W. Grant Hague

How to Prepare Milk Mixtures—Sterilizing the Food for the Day's Feeding—How to Test the Temperature of the Food for Baby—When to Increase the Quality or Quantity of Food—Food Allowable During the First Year in Addition to Milk—Beef Juice—White of Egg—Orange Juice—Peptonized Milk—The Hot or Immediate Process—The Cold Process—Partially Peptonized Milk—Completely Peptonized Milk—Uses of Peptonized Milk—Objections to Peptonized Milk—What a Mother Should Know About Baby's Feeding Bottle and Nipple—Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks is not Quite Enough to Satisfy it—Certain Conditions Justify the Adoption of Artificial Feeding from the Beginning—Mothers' Mistakes in the Preparation of Artificial Food—Feeding During the Second Year—Sample Meals for a Child Three Years of Age—The Diet of Older Children—Meats, Vegetables, Cereals, Bread, Desserts—Fruits.

HOW TO PREPARE MILK MIXTURES

The mother should always remember, that the secret of success in raising a baby efficiently on artificial food is to be cleanly and to be exact. The bottles and the nipples must be scrupulously clean; the hands of the mother must be clean; the water used must be boiled and each ingredient must be measured exactly.

First dissolve the sugar in the boiled water, which must be the exact quantity; then remove the top-milk and measure the exact amount wanted in the graduate, pour into the jar, add the water and sugar mixture, and finally the lime water.

It is always desirable to make the entire quantity for the day at one time. After the total quantity has been mixed in the jar, fill each bottle with the amount for each feeding, put in a cotton stopper, and place the bottles in the ice box.

In measuring the sugar, it should be remembered that two scant dipperfuls equal one ounce by weight of the sugar.

When each individual bottle is to be filled, do it with the aid of the glass funnel which has been previously sterilized.

Sterilizing the Food For the Day's Feeding.—The simplest method is to place the two-quart jar containing the milk mixture for the next twenty-four hours' feeding upon a saucer in the bottom of an open pan, and then to pour enough tepid water into the pan (outside of the jar) until it will come up as high as the milk level. The water in the pan is then brought slowly to the boiling point. The pan is then moved to the back of the stove and left for half an hour. The jar is then removed and rapidly cooled by allowing cool water to flow over the outside; the individual bottles filled and put in the ice box.

It is always wise to taste the milk before making up the day's feeding to be sure it is not sour. The milk from a herd of good cows is always better than the milk from one cow no matter how good that one cow may be.

When about to feed the baby, the bottle is taken out of the ice box and heated to the desired temperature in a water bath. The temperature of the milk can be tested by allowing a few drops to fall on the wrist; it should feel warm, not hot; it should not be tasted by putting the bottle to the mouth of the nurse, or mother, as it may become infected by doing so. A flannel cover, or bag, should be made to fit the bottle and it should be put on while the baby is nursing so that the milk may retain its heat. The baby must not be disturbed while nursing, nor should he be jounced or carried around after nursing. These habits cause vomiting and indigestion. He should be put in his crib.

When to Increase the Quality or Quantity of Food.—Children of the same age may have different digestive abilities. A strong, robust child may be permitted to take a richer quality of milk than a weak, puny infant of the same age. If the quality or quantity of each feeding is too weak or small for the baby he will be dissatisfied and he will cry after the feeding. In such cases, if the bowel discharges are natural and yellow without curds or white specks, and if he is not gaining sufficiently in weight, the next stronger formula may be tried. If it is decided to put him on the stronger mixture, it is wise to cut the quantity down for a day or two in order to test out his digestive ability. If the stools remain good after three days, the quantity may be slowly increased until the amount in the recipe is allowed. It is a much more serious risk to overfeed the baby than to underfeed him. If too large a quantity is given, he may vomit it at once, or he may develop colic with intestinal indigestion. Such babies lose weight, become fretful and irritable, even though the appetite may remain good. If too strong a quality is given he may vomit sour, buttery-smelling milk, or have colic, and pass curds in the stool. If this happens it may be necessary to go back to a weak formula and work up from that standard. This is always a tedious and anxious experience and may lay the foundation for digestive disturbances for a long time. Don't be too anxious to increase the quality, or quantity, of your baby's food. It is much better to go slow and have a well baby, than to try to force matters and get into all kinds of trouble. No science calls for more elementary common sense, than the science of infant therapy.

Digestive disturbances incident to this period are fully explained in the chapter on Diseases of Children.

FOOD ALLOWABLE DURING THE FIRST YEAR, IN ADDITION TO MILK

About the twelfth month the baby should receive plain milk mixtures instead of the top-milk heretofore used in making up the food. At first the milk may be plain milk from an ordinary bottle shaken up. Of this he may take five ounces, to which may be added three ounces of barley water. The barley water may be gradually withdrawn, an ounce at a time, replacing this amount with milk, until the child is taking eight ounces of milk and two ounces of barley water. Later plain mixed milk will be suitable for a child about the fourteenth month.

Barley water may be added to the milk at any time after the third month in place of the plain boiled water in the preceding formulas. It is advisable to do this if there is any trouble with digestion, or if there are curds in the stools. Some children take more kindly to barley water than plain water at a very early age.

Beef Juice.—The juice squeezed from broiled steak may be given a child at about the eighth or ninth month, or, in cases of anemia, earlier than this. It is given before the milk feeding, diluted with an equal amount of water. At first a teaspoonful of the extracted juice should be given with the same quantity of water; increase every four days until at the end of two or three weeks two tablespoonfuls are given.

White of Egg.—Place an egg in boiling water and allow the water to cool with an egg in it. In ten minutes the white of the egg will be coagulated and ready for use. It may be used in place of the beef juice if the latter does not agree and may be begun at the sixth month and given once daily. One-half of the white of the egg should be tried, then at the end of a week, if it agrees with the child, the whole white of one egg may be given.

Orange Juice.—This juice has a good effect on the bowels and may be given even to very young children who are disposed to be constipated. It is also of benefit in counteracting the effect of boiled milk. The juice should be extracted from fresh oranges and strained. One teaspoonful may be given at first one hour before a feeding. The amount may be increased until four teaspoonfuls, or one tablespoonful, are given daily.

Peptonized Milk.—The object of peptonization of milk is partly or wholly to digest the casein, or curd, of the milk before feeding.

Fairchild's Peptonizing Powder is used for this purpose. The powder is put up in tubes, and instructions are furnished in each box as to its use.

There are two methods of using the powders:

The Hot or Immediate Process.—Fifteen minutes before feeding add from one-eighth to one-quarter of the contents of a tube to the milk mixture in the nursing bottle ready for use. The bottle is then put in water at a temperature of from 110° to 120° F., and allowed to remain in the water for fifteen minutes. The amount of the powder used and the temperature of the water depend upon the amount of milk in the nursing bottle.

The Cold Process.—Four ounces of cold water are put into a clean quart bottle and the powder from one of the tubes. Shake the mixture thoroughly until the powder is dissolved. Add a pint of cold fresh milk, shake the bottle again and place directly on ice. When any of this milk is used the bottle should be again shaken and put immediately back on ice.

If necessary this process may be modified so that partially or completely peptonized milk may be made.

Partially Peptonized Milk.—Put four ounces of water and a whole tube of powder into a clean pan and stir well; add a pint of cold milk and heat to the boiling point, stirring the mixture all the time. There should be enough heat to bring the milk to the boiling point in ten minutes. Allow the mixture to cool somewhat and strain into a clean jar, cork tightly and keep in a cool place. Shake the jar before and after using any of the contents.

If partially peptonized milk is properly prepared it should not become bitter.

Completely Peptonized Milk.—Put four ounces of cold water and the powder contained in one of the tubes into a clean quart bottle and shake thoroughly. Add a pint of cold fresh milk and shake again; then place the bottle in a pan of warm water about 115° F., or not too hot to place the hand in comfortably. Keep the bottle in the water bath for thirty minutes; then place the bottle directly on ice.

Uses of Peptonized Milk.—Partially peptonized milk is useful in young infants who have difficulty in digesting the curd of milk. Completely peptonized milk is frequently used during attacks of indigestion. It is used also to tide a delicate infant over a period when for some reason the digestive apparatus refuses to digest and assimilate even dilute mixtures. It is of value also in acute or chronic illness when the child has to be fed through a tube. When it is necessary to feed per rectum peptonized foods are often selected in preference to others.

Objections to Peptonized Milk.—Complete peptonization of milk renders the milk bitter. For this reason many children will not take it. Very young children whose sense of taste is not developed may be induced to take it after a few days. It is not wise to continue its use long because the function of the stomach will become accustomed to the use of predigested food and refuse to work when called upon. If it is used for a number of weeks it is wise to stop it gradually in order to permit the stomach to resume its function in a normal way.

What a Mother Should Know About Baby's Feeding Bottle and Nipple.—In the first place, always buy round bottles,—round everywhere, inside and out,—there should be no corners anywhere. The reason for this is, that bottles that are round everywhere, are easily cleaned, and can be thoroughly cleaned, and having no corners they do not lend themselves to collecting dirt and bacteria. When these bottles are first bought they should be boiled. After each feeding they should be thoroughly washed with soap or washing powder. A long-handled bottle brush should be used to help clean the bottle. After the bottle has been thoroughly rinsed a number of times with hot water, it should be set aside filled with warm water into which one teaspoonful of bicarbonate of soda has been put. Before filling them with the freshly prepared food each morning the bottles should be boiled. Every mother with a bottle-fed baby should buy a dozen bottles, all of the same kind and size to begin with. This is a great advantage for a number of important reasons, two or three of which I will mention:

1st. Having enough bottles means that each bottle will be used once only during the twenty-four hours; there is less chance therefore of a bottle being cleaned carelessly.

2nd. Having a fresh bottle for each feeding permits all of the food for twenty-four hours being made at one time. This ensures uniformity of quality of each feeding.

3rd. By cleaning all the bottles at one time (previous to filling) it is more apt to be done thoroughly; and by making all the food for a day at one time it is more apt to be correct than if each feeding was made separately.

The baby's nipple should be made of plain black rubber. It should not be too thick because it is necessary to turn it inside out in order to clean it thoroughly. The hole in the nipple should not be too large—if the child can empty the bottle in less time than fifteen minutes the hole is too large. If the milk drops out but does not run it is about right. Don't buy nipples too long or too large. A long nipple tends to gag the child and cause vomiting. A large nipple prevents the child from sucking properly and usually allows the food to be taken too quickly and with air, which causes colic and indigestion. It is well to have always half a dozen nipples of the right kind on hand. When new, nipples should be boiled before using. After each feeding the nipple should be washed in borax and water on both sides, then it should be put in a dish containing fresh, cold, borax water and left there until again required. A large portion of the success of raising healthy, bottle-fed babies is in being everlastingly clean in the details of caring for the bottles and nipples which are in daily use.

Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks, is Not Quite Enough to Satisfy It?—This is a question that cannot be answered by a simple yes or no. A great deal depends upon circumstances, and these circumstances must be weighed and counterweighed before an answer is given. It is a serious matter, in our judgment it is a criminal proceeding for a physician to advise the use of an artificial food without exhausting every aid and means to preserve and increase the mother's milk. This is a subject in need of earnest missionaries in all walks of life, and it should be the duty of every woman's club and gathering to voice the conviction of the highest womanhood by advocating the use of mother's milk with every child born. A woman who can and will not nurse her own child is scarcely deserving of the name of mother.

It does not seem quite human to deprive a baby of the milk which rightfully belongs to it; yet in certain walks of life this is not an uncommon procedure. On the other hand the percentage of women able to nurse their children is decreasing. This is especially true as applied to cities, though it is also true, in a less degree, in the rural districts. One eminent authority states that less than twenty-five per cent. of the well-to-do mothers, who have earnestly and intelligently attempted to nurse their babies, succeed in doing so for a period longer than three months. This authority also says: "An intellectual city mother who is able to nurse her child successfully for the entire first year is almost a phenomenon." Women nowadays have so many diversified interests, that the primal duty of maternal nursing is not at all a fashionable function. If, however, the mother is willing, and has conscientiously tried to nurse her baby, and after seven or eight days it is found that she has not enough milk to satisfy it, and if the quality seems to be good, some expedient should be immediately adopted to tide the condition over until the mother resumes her customary household routine. The safest expedient under these circumstances is to alternate the feedings; one feeding from both breasts of the mother, and the next an artificial food. Some arrangement of this kind is the just and the safest way, because a very large percentage of mothers suffer from inactivity while lying in bed after a confinement. This inactivity expresses itself in a failure of some of the organs to perform their duty properly. This may affect the quantity, and sometimes the quality, of the milk, but it is, as a rule, quickly rectified as soon as the mother is up and active.

If, however, the milk is still found to be inadequate after she is up and has resumed her usual habits, and if her health is good, and she is eating well, it is distinctly best to put the child exclusively on an artificial diet.

CERTAIN CONDITIONS JUSTIFY THE ADOPTION OF ARTIFICIAL FEEDING FROM THE BEGINNING

1st. Woman suffering with any wasting disease such a cancer or tuberculosis. (One of these days, and very soon we hope, it will be legally impossible for a tubercular or cancerous patient to become a mother.)

2nd. When a mother is the victim of any of the serious childbed complications such as convulsions, kidney disease, extensive loss of blood or blood poisoning, or runs a high temperature because of some disease occurring at the same time as the confinement, as, for example, appendicitis, scarlet fever, typhoid fever, etc.

3rd. Epilepsy, chorea, insanity, are also conditions which render artificial feeding necessary.

It is much wiser immediately to put the child on artificial feeding if there is a justifiable reason for it than to experiment, because any experiment at this time is almost certain not to be in favor of the child. Artificial feeding is a comparatively easy and successful problem, provided it is begun with healthy digestive organs. If you keep the child at the breast of a mother whose milk is inadequate in quantity or quality, or both, for two or three days, and then begin artificial feeding, the child's stomach is already unable to perform its duty, and you have to treat it with the greatest degree of care and attention, and probably begin with a weak food, until you regain the lost ground.

Mothers' Mistakes in the Preparation of Artificial Food.—Another interesting condition which is quite common, is the tendency on the part of the mother to fail to follow instructions correctly,—even though written or printed,—regarding the preparation of the baby's food. When the baby is not thriving and gaining steadily in weight, or is fretty and cries a good deal, and does not rest and sleep peacefully, something, of course, is wrong. If, after a careful physical examination of the child, nothing is found to justify these symptoms, a physician invariably finds, if he questions the mother closely, that she has mistaken the instructions and is preparing the food wrongly.

Infinite care in every little detail is the price of success in raising babies as well as in every other field of human endeavor. Revise carefully your method of preparing baby's food if there is any trouble such as is described above. Despite your absolute assurance that you are making no mistake, do not be surprised to find that you are not following directions to the letter, and because of this unintentional mistake, your negligence is responsible for your baby's condition. Go over the instructions with your husband, and let him follow your method of preparation, as you repeat it. He may detect the mistake if any exists,—two heads are always better than one. So important is this matter that the following two actual cases will demonstrate how easy it is to make a mistake, despite the absolute confidence of the mother, in each case, that she was following the printed directions correctly:

I was called to see a baby whose mother informed me that it was having a great deal of trouble. It was apparently not thriving; its bowels were bad; it constantly cried, and seemed to be suffering from colic and indigestion. The mother stated that it lay with its legs constantly drawn up and passed enormous quantities of gas. The baby certainly looked sick. It had been a small baby at birth; and at three months it weighed only six pounds. After a careful examination, I could find nothing in the physical condition of the child itself, which satisfactorily explained the condition, and had made up my mind that the food upon which it was being exclusively fed, and upon which it had been fed since birth, was not agreeing with it. Before recommending a change of food, I asked the mother to state in detail just how she prepared it.

The directions printed on the can in which the food was bought called for so many ounces of a certain quality of "top milk." She thought this meant simply so many ounces off the top of a bottle of milk, which, of course, meant that she was feeding her baby exclusively a very rich cream and absolutely no milk. The result was that the baby—small and weak to begin with—could not digest this rich mixture, so it gradually lost vitality, as the mother kept increasing the strength of the food, according to the age, as directed by the instructions, until it was completely knocked out. I pointed out her mistake and suggested a change in her methods; she was instructed to use the formula for a child of two months, instead of the one for three months, as she was doing. The child immediately began to pick up and in the course of six weeks was entirely cured, and had gained considerably in weight. This mother was a careful, clean, painstaking, attentive nurse, and it was a long time before she forgave herself for the mistake. The mistake here was a little matter, but the results were big and convincing.

The second case was that of a child of about the same age, but in this instance it had been a robust, healthy child when born, and of normal weight and size. The mother nursed it for about one month, when her milk failed, and it was put upon a well-known, patent barley preparation. The food seemed to agree with it for a time, but, as the mother explained, the child soon seemed to be dissatisfied at each feeding,—it gave her the impression that it was not getting enough to eat, so she increased the quantity. Despite this increase of food, it was apparent that the baby was getting weaker, and more and more irritable, and sleepless, until there was no rest night or day for the mother or baby. About this time the child began to "swell up" as if dropsical; it lost its healthy color and looked as if made of wax. It was very evident that the child was being starved, yet this scarcely seemed probable when the actual quantity of food consumed was considered. The directions on the can of this food, called for a certain amount of the barley powder to be mixed with boiled water; and in an additional paragraph it was directed to mix this with a certain amount of milk. When I requested the mother to state how she prepared the food, I was astonished to learn that she had evidently never read the second paragraph of the directions. She was feeding her baby on barley powder and boiled water,—an excellent starvation diet. When her attention was called to the grave carelessness she had been guilty of, she was the most contrite mother I ever knew. As soon as the milk was added to the food the baby immediately began to thrive was very soon a robust, healthy infant.

Of course these were errors of bad judgment and gross negligence of which few mothers would be guilty, but these types of mistakes come to the attention of physicians frequently, and emphasize the need of constant vigilance in every detail in the management of babies if we wish to achieve success.

FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should be fed at the following hours, 6 and 10 a. m., 2, 6, and 10 p. m.

Early in the second year the child should be taught to drink from a cup.

A proper diet for a child of twelve months, of average development, would be as follows:

6 a. m. Milk and barley water, or milk and oat gruel, in the proportion of seven ounces of milk to three ounces of the diluent.

9 a. m. The juice of an orange (strained).

10 a. m. The same as at 6 a. m.

2 p. m. Chicken broth with rice or stale bread crumbs, six ounces; or a light boiled egg mixed with stale bread crumbs; or beef juice, three ounces. Milk and gruel same as at 6 a. m., but four ounces only.

6 p. m. Two tablespoonfuls of cereal jelly in eight ounces of milk; a piece of stale bread and butter. (The jelly is made by cooking the cereal for three hours the day before it is wanted; it should then be strained through a colander; oatmeal, barley, or wheat may be used.)

10 p. m. Same as at 6 a. m.

About the fifteenth month the cereals may be given much thicker and fed with a spoon. The child can at this time take a number of various fruit juices. Orange juice is the best. Carefully strained juice of ripe peaches, strawberries, raspberries, may be given in reasonable amounts, one or two tablespoonfuls, once daily. Custard, cornstarch, plain rice pudding, junket, wheatena, cornmeal, hominy, oatmeal, zwieback, bran biscuit, each with butter, may be added in reasonable quantities between the eighteenth and twenty-fourth months. When cereals are given they should be thoroughly cooked, usually for three hours, and strained. When apple sauce is given to a child about the second year it should contain very little sugar and baked apples should be fed without cream. Water must be given to the child between meals especially during the summer. It should be boiled and cooled kept in a cool place. The following schedule for a child about the third year constitutes a good average diet for a healthy child:

TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT

[Transcriber's Note: The ages were difficult to read and may not all be correct.]

MENTAL DEVELOPMENT

Breakfast:—(7 to 8 o'clock) Oatmeal, hominy or cracked wheat (cooked three hours), served with milk, a little salt but very little sugar. A soft egg, boiled, poached, or coddled. Stale bread and butter. One glass of warm milk. At 10 o'clock, the juice of one orange.

Dinner:—(12 o'clock) Strained soup, four ounces. Chop, roast beef, steak, chicken, small quantity of any one. Baked potato and cooked rice, or spaghetti. A selection of green vegetables may be made from asparagus tips, string beans, peas, spinach, cauliflower, carrots; they should be cooked until very soft, and mashed or put through a sieve. For dessert, plain rice pudding or bread pudding, stewed prunes, baked or stewed apple, junket, custard or cornstarch. A glass of milk or water.

Supper:—(6 o'clock) Cereal; farina, arrowroot, cream of wheat, wheatena (each cooked two hours), with salt but no sugar. Give two or three tablespoonfuls. Drink of milk with stale bread and butter. Twice a week, a little plain ice cream, or junket, custard or cornstarch.

Three meals a day at this time are better than more frequent feedings. The child has a better appetite and much better digestion. It may be found necessary to give delicate children a luncheon at 3 o'clock. A glass of milk and a Graham wafer, or a cup of broth and a zwieback, will answer the purpose. Children recovering from serious illness will need more frequent nourishment. Up to the sixth year the diet may conform to the above schedule, increasing the individual quantities as circumstances may warrant.

THE DIET OF OLDER CHILDREN (FROM SIX TO TEN YEARS)

After the sixth year the diet will conform to the adult diet, with certain exceptions. The important exceptions are as follows: All meats are to be excluded except roast beef, steak, lamb chops, roast lamb, mutton chop; all meats should be cooked rare and either scraped or finely divided. They should be broiled or roasted, never fried, and never given oftener than once daily, and then only in small quantity. Pies, rich puddings, pastries of all kinds, gravies, sauces, all highly seasoned dishes; wine, beer, coffee, tea, should never be given to children. Ham, bacon, sausage, pork, liver, kidney, game, and all dried and salted meats, codfish, mackerel and halibut, are particularly bad.

The following articles are permissible: Broiled chicken, shad, bass. The "platter gravy" from a roast is very nourishing if given in small amounts. Milk should continue to form an important part of the dietary up to the tenth year. It should be clean and fresh but not too rich. Sometimes it is found advisable to dilute the milk with water that has been boiled and cooled. Some children will take it if a pinch of salt or bicarbonate of soda is put into it, and they will digest it easier and better. They should never be allowed to take more than one quart daily and frequently less will do more good. Cream is not good for children of this age. Eggs are valuable; they should never be given fried or in the form of omelets, they are best given boiled, poached or coddled and only slightly cooked. It is never necessary to give more than one egg at a meal. There are children with whom eggs do not agree; these children are disposed to "biliousness."

Vegetables.—Certain vegetables are objectionable at this age: Raw celery, radishes, raw onions, cucumbers, tomatoes, lettuce, corn, lima beans, cabbage, egg plant. The following are good: White potatoes (never fried), spinach, peas, asparagus tips, string beans, celery, young beets, carrots, squash, turnips, boiled onions and cauliflower. It is important to remember that all vegetables should be thoroughly cooked; they cannot be cooked too much. After boiling for some time the water should be drained off and fresh water used to complete cooking. Vegetables should be fed in small quantities. From the third to the tenth year they form an important and essential part of the diet of all children. After the tenth year they can be eaten as served to adults, and other vegetables may then be added. As a rule salads of all kinds should be omitted until after the twelfth year.

Cereals.—Children should not be allowed to eat too much cereal at one meal,—never more than one small saucerful. Cereals should be properly cooked. It is not safe to adhere strictly to the directions on the package of any cereal. As a rule they require much longer cooking. They are best cooked in a double boiler. They may be served with milk, salt, and not more than one teaspoonful of sugar.

Bread.—Fresh bread is never allowable. Graham wafers, oatmeal crackers, Huntley and Palmer breakfast biscuits, bran muffins, rye bread, corn bread, stale rolls, are all suitable to growing children.

Hot bread, fresh rolls, buckwheat or griddle cakes, all sweet cakes, are objectionable.

Desserts.—The only permissible desserts for this age are junket, custards, plain rice, or sago; or bread pudding. The only safe rule to follow so far as "sweet things" are concerned, is not to give them at all. This applies to candy, ice cream, pies, pastries, jam, syrups, preserved fruits, nuts and dried fruits. The parent who indulges a child to "a taste," is guilty of a bad habit, and it can only lead to trouble.

Fruits.—These should always be fresh and selected with care. Fruit is the most important article of diet to a child of this age. Up to five years it is safest to use only cooked fruits and fresh fruit juices: of these the juice from sweet oranges, grape fruit, peaches, strawberries, and raspberries may be given. Stewed or baked apples, apple sauce, figs, prunes, peaches, apricots, pears are excellent because of their effect on the bowels. When the bowels are loose, and especially in hot weather, great care must be taken when fruit of any kind is used. The pulp of any fruit should never be used; cherries, bananas, pineapples, and berries are not to be given to children. Milk should never be allowed at the same meal when sour fruit is served.