The premature or debile infant requires infinitely greater care and watchfulness than the healthy newborn. It is more liable to sepsis, to digestive and respiratory complications, to ophthalmia, and, in general, exhibits a weakness against all noxious influences. The writer cannot here enter into a discussion of the various methods of treatment, but will describe the course he instituted at the Lying-In Hospital. The incubator. The ventilation need not be altered for each infant. Just enough to keep air changing is right, and the nurse attends to this by operating the damper in the fresh air flue. In winter less air is needed, in summer the valve is wide open.

The temperature of the incubator is usually set at 89° F. If the infant is very premature, or has a very subnormal temperature, one may begin with 91° or 92°, though we have found 89° meets with most requirements. If the child is larger, or when it is ready to leave the couveuse, the temperature is set 86°, 84°, and 82°, successively. Then the slide is opened to accustom it to the external air, and then the heat is turned on only at night. If the child’s temperature goes below 90° it almost always dies. The moisture is likewise regulated, according to the needs of the child. Thirty five to fifty degrees is a proper range. The nurse has to attend to this, which is done by offering a greater or less surface in the moisture box, or by putting water in the moisture pan. The punier the infant, the more moisture needed; otherwise, the little body dries up, the beginning of which is noticed by dryness of the lips and tongue. The higher the temperature of the incubator, the more difficult is the attainment of a regular and normal relative humidity. The incubator should always be kept closed, being opened only to remove and replace the infant; otherwise the thermoregulator will provide more heat and disturb the accuracy of the temperature regulation. The dress of incubator infants should be all of wool, except the diaper. Soft, thin, wool flannel, a simple bag tied around the neck and left long enough so as to be doubled over the body, a woolen binder and the diaper, complete the apparel. The baby is covered with a thin, wool flannel blanket, leaving only the face exposed. This dress allows changes to be made quickly, and gives freedom of motion so necessary to prevent hypostasis. The diet is equal in importance to the incubator. After much experience, I must say that without mothers’ milk, it is almost impossible to raise a premature infant certainly to be a healthy one. For this reason, an incubator station, to be successful, must be in connection with a lying in hospital. I have given up all attempts with artificial feeding and get mothers’ milk at any trouble and expense. The next best is mixed feeding. One must regulate the frequency and the amounts of the feedings by the size and vigor of the infant. For the smallest twenty to thirty drops of a two-thirds diluted mothers’ milk are given every forty minutes to an hour, later, two drams every hour, larger children in proportion. Some children require more, others less, and the amounts every day and hour. One must not overfeed, because of digestive disturbances, fermentations and indigestion, and, too, regurgitation causing choking and cyanosis, which may be fatal. One must give sufficient, and begin within a few hours after birth to avoid weakness from hunger which sometimes shows itself in attacks of collapse or cyanosis. The amount at each feeding must be recorded, and if the baby nurses at the breast great exactness must be practiced to be assured it has obtained food. Method of Feeding. If the infant can suck and swallow, the food is given with a tiny nipple on a little vial. If the child cannot suck, it may be given with a medicine dropper, either by mouth or through the nose. Gavage is the practice of feeding with a stomach tube. The catheter is passed into the stomach and food poured in slowly. The tube is then quickly withdrawn, the infant being held quiet for a few minutes. If the child can be taken to the breast, it is fed by means of a teterelle. The mother draws the milk into the bulb of the glass, and then allows it to flow into the mouth of the child. One should see that the infant has plenty of water, especially in hot weather, because evaporation is rapid and such children have a relatively large surface and thin skin. With tiny infants, for the first week, feeding is done in the incubator, through the side window. Later they are fed in a warm nursery. The Bath. The incubator infant at first needs no baths. It should be anointed daily with benzoinated lard. Dried discharges on the face and buttocks may need a little water and soap. After the infant is ten days old, it may be bathed in water at 103° F., in a hot room. The nose, ears, mouth and buttocks must be kept scrupulously clean, which is not easy, because of the smallness and tenderness of the parts. No force dare be used, because injuries invite infection. Daily general massage and passive motions must be practiced, with extreme gentleness at first, but later the infant must be accustomed to external conditions. The infant is weighed daily and the temperature taken morning and evening, per rectum, and oftener, if the nurse suspects unusual variation. The child should not be disturbed, except for giving it needed attention, and should be placed alternately on its two sides. Removal from the apparatus, depends on the age of the infant and its rate of growth. As a general rule, when the temperature remains normal for days, when the child is about four and one fourth to four and one half pounds in weight, we remove it to its cradle. This varies, of course, so the length of stay is from five days to four weeks. There is no haste in removing the child; it will thrive better in the apparatus, having less to contend with. Operative cases are removed when they have recovered from the shock of the delivery. It has occurred to the writer that an incubator on a large scale would be useful in treating shock in adults. Success in incubator work depends as much on the nursing as on the apparatus. Without a conscientious, selfsacrificing, intelligent and trained set of nurses, the best system will give poor results.