582 
Substitute  In f ant-Feeding. 
{Am.  Jour.  Pharm. 
December,  1900. 
take  properly  prepared  cow's  milk  are  very  rare.  The  trouble  often 
comes  from  the  inability  of  the  physician  to  properly  modify  the 
milk  so  as  to  make  it  suitable  for  the  case  in  hand.  It  is  impossible 
to  lay  down  fixed  rules  for  infant-feeding,  as  each  case  must  be 
treated  by  itself,  but  there  are  certain  underlying  principles  involved 
which,  if  understood,  will  greatly  simplify  the  problem. 
The  important  things  to  know  are,  first,  how  to  secure  good  cow's 
milk,  and,  second,  how  to  change  or  modify  it  so  that  it  shall  be  as 
near  as  possible  an  approach  to  mother's  milk  in  composition  and 
digestibility.  The  first  problem  before  the  physician  is  to  secure  a 
supply  of  good  fresh  milk.  This  can  be  had  anywhere,  by  the  exer- 
cise of  a  little  care.  Let  the  cows  be  cleaned  as  thoroughly  as 
horses,  and  the  udders  and  sides  wiped  off  with  a  damp  cloth  just 
before  milking.  Let  the  milking  be  done  with  clean,  dry  hands, 
into  a  clean  pail  held  close  to  the  udder.  The  first  stream  or  two 
from  each  teat  should  be  thrown  away,  and  not  allowed  to  get  into 
the  pail,  for  during-  intervals  between  milking  bacteria  from  the  air 
get  into  the  cow's  teats,  and  grow  with  wonderful  rapidity.  By 
throwing  away  the  first  few  streams,  at  the  beginning  of  the  milking, 
these  are  disposed  of.  If  the  sides  of  the  cow  are  plastered  with 
dirt  and  manure,  as  is  often  the  case,  a  certain  amount  is  sure  to  fall 
into  the  pail  of  milk.  This  is  where  the  trouble  really  begins,  for 
this  dirt  and  manure  abounds  in  bacteria.  Over  two  hundred  spe- 
cies of  bacteria  have  been  found  in  milk,  about  twenty  of  which  pro- 
duce lactic  acid.  Other  species  produce  ropy,  slimy,  blue  and  red 
milk,  also  alkaline  products.  These  bacteria  themselves  are  practi- 
cally harmless,  but  the  products  of  their  growth  may  seriously  affect 
the  healthfulness  of  milk.  Pathogenic  bacteria  are  occasionally  found 
in  milk,  but  they  get  there  almost  invariably  through  the  water  used 
in  washing  the  milk  cans  or  bottles,  or  from  the  skin  of  some  infected 
attendant.  Tubercle  bacilli  are  found  in  milk  from  cows  with 
tuberculous  udders,  but  the  danger  of  infecting  human  beings  is 
thought  to  be  greatly  overrated.  Tubercle  bacilli  do  not  grow  in 
milk.  » 
As  soon  as  each  cow  is  milked,  the  milk  should  be  run  through 
an  aerator  and  cooler,  in  a  room  free  from  bad  odor  or  tobacco 
smoke,  and  then  kept  as  cool  as  possible  until  used.  It  is  obvious 
that  cows  should  be  stabled  in  clean,  well-ventilated  barns.  These 
conditions  should  be  possible  everywhere,  and  if  the  physician  will 
