crumbs, just enough crnmbs to cover the apples. Add bits of butter, sugar, and ground cinnamon. Do this until the pudding dish is full, having bread on the top. Pour half a cup of molasses or milk and half a cup of water over the whole, set the dish in a pan of boiling water, and bake in a moderately hot oven for three- quarters of an hour. Serve with cream. FRUIT TAPIOCA PUDDING. Boil one-half cupful of pearl tapioca in one quart of boiling water until soft and transparent. Add one-half teaspoonful of salt and one-half cupful of sugar ; pare and core three tart apples, or three pears, and fill the centres with sugar and a little cinnamon or cloves ; put in a baking dish, pour the tapioca around them, and bake until the fruit is tender. Serve hot or cold with cream. STRAWBERRY CUSTARD. Make a boiled custard with the yolks of five eggs, one quart of milk, one-half cupful of sugar, and one- half teaspoonful of vanilla. Crush and strain one pint of berries, and mix with them one-half cupful of powdered sugar. Gradually beat this into the well- beaten whites of four eggs. If the fruit is very acid, more sugar will be required. Serve the custard in small glass cups, and pile the strawberry float on top. {Household.) 214 HOW TO FEED CHILDREN. EASPBEEEY BLANC-MANGE. Any blanc-mange may be made with fruit juice according to the following directions : Into a pint of boiling fresh milk stir two table- spoonfuls of corn starch made smooth in a little cold milk. While thickening, add two tablespoonfuls of sugar and one-half cupful of raspberry juice, and turn into a double boiler, where it should be steamed for half an hour. Place in moulds (tiny cups are desirable for nursery use), cool, and serve with sweet cream. CHERRY JELLY. Use one pint of cherry juice instead of cold water to soak the required amount of gelatin ; add the juice of two lemons, two cups of sugar, and three cups of boiling water. Some may prefer a trifle more sugar. Sweeten to taste, and seal in jars or tumblers. RHUBARB AND ORANGE JAM. Allow one quart of finely cut rhubarb, six Valencia oranges, and the same weight of sugar as of fruit. Peel the oranges, remove as much of the white pith as possible, divide them, and take out the pips. Put the pulp, half the rinds, and the rhubarb, peeled and cut up, into the scales, weigh, and allow the same quantity of sugar as of fruit. Then put all into the preserving kettle, bring to a boil, skim, and simmer for an hour, or until done. DATES AND CREAM. Hemove the stones from dates, then cut them rather fine, and put them in a glass dish ; cover them with RECIPES. 215 whipped cream, and stand aside in a cold place for thirty minutes before serving. You will have a dainty and wholesome dessert that can be eaten by the chil- dren of the family. Dates and figs may be washed, soaked overnight, and stewed slowly, adding a little lemon juice if liked. JELLIED APPLES. Pare and slice thin a dozen or more tart apples. Place in a pudding dish alternate layers of apple and brown sugar, and a sprinkling of cinnamon, and when the dish has been filled in this way, pour over it one- half cup of water. Lay a buttered plate over the top, and cook slowly for three hours. Set in a cold place, and when ready turn out into a glass dish. Whip half a pint of cream and pile it up around the jellied apple. APPLE SNOW. (Adapted from Davies.) Reduce two apples to pulp, press this through a sieve, sweeten, and flavor. Have ready the whites of two eggs, beaten stiff. Beat the apple-pulp to a froth, and whisk the two together until they look like stiff snow. RHUBARB JELLY. To be made in May. Wash the stalks, and cut without peeling ; cover with cold water and simmer until soft. Then proceed in the usual manner, letting the juice drip through a jelly-bag ; do not squeeze. Use one pound of sugar (granulated) to a pint of juice, and boil fifteen minutes. Heat the sugar in the oven, stir- ring frequently ; add it at the end of the fifteen min- 216 BOW TO FEED CHILDREN. utes' boiling, and stir until it comes to a boil. Strain through cheese-cloth, pour into jelly-tumblers, and cover with melted paraffin, a second layer after the first has cooled. RHUBARB MOULD. (Davies.) One quart of red rhubarb cut in pieces, put into a covered saucepan. Let it boil until it is a pulp ; soak half an ounce of gelatin in cold water, pour just enough boiling water over it to dissolve it ; add to it the rhu- barb, with sugar to sweeten ; let it boil fifteen minutes ; add a few drops of essence of lemon. Butter a mould and pour in the rhubarb. Next day dip the mould in hot water, and turn out on a glass dish. RHUBARB JAM. Rhubarb jam is desirable for nursery use, and may be made in the proj^ortion of a pound of sugar to a pound and a quarter of rhubarb, adding a little lemon peel. Boil one hour after the sugar has dissolved. ORANGE JELLY. Dissolve three-fourths of a box of gelatin in one and one-half pints of water ; add one-half pint of orange juice, sugar to sweeten, and the juice of one lemon. Boil, strain, and cool, and keep covered until used. SAGO JELLY. Soak one cup of sago overnight in one pint of cold water. In the morning add one pint of boiling water. Boil in a double boiler one hour ; add one teaspoonful RECIPES. 217 of salt, one cup of sugar, and one teaspoonful of lemon juice. {Trained Nurse.) PRUNE JELLY. Cover one pound of prunes with one quart of water ; cook slowly. Add sugar to sweeten, and one-half box of gelatin dissolved in a pint of water and boiled. Strain, cool, and keep covered. CLARIFIED APPLES. Prepare the apples as for sauce, in even-sized pieces, and simmer until tender in the boiling sugar and water, turning the pieces once, using a flat agate saucepan, from which it is easy to remove the pieces of apple without breaking them as they become tender. Use a pint of sugar to a quart of water for the syrup. Cook the syrup for ten minutes after the apples have been taken out, then pour it over them, sprinkle with cinnamon, and let them cool in the syrup. Orange or lemon juice may be used for flavoring, APPLE WATER. Mash two large tart apples that have been sprinkled with sugar and baked tender and slightly brown, and pour over them a pint of boiling Avater ; let stand cov- ered in a cool place for an hour or two, strain, and use. IRISH MOSS TEA. Take a handful of Irish moss that has been washed and drained ; pour cold water over it, and let it simmer on the back of the stove until it is dissolved ; then strain and mix with lemon juice and sugar. This is said to K 19 218 HOW TO FEED CHILDREN. be excellent in rheumatic affections. If one is troubled with a dry, hacking cough at night, it will often give relief if kept near the bedside and frequently sipped. FRUIT SAUCE. Mash a quart of ripe fruit ; beat it, sift a cupful of sugar over it, and set away ; if the fruit is very sweet, less sugar will be required. About ten minutes before the sauce is needed, set it over the fire and stir constantly ; when heated nearly to boiling, turn it about the base of the pudding, which has been placed in a deep platter. If the pudding boiler has a tube in the centre, as it usually has, there is, of course, a hole in the centre of the pudding, and this may be filled with the fruit sauce, which is, by the way, as attractive in apj)earance as it is delicious in taste. MAESHMALLOW DROPS. This is a confection greatly relished by many, health- ful and unobjectionable. It can be made quite con- veniently at home ; if the best of materials are used and care is exercised, the product, will be fully equal to any that the market affords, and it can be made at any time and in any quantity to suit the occasion. Few people have an idea of the ingredients used or of the manneV of their use, but here is the whole secret : A half pound of gum arable is to be dissolved in a pint of watei ; strain the solution, to remove any specks or organic matter contained in the gum, then add one- half pound of wdiite sugar; place the whole over a moderate fire, and stir continually until the sugar is dissolved and a honey-like consistency is reached ; then RECIPES. 219 add, little by little, the whites of four eggs, thoroughly beaten^ and stir the mixture till it becoraes thin and will no longer adhere to the finger. The marshmallow factor is added by flavoring with as much tincture of marshmallow as may be desired. The compound is then poured into a tin or earthen vessel which has been lightly covered with powdered starch ; when cool, it is cut into squares, which are also dusted witli the starch, and the process is completed. (Good House- keeping.) ORANGE SYEUP. Squeeze the juice of thin-skinned oranges through a sieve, and to every pint add one and one-half pounds of powdered sugar and the juice of one lemon. Boil the syrup fifteen minutes, and skim as long as any scum rises. Strain it, bottle, and seal up tight, and it will keep a long time. Added to a glass of water it makes a delicious drink for an invalid. LIME WATER. Lime water is easily made at home for nursery use by putting a piece of unslaked lime the size of a walnut into two quarts of filtered water in an earthen vessel, and stirring thoroughly ; allow the mixture to settle, and pour oif the clear solution as required for use, re- placing the water and stirring up as consumed. (Yeo.) RICE WATER. This is a useful drink in dysentery, diarrhoea, etc. Wash well one ounce of rice in cold water, then soak for three hours in a quart of water kept at a 220 jb:ow to feed children: tepid heat, and afterwards boil slowly for an honr and strain. It may be flavored wdth lemon peel, cloves, or other spice. (Pavey.) EICE MILK. Soak one onnce of rice for twelve hours, wash it qnite clean, and drain it. Add the soaked rice to a pint of boiling milk, with half a teaspoonful of salt and sugar. Stir well and cook slowly for one honr. Rub through a hair sieve. Sago or tapioca may be substituted for rice. (Yeo.) BREAD JELLY. Take four ounces of bread crumbs two or three days old, soak in cold wateT for six or eight hours, then squeeze all the water out of it (lactic acid and other peccant matters are thus removed). Place the pulp in fresh water, and boil gently for an hour and a half to break up the granules of starch and promote its conversion into dextrin and glucose. Rub this semi- fluid gruel through a fine hair sieve ; when cold it forms a smooth jelly. It will not keep long. (Yeo.) MULLED EGG. To be used in diseases in which the symptom of cough shows a certain degree of persistence. It is simply an emulsion of the yolk of egg in warm water, sweetened and seasoned to taste. It is prepared, as is well known, by mixing powdered sugar, the yolk of an egg, and a coffeespoonful of orange-flower water, adding boiling water gradually while stirring the mix- ture. (Fonssagrives.) RECIPES. 221 KOUMYSS. With a little attention to some important details, koumyss may be readily made by any one, the sole in- gredients requisite being milk, sugar, and yeast. A clean quart bottle is filled three-fourths full of per- fectly fresh milk, and to this is added a tablespoonful of fresh brewer's yeast, or one-fourth of a cake of compressed yeast, and a tablespoonful of white sugar. The bottle is thoroughly shaken, and then filled with milk to within two or three inches of the top, and again shaken. It is then tightly corked with a cork that has been softened by soaking in hot water, and for this pur- pose a corking machine should be employed. When the cork is driven home it is properly tied down. The bottles are now placed in an upright position in a cold place, at or near the temperature of 52° F., where they should remain two or three days. They are then put on their sides in a cool cellar or refriger- ator. Koumyss is at its best probably when five or six days old, but can be kept indefinitely at a temperature not exceeding 52° F. (Frederick P. Henry, M.D.) WINE WHEY. Boil a quart of milk, add to it half a pint of wine ; put on the fire till it boils again, then set aside till the curd settles ; pour oft' the whey and sweeten to taste. It is said that good country cider is as nice as the wine. ( Trained Nurse. ) BARLEY WATER WITH WHITE OF EGG. Take a tablespoonful of coarse barley and w^ash well with cold water, rejecting the washings. Then boil for 19* 222 HOW TO FEED CHILDREN. an hour or more with a pint and a half of clean water, in a covered vessel or saucepan. Add a pinch of salt and enough sugar to render j^alatable^ and strain. To four or six ounces of barley water thus prepared add the white of one egg. The value of this preparation in gastro-intestinal inflammation and irritation is not easily overestimated. In the enterocolitis (inflammation of the small intes- tine and the colon) of very young infants its exclusive administration for thirty-six or forty-eight hours will often relieve when all other measures have failed. (J. Hobart Egbert, M.D.) INDEX. Abstinence from food, 180. Acidity caused by sweets, 114. Acids for constipation, 108. in fruits, 97. Adams, Dr., on naps, 162. Adhesive breads, 62. Alcohol wholly forbidden, 199. Ansemia, dietaries for, 186. faulty diet a cause of, 192. grape juice useful in, 103. Analysis of mother's milk, 23. Antidotes for poison, 188. Antiscorbutic, cranberries an, 101. Aperient, dates an, 101. Appetite, capricious, dffficulty of catering to, 113, 151. dainty serving invites, 122. salt stimulates the, when deli- cate, 85. Appetizer, beets an, 92. Apple bread, 210. jelly, 105, 215. sauce, when to use, 93. snow, 215. water, 217. Apples, clarified, 217. for breakfast, 148. for dessert, 115. for two-year-olds, 99. how to bake, 115. raw scraped, 100. stewed, 100. with concentrated diet, 100. Arrowroot gruel, 208. Artificial foods, 35. Asparagus a diuretic ; strongly rec- ommended ; how to serve, 92. Assimilation : if certain foods dis- agree, wait for second teeth, 97. of beans, 91. . of peas, 91. Astringent, cranberries an, 101. Atwater, Dr., on constituents of foods, 178. on food energy, 63. Bacilli, 36. Bacteria killed by heat, 45. Baked apples, 115. potatoes, 124. Bananas, value and danger of, 101. Barley broth, 73. gruel, 207. water, 221. Bauer, Dr, on heat-giving proper- ties of fat, 142. Beans, when and how to use ; care as to assimilation ; take the place of meat, 91. Beef broth, 70. cakes, 77. essence, 201. gravy, 204. juice, 201. scraped, 77. tea, 201. Beets a valuable appetizer ,• contain sugar; how to prepare j when to give, 92. 223 224 INDEX. Benzoinol for catarrhal colds, 135. Blackbei'ry jelly, 104. juice as a drink, 100. Blanc-mange, different ingredients of, 126. raspberry, 214. with fruit juice, 105. Blood, fruits cool the, 97. Boiling, rapid, 77. meats, 74. degrees of heat required for, 78. length of time required for, 78. Bones, formation of the, 76. Bottles, the " Hygeia," how to clean, 49. Bowel complaint, sudden, 136. Bowels, action of the, 179. Brain, nourishment of the, by fruit, 97. Bread, adhesive, 62. apple, 210. home-made, 59. hot, 60. how to keep, 60. jelly, 105, 215, 220. judgment to be used in case of refusal of, 159. pudding, 212. recipe for making, 61. Breakfast, a sample diet for, 196. for midsummer, 124. for second teething, 174. for summer, 122, 172. for winter, 174. when to use raw or baked fruit at, 100, 148. Breast-pump, 26. Broiling, how to prepare fire for, 76. of fish, 83. of meat, 74. Broiling of thin steak, 76. on solid pan, 77. the art of, 76. Bronchitis, liberal diet in, light and nourishing, 186. Broth for nursery, 67. for three-year-olds, 71. recipes : barley, 73 beef, 70. how to thicken chicken, 72. veal, mutton, chicken, oyster, etc., 202. skimming of, 67, 73, 154. vessels to use in making, 69. with vegetable waters, 71. Brown Betty, 213. Bruen, Dr., on bowel action, 179. Brussels sprouts for children over six years old, 93. how to serve, 93. Burnet, Dr., on fats for the nervous, 142. on foods in illness, 185. recipe of, for snow pudding, 212, 215. mentioned, 123. Butter, cold, on bread, 76, 144. in cream sauce, 76. never to be melted on meat, etc., 76. Cake, 146. beef, 77. sponge, 211. Candy, 146. deplorable results of the abuse of, 131. Capricious appetite, 113, 151 Carbohydrates, 11, 177. Carrots, preparation of, for fire- year-olds, 90. INDEX. 225 Castor oil, to be used carefully ; only to be given by doctor's advice, 106. Catarrh, 135. grape juice useful in, 103. of stomach, 111. Cauliflower, how to prepare and serve, for children over three years old, 90. Celery, stewed, for nursery; when to give raw ; cellulose covering of, harmful ; how to stew and serve, 89. {See Vegetable Waters.) Cellulose harmful, 89. Centrifugal cream, 145. Cereals, 39, 53, 206. Chafing, 134. Chalk mixture, 135. Chapin, Dr., on acquired diseases, 36. Cherries, 100. beef broth or cocoa to be given with, 124. Cherry jelly, 105, 214. Chest cold, 134. Chicken broth, 72, 202. custard, 202. milk, 72. roast white meat of, 84. Childhood, 160. combining foods for, 16. Chlorosis, faulty diet a cause of, 192. Cholera infantum, 106, 119. Cider whey, 221. Clam broth, 203. Clarified apples, 217. Cocoa, 21. Cod-liver oil, 143. Colds, catarrhal, 135. head and chest, 134. Colic, excess of proteids in mother's milk a cause of, 23. Colic, mother's failure to exercise a cause of, 22. too frequent nursing produces, 25. Combining foods, method of, 16. Complete foods, 177. Concentrated diet corrected by scraped apple, 100, 108. Condensed milk lacks fat, 32. Constipation, causes of, 107, 108. corrected by acids and salts, 108. by adhesive breads, 62, by fruit, 97. by water, 109. {See Laxatives.) lack of fat produces, 32. of girls, 192. Constituents of foods, 178. Consumptives, 186. Contagion carried by unwashed fruits, 103. Convalescence, grape juice useful in, 103. Convalescent children, diastase for, 67. diet suitable for, 185. Convulsions from " teething," 13. Cool drink, boiled water on ice recommended, 139. weather, 146. Corn always to be used as a puree or boiled on cob for three- year-olds; how to prepare, 93. omelet for dinner, 127. to be grated in pudding or omelet for children over three years old, 94. Cornmeal, 60, 148. mush, 208. Corn starch with fruit juices, 105. 226 INDEX. Cow's milk necessary for substitute feeding, 33. Crackers, danger of certain kinds of, 65. Cranberries, as a sauce or a drink, astringent and antiscorbutic, 101. Cream a desirable fat for infants, 144, centrifugal, 145. muffins, 209. sauce, 76. top milk supplies, 136. whipped with fruit juice, 105. with dates, 214. Currant jelly, 105. Custard, 115. a savory breakfast, 206. chicken, 202. cup, 116. egg, 205. strawberry, 213. Dainty serving of meals, 122. Dates aperient, 101. highly nutritious, 101. with cream, 214. Decker, Dr., " Hygeia" bottles de- signed by, 49. Delicate children, 195. appetite of, 85. Dentition, breakfasts during period of, 174. Dessert should be nutritious, 13. Desserts as supplementary foods, 127. chief constituents of, 116. use of apples in, 115. Dextrine easily digested, 56, 65. Diarrhoea, castor oil in, 106. chalk mixture for, 135. farinaceous foods useful in, 186. Diastase for convalescents, 57. Diet, convalescent, 185. faulty, causes anaemia, 186. for one week, 168. in illness, 179, 183. light, 184. liquid, 184. preventive, 181. sample of, for school-children, 196. well-balanced, 11. while nursing, 21. Dietaries for anaemic children, 186. for the nursery, 152. Dietetics, study of, necessary, 9. the fundamentals of, 10, 14. value of, in digestive disease, 10. Digestion, duration of, for different meats, 77. forced, 179. fruits aid, 97. physiology of, 180. Dining-room appointments, 123. Dinner, a sample diet for, 197. menus for, in summer, 126, 172. Diphtheria, abundant nourishment necessary in, 186. Disease due to errors in diet, 17. influence of, on nursing, 21. relation of, to hygiene and diet, 14. Disks, Dr. Seibert's, 45. Dislikes of patients, 182. Disorder, gastric, 82. Diuretic, asparagus strongly recom- mended as a, 92. Drink, juices of fruits recommended for, 98, 100. Drinking glasses, 140. Dukes, Dr., on food required for school period, 19X. INDEX. 227 Dyspepsia from use of animal crackers, 64. hot water useful in, 185. Eczema in relation to diet, 87. Egbert, Dr., recipe of, for barley water with white of egg, 221. Egg custards without milk, 205. Eggs a complete food, 177. Fonssagrives's method of cook- ing, 184, 220. how to tell if fresh, 81. may be given to children over twenty months old, 160. mulled, 220. poached, 206. proper method of boiling, 81. Thompson's method of cooking, 81. when to use, in desserts, 116. white of, beaten with fruit juice, 105. of, diluted with water or milk and eaten raw, easily absorbed and good for gastric dis- orders, 82. Emotion, influence of, on nursing, 21. Energy of food, 63. Essence of beef, 201. Excess of starch in food, 154. Exercise, importance of, during nursing, 22. Fairchild's peptogenic 'powder, 58, 135. process of weaning, 31. Farina, great caution necessary in use of, 58. gruel, 207. porridge, 209. Farinaceous foods, usefulness of, in diarrhoea, 186. Fat, child's need of, 197. heat-giving, 142. importance of, 141. ratio of, to other food, 11. Fats, list of, 178. Faulty diet causes anaemia, 186. chlorosis, 192. Feeding at night, 25. Seibert's graduated tubes for, 52. the science of, 157. Feedings, number of, in twenty- four hours, 25. Fever, juice of a sweet orange indi- cated in, 99. Figs, aperient nature of; highly nutritious, 101. before breakfast as a laxative, 108. stewed, 101, 215. Filtering of milk, 41. Fire, preparation of, for broiling, 76. Fish, how to broil, 83. how to prepare ; never fry for nursery, 82. nutritive value of, compared with meat, 82. white-fleshed, only to be used, 82. Flatulence from use of sweets, 114. Flour, how to buy, 64. Fonssagrives, Dr., on cod-liver oil, 143. on cooking eggs, 184. on nursing instinct, 179. on preventive diet, 180. recipe of, for mulled eggs, 220. Foods, adaptation of, to different conditions, 10. 228 INDEX. Foods, combining of, 16. complete, 177. constituents of various, 178. energy of different, 63. forbidden, 176. in illness, 186. quantity and quality of, re- quired, 10. suitable for school period, 190. the four great classes of, 176. to prevent disease, 14. Forbidden foods, 176. abstinence from, 180. alcohol one of the, 199. Forced digestion, 179. France, nursing-bottles forbidden in, 15. solid food for infants prohibited in, 15. Freeman's Pasteurizer, 47. Fried fish not allowable, 82. Fruit sauce, 218. tapioca pudding, 213, Fruits, acids of, 97. care as to solid parts of; to be used moderately ) best time to give, 98. in selection of, 98. cooked, for supper, 98. for breakfast, 100, 130, 148. fresh, for dinner ; never after dinner, 130. how to prepare, 100. in second nutritive period, 159. juices of, for corn starch and blanc-mange, 105. of, perfectly wholesome, 98. laxative, 100, 109. nourish the brain, 97. over or under ripe, forbidden, 126. stewed, to be freely used, 100. Fruits, stewed, supply sugar and salts, 149. their chief food value j relation of, to the nervous system, 97 to be avoided when travelling, 138. to be washed in boiled water, 103. unwashed, carry contagion, 103. when not desirable, 105. Funnels, Dr. Seibert's, 45. Gastric disorders, raw white of egg in, 82. Gee, Dr., on rachitis, 179.j Gelatin, how used, 117. with tomatoes, 92. Gingerbread, laxative effect of, 109. maple molasses, 210. Girls, constipation of, 192. Glasses, drinking, 140. Gluten flour for bread, 59. needs little yeast, 60. {See Macaroni, Spaghetti, and Vermicelli.) Graham flour, 208. muffins, recipe for, 210, Grape jelly, 105. juice, laxative property of, 109. useful when travelling, 139. Grapes, juice of, as a drink, 100. how to prepare juice of, 104. useful in anaemia, in catarrh, and in convalescence, 103, 186. Gravy, roast beef, 204. Gross, Professor, on sick-room diet, 183. Growth, first and second years of, 27. INDEX. 229 Gruel, arrowroot, 208. malted, barley, farina, and oat- meal, 207. Head cold, 134. Health of mother, 133. Heat from fat, 142. kills bacteria, 45. Height, normal, 199. Henry, Dr., recipe of, for koumyss, 221. Herd milk preferable, 41. Heredity, when to be combated, 192. Hills, Dr., on plentiful use of water, no. Holt, Dr., on children who " ate everything," 88. on use of orange juice, etc., 167. Home-made bread, 59. Hominy, cornmeal in place of, 148. preparation of, 208. when not eaten use oat jelly as a substitute, 148. Honey a laxative, 108. Hot bread, 60. milk, 137. Hydrocarbons, list of, 178. " Hygeia," Dr. Decker's bottles, 49. sterilizer, 49. Hygiene, 14. Ice-cream, Dr. Yale's opinion of, 113. Ice water to be avoided, 139. Illness, diet during, 1 79. Improper nutriment, 19. Indigestion, sudden, 136. Infected milk, 36. Inflammation of intestines, 222. Inorganic salts in food needed to form tissue and to prevent rickets, 86. Instinct of nursing, 179. Intestines, action of, promoted by fruit, 97. Irish moss tea, 217. Jacobi, Dr., on the necessity of con- sulting books, 141. on the pleasures of the table, 113. Jam, fruit, 117. rhubarb, 216. and orange, 214. Jelly of different fruits, 104. apple, 105, 215, 220. bread, 220. cherry, 214. oat, 209. orange 216. prune, 217. rhubarb, 215. sago, 216. savory, 203. Journeys, higher heat required fof preparing milk for, 45. Juice, beef, 201. grape, useful in anaemia, 186. Juices of fruits as drink, 98, 167, how to prepare, 100. Junket made with essence of pepsin, 115. Kidney troubles, 186. Koumyss, Dr. Henry's preparation of, 221. Laboratories for the modification of milk, 39, 40. mail or express facilities for transporting milk prepared according to methods of, 30. 20 230 INDEX. Lamb, when in season, 78. Lanolin for head nd chest colds, 134. Laxatives (study lists of diet), 107. {See Constipation.) adhesive breads, 62. castor oil, rule for administra- tion of, 106. cream, 186. diflFerent foods acting as, 107. fruits, 108, 109. Graham crackers, 64. honey, 108. massage, regular stools, and use of water as, 107, 111. onions, 89. Liberal and nourishing diet re- quired in bronchitis, 186. Light diet, what it is, 1 84. Likes of patients as to food, 182. Lime water, recipe for, 219. when to add to milk, 46. Liquid diet, its usual acceptation, 183. Mail, use of, for transmitting labo- ratory food and physician's ad- vice, 30. Malnutrition after puberty, 192. Malted gruels, 206. milk, lack of fat in, 32. Maple molasses, 210. Marshmallow drops, 218. Massage for constipation, 107. Meals, dainty serving of, 122. Meat, beans take the place of, 91. beef most nutritious, 75. heat required for boiling, 78. how to cook, for soup, broil, boil, or roast, 74. powder, 204. relative nutritive value of, 75. selection of, 75, Meat to be given only after thirty months, 160. Mellin's food with cool milk for sup- per, 131. Menstruation in relation to nursing, 26. Menus, alternating, for second period, 163. dinner, after thirty months, 167. in summer, 125. for second period, 161. for supper, 129. fruit, for* breakfast when fat and meat are given for din- ner, 99. in winter, 150. one week's sample, for five- year-olds, 168, principles of, 152. the safest rule as regards, 153. use broths with fish, 82. Microbes, 36. Milk a complete food, 177. analysis of mother's, 23. apparatus required for home modification of, 40. broth, hot, 69. carelessness in handling, 36-38. chicken, 72. condensed, lacks fat, 32. five general rules as to feeding, 54. jelly, 118. laboratories, 15. modification of, 27. powder, 58, 135. puddings, 116. purity of, 45. rice, 220. soup, 71. to be freely given, 197. varieties of human, 23. INDEX. 231 Milk, when away from home to be given steaming hot, 137. Mineral salts, importance of, in forming bone, 86. Mixed diet, salts not to be forgotten in, 87. Molasses a laxative, 108. maple, gingerbread, 210. Morning bottle, 162. Moss, Irish, tea, 217. Mother, duty of a, in selection of food, 12. of a, to keep v^ell, 133. Mould, rhubarb, 216. Muffins, cream, 209. Graham and cornmeal, 210. whole-meal, for breakfast, 449. Mulled egg, 220. Mush, cornmeal, for chilly days, 148. how to prepare, 208. Mutton broth, 202. tea, 201. when in season, 78. Naps, Dr. Adams's opinion of, 162. Neglect, when wholesome, 134. Nervous children, a hearty break- fast beneficial to, 122. nourished by fruit, 97. value of fat food for, 142. Nibbling to be forbidden, 193. Night feeding, 25, 163, 195. Nipples for bottles, advantages of the seamless rubber, 49, 136. use of shields and bathing in small or depressed, 26. Nitrogenous foods, potato, etc., to be eaten with, 95. Normal development, 141. height and weight, 199. Nourishing and liberal diet re- quired in bronchitis, 186. Nursing, forbidden during preg- nancy, 27. ideal conditions for, 20. importance of daily exercise while, 22. in relation to menstruation, 26. influence of disease on, 21. of emotion on, 21. instinct and art in, 179. proper diet for mothers while, 21. intervals for, 24, 25. results of too frequent, 25. should begin early, 24. to be continued so long as child gains in weight, 27. what to do in cases of delayed, 24. when too frequent, 25. Nutrients in different foods, 63. Nutriment, proper and improper, 19. Nutrition, best evidence of, 26. Nutritive period, first and second, 157. third, 159. Oatmeal displaced by rice in sum- mer, 95. gruel, 207. heat-giving ; to be used in cool weather, 148. jelly, 121, 209. porridge, 208. the usual cereal to begin with, 58. Oil, castor, 106, olive, 97, 107, 144. when laxative, 109. Olive oil a valuable nutrient after second dentition, 97. with salads, 144. 232 INDEX. Omelet, 94. {See Corn.) One week's diet, sample of, 168. Onions require sweet dessert, 89. slightly laxative, 89. stewed, raw juice of, or grated, for omelets, 127. stimulate digestion, 89. Orange jam, 214. jelly, 105, 216. juice of, allowable after fifteenth month, 167. of, for feverish conditions, 99. syrup, 219. Overfeeding, how detected, 121. in typhoid fever, 186. wastes energy, 11. Oyster broth, 203. Oysters, how to keep, 83. in milk soup, 83. use of juice and soft parts of, 83. when to be eaten, 83. Pale face, reason for, 154. Pan, solid, for broiling, 77. Parry, Dr., on rachitics, 179. Parsley not to be minced when used for seasoning, 68. Partridge, broiled, 83. Pasteurizer, the Freeman, 47. Patients, likes and dislikes of, 182. Pavey, Dr., recipe of, for rice water, 219. Peaches may be used from eighteen months up, 103. stewed, 100. Pears not to be given for first five years, 103. Peas, when and how to use ; how to cook ; take the place of meat ; danger of non-assimilation, 91. Pepsin in junket, 115. Peptogenic powder (Fairchild's), 58, 135. Pheasant, broiled, 83. Phosphates, foods rich in, to be given to the expectant mother, 87. Physician should be consulted and his advice followed strictly, 31. Physiology of digestion, 180. Pineapple jelly, 105. Pineapples, juice of, as drink or dessert, 100. Poached eggs, 206. Poisoning, Dr. Walker's directions in cases of, 187. antidotes for, 188. Porridge, farina, 209. oatmeal and wheat, 208. Potash, greater abundance of, in cow's milk than in mother's ; therefore the former needs salt, 86. in baked potatoes, 95. Potato, baked, in breakfast menu, 148. soup, 203. Potatoes as a cause of child's crav- ing for salt, 85. baked, preferred ; easy to digest and potash not lost, 95, 124. care to be exercised in selec- tion of, 95. how to mash, 96. should be eaten with nitroge- nous food, 95. supply starch and salts, 95. use and abuse of, 85, 155. with gravy, 95. Powder, meat, 204. peptogenic, 31, 58, 135. Pregnancy, nursing not compatible with, 27. Prescription for milk, 39. INDEX. 233 Preventive diet, 181. Proper nutriment, nature as a guide in selection of, 19. Proprietary fooda failures, 33. unnecessary, 31. vary greatly, 34. Proteids cause colic, 23. in constipation, 12. list of, 176. ratio of, 11. reduced in human milk by exercise, 22. Prune jelly, 105, 217. Prunes as laxatives, 108. stewed, 100. Puberty, diet of girls at period of, 198. nutritive food necessary at time of, 192. Pudding, apple, 212. bread, 212. corn, 94. * fruit tapioca, 213. snow, 212. with or without eggs, 211. Pump, breast-, 26. Puree of onions, 89. vegetable, for summer, 126. Rachitis, bad diet a cause of, 179. Eaisins rich in sugar and easily digested, 103. Rapid growth, 195. Raspberries, juice of, as a drink, 100. Raspberry blanc-mange, 214. jelly, 105. Raw apples scraped, 100. Recipe for home-made bread, 61. Recipes, list of, 200. Refrigerator milk, 137. Regimen, faulty, 129. Regulation of diet in disease, 181. Rhubarb jam, 214, 216. jelly, 105, 215. mould, 216. Rice, how to soak and cook, 94. may be given freely after two and one-half years, 94. milk, 220. poor in fat, salts, and albumen, 94. pudding with or without eggs, 211. starch in, easily digested, 94. takes the place of oatmeal in summer, 94, 124. use of, in broths at first, 94. water, 219. Rickets, Ufi"elmann and Smith on cause and prevention of, 86. Roast beef, gravy of, 204. should be rare and lean, 79. time required to cook, 79. meats, 74. Rotch, Dr., on bread and butter, 64. on general feeding, 117. on the different nutritive periods, 19, 157. plan of, for home modification of milk, 40. recipe of, for oat jelly, 209. Rouchard, Dr., founder of the Society for the Protection of Children, 15. remarks of, on mortality among infants in France, 37. Rules for feeding, 54. for preparation of menus, 153. Sago jelly, 216. Salads with oil allowable after second dentition, 97. Salt, how it aids digestion, 85, in drinking water, 85, in fruits, 97, 149. 20* 234 INDEX. Salt in potatoes, 95. necessary with potash foods, — e.g.y cow's milk, 85. Salt-giving foods, 178. Salts, inorganic, importance of, in forming tissue, 86. use of, in constipation, 108. Sample diet for school-children, 196. Sauce, apple, 93. fruit, 218. milk and flour, 80. Savory jelly, 203. Scales, use of, to reveal underfeed- ing, 199. School period, food needs salts during, 86. proper diet during, 190. Science of feeding, 157. Scraped apple, 100. beef, 77. Scurvy due to lack of vegetables, etc., 87. use of lemon juice in, 186. Seamless nipples, 49, 136. Second dentition, breakfast menus suitable for, 174. when necessary to wait for, 97. summer, 120. Sedentary children require more fish and broth than meat, 82. Seibert system of filtering, 44. disks and funnels, 45. Semi- starvation due to ignorance, 199. Serving of meals, dainty, 122. Shields, nipple, 26. Skimming of soup, 67, 73, 154. Sleeplessness a sure indication of faulty regimen or disease, 129. Smith, Dr., on rickets, 86, Snow, apple, 215. pudding, 123, 212, 215. Solid food not to be given to in- fants, 15. Soup, how to skim, 73, 154. its value at the commencement of a meal, 73. method of making, for nursery use, 67, 183. milk, 71. needs low temperature, 74. potato, 203. should not be the principal feature of the meal, 73. vessels to be used in making, 69. Spaghetti a substitute for meat, 96. care requisite in selecting, pre- paring, and serving, 96. digests easily and rapidly, 96. how to prepare, 127. Spinach an aperient, 88. how to boil, 71. preparation of, for children, 88. Sponge-cake, 211. Sprouts, Brussels, 93. Squabs, stewed or broiled, 83. Starchy foods, how to cook, 56. list of, 177. result of excess of, 154. rice, potatoes, and maca- roni the most impor- tant, 94. Steak, how to broil a, 76. Steamer, the Arnold, 48. Sterilizer, directions for use of, 46. for home use, 40. the Arnold, 48. the Hygeia, 47. Stews, apple, 100. celery, 89. meat, 78. Stimulate a delicate appetite, 85. INDEX. 235 Stomach, catarrh of the, 103, 111. size of the, 53. Stool, appearance of the, an evi- dence of nutrition, 26. Strawberries, beef broth or cocoa should be given with them, 124. danger of decayed, 98. generally wholesome if ripe, 101. juice of, as a drink, 100. Strawberry custard, 213. Study hours during school period, 193. Substitute food, general rules re- lating to, 61. must contain cow's milk, 33. to be given if teething is delayed, 27. Sugar in beets, 92. in fruits, 97. list of foods containing, 177. measure, 41. permissible in cold weather, 146. satisfactory way to feed ; ways to be avoided, 147. to be given in its natural state, 148. Summer menus, 126. for breakfast and dinner, 122, 124, 172. Supper, a sample diet for, 197. bread and milk a perfect com- bination for, 151. dishes suitable for both winter and summer, 132, two safe rules in regard to, 128. various menus for, 129. Supplementary foods. {See Des- serts.) Suppositories, gluten, 134. Sweetbreads, how to prepare, 79. Sweets, acidity and flatulence some- times caused by, 114. to be avoided, 126. Syrup, orange, 219. Tapioca, fruit, pudding, 213. valuable as a summer diet, 124. with meat jelly, 205. Tea, beef or mutton, 201. Irish moss, 217. Teeth, second, breakfast menus de- signed to promote the growth of, 174. when necessary to wait for, 97. their presence allows of starchy foods, 28. Teething a cause of convulsions, 13. substitute feeding should be re- sorted to if delayed, 27. Tenement life, 37. Thin steak, how to broil, 76. Thompson, Dr., on proper diet during school period, 191. on inherited weakness, 191. on rules for feeding, 156. Toast, how to make, 66. Tomato jelly with gelatin, 92. Tomatoes, caution necessary if eaten raw, 92. how to cook ; do not use with milk, 92. not to be eaten until child is five years old, 92. Top milk for cream, 136. Travelling, how to treat milk when, 138. what to avoid when, 138. with young children ; outfit necessary, 134. Turkey, give only roast white meat of, 84. 236 INDEX. Two-year-olds may eat scraped apple, 99. Typhoid fever, danger of overfeed- ing in, 186. kinds of food to be given in, 180. Uffelmann, Dr., on causes of rickets, 86. views of, as to children's diet, 113. Underfeeding revealed by scales, 199. Unwashed fruits, diphtheria carried by, 103. Vaseline for travelling outfit, 134. Veal broth, recipe for, 202. Vegetable waters, 69, 71. Vegetables in soups, 68. to be avoided when travelling, 138. when scarce, use apple sauce, 93. Vermicelli as an addition to broths, 97. care essential in selection of, 97. digests easily and rapidly, 97. Vomiting, cause of an infant's, 26. Walker, Dr., on poisoning, 187. Water, apple, 217. barley, 221. boiled, for drinking, 139. for constipation, 109. habit of drinking, 132. ice, to be avoided, 139. in infant feeding, 13, 111, 120. lime, 219. rice, 219. Weaning, Dr. Rotch's method of, 29. Fairchild process for, 31. imperative in pregnancy, 27. should be gradual^ 29. time limit for, 28. Weighing will reveal underfeeding, 199. Weight, rate of increase of, 27. Wet-nurse, diet and habit of life of, not to be changed, 28. Wheat a perfect summer cereal, 122. for bread, 59. need not be abandoned in cool weather, 148. porridge, 208. Whey, cider and wine, 221. White meat of chicken, etc., only to be used, 84. Wine whey, 221. Winter breakfast should give heat, 174. menus, 150. Yale, Dr., on ice-cream, 113. on vegetables, 69. Yeast, brewer's, 60. {See Gluten.) Yeo, Dr., on bread, 62. on school life, 190. recipe of, for bread jelly, 220. , of, for rice milk, 220. Zwieback, crumbed, in stew or broth, 79. menu for four-year-olds, 79. more easily digested than bread, 65. recipe for, 65. THE END. PATE DUE __, ,nl y Demco, Inc. 38-293 RJ206 Bogan mi?, 1896 I -4 COLUMBIA UNIVERSITY LIBRARIES 0043058175