DISTURBANCES OF NUTRITION IN ARTIFICIALLY FED NURSLINGS problem of artificial feeding, its importance for the organism of the nursling, and the dangers connected with it, are matters of history. But in spite of all contradictions it should again be pointed out that it was Biedert who, from his clinical. observations, and with the aid of chemical experiments, first established the fact that cow's milk has an injurious effect not only in regard to its percentage deviation in composi tion as compared to breast milk, but also in regard to the quality of its various components, more especially in regard to its casein content. Possibly he has not seized upon the right material, or, to express it more carefully, the most frequent causative factor. More recent investigations seem indeed to have made this plausible, but at all events his merit is to have furnished the foundation by correct alteration of the composition and by establishing the important conception of the "minimal require ment" for all future investigations in this regard. Furthermore, it has been a matter of great importance that Czerny and his disciples detracted attention from the processes of the gastro-intestinal canal and directed it to the intertnediate metabolism which explains the cause of pathological processes by acid intoxication and its deleterious consequences. Recent works (notably the investigations of M. Pfaundler, Steinitz, L. F. Meyer, and Langstein) have furnished proof that acidosis is a symptom, and even a constant symptom, of the disease, and not the disease itself.
There is no doubt that a closer examination into the pathology of metabolic processes and the rigid division of the methods of action of the various nutritive coniponents (albumen, fat, and carbohydrates), such as were comtnenced by Czerny and Keller in their studies on acidosis, have resulted in clearing up the problem. They gave a more precise form to the conception of the disorders of nutrition, by clearly dis tinguishing between the various types of affections caused by fat (milk affections) and those due to farinaceous food (flour affections).
Going further into these details, Finkelstein and his collaborators have strongly emphasized the toxic effects of sugar and salts, based upon careful clinical and bacteriologico-chemical investigations of numerous affections of nutrition.
Rietschel's studies on the exact cause and nature of the type of affection from exclusive or preponderating farinaceous food were not less meritorious.
In this way we have arrived in the course of a few years at a com plete revolution in our views on the nature of disturbances caused by artificial food in nurslings, and, by returning to former observations, placecl the child in the foreground of interest, above the study of evacua tions, intestinal bacteria, urine, and other less important things, and this fact appears to me the most valuable item in the changes that have taken place.
The reaction on injuries caused by nutrition, the changes it causes in appearance, behavior, temperature, weight, respiration, consciousness, niotility, musculature, and organic tissues, have again become a matter of supreme importance, and even if this method of observation has, owing to the shortness of time, not yet been able to explain the manifold pathological pictures which occur in artificially fed nurslings, it has nevertheless solved many problems, and explained many phases which had previously not been understood and pointed out the way for their prevention.
It has afforded me satisfaction and pleasure to follow these changes in the present edition of my book in explaining the disturbances of nutrition, more especially- so as their study otTers genuine enjoyment and incitement to the experienced physician, and I clid not mind the trouble to completely rewrite this chapter in order to do justice to the changed views so far as they have been given expression.
Aside front its y-egetative function the infant has to satisfy a very active demand for growth, and the breast-fed infant responds to this double requirement in the most perfect and economical manner. The components of the food are changed by the epithelium and glandular secretions of the gastro-intestinal canal and abdominal glands, and present the same in an assimilable form for metabolic purposes. There are no rigid laws in regard to quantity and intervals of feeding, as long as the infant is breast-fcd, and the frequent and almost constant excesses beyond actual requirements are merely followed by such disturbances as have been described on page 97 and following, without causing any lasting ill effects. This is explained by the great adaptability of the infantile organism to natural feecling, for the totality and components of which there exists considerable tolerance, as Finkelstein has felicit ously expressed it.