Matters are considerably different if substitutes for human milk are resorted to, and it is only in very healthy children, or in advanced periods of infantile life, or with very carefully adjusted meals, that the reaction in regard to weight, temperature, and general condition takes as satisfactory arid undisturbed a course as in breast-fed infants.
The increased digestive requirements which an artificially fed nurs ling is called upon to perform, even under the most favorable circum stances, coupled with an alteration of osmotic conditions in the intestine and in the absence of digestive aids in the shape of ferments or comple ments in Pfaundler's sense, as supplied by human milk, contribute to the exhaustion of digestive capacity on the part of the epithelium and secretions, causing the illy or imperfectly digested food to enter the tracks between the intestinal wall and the blood current, where it will not fail to exert an injurious effect.
Fortunately, this will not happen with the elementary force of a catastrophe, but will only occur after the onset of \yarning symptoms, the correct interpretation of which renders it possible to check the attack, and the exact knowledge of which is therefore of the greatest importance.
Comparing this kind of affection, caused by food qualitatively per fect, but quantitatively injudicious from tnisproportion between the requirements of the organism and its digestive capacity, we find that other affections which are caused by an almost exclusive nutrition of a nearly uniform farinaceous nature, giving rise to bacteriotoxic effects, take a much more unfavorable course.
We therefore propose to deal first with those deleterious effects which are by the administration of diluted or undiluted cow's milk or its various preparations, containing sometimes an excess of fat, sometimes of sugar or other carbohydrates, such as buttermilk, malted soup, bake house milk, gardener's milk, ramogen, ete., and, in doing so, follow as closely as possible the comn,unications made by Finkelstein and his school.
(a) The Effects Resulting from the Use of Cow's Milk as a Disturbance of Balance.—As such WC describe a condition resulting from the use of an apparently pure milk given at intervals and in amounts which conform to the requirements for the normal, but upon which the child, so far as weight and physiological qualities are con cerned, remains below normal.
Such children show, on a so-called "supporting diet" as well as on a "weighed diet," which in the first year averages 70 calories per kilo gram, a normal appearance so far as their physical characteristics, temperature, stools, etc., are concerned. The weight, however, in accord ance with the nourishment giver, remains stationary.
On increasing the quantity of this diet there is fluctuation in the weight curve, now and then registering a sharp decline; the temperature becomes uneven and, instead of a healthy, rosy appearance, these children become pale and anmmic. The muscles become soft and Gabby and the tissues appear shrunken. In general the nourishment is defective, the children being lighter in weight than normal children of the same age.
'Unlike other cases due to defects from the feeding of COW'S milk, there are no serious disturbances of the general system, the respiration, pulse, or urine. An important diagnostic feature is the "paradox reaction," so called because when the nourishment is increased in healthy children there is a gain in weight, while in these infants there is rather a decline or they fail to gain.
At times the stool appears normal, at times harder or softer, but yet the stools are fairly regular. Occasionally the fatty stool, which is light in color, dry, and offensive in odor, is seen. This is supposed to be due to the soaps and neutral fats.
The cause of this form of disease is due to a deviation from that broad tolerance of nourishment which is only beneficial in limited quan tities. An increase of nourishment means a complete failure to gain or if the increase be of too much fat or other material difficult of digestion there will be a decline in weight altogether.
There seems to be no reason to believe that the protein of cow's milk, whether appearing as fine or large curds, plays any. part in the causation of this disease.
The tolerance to carbohydrates in such cases is well established, and this fact is of the greatest importance from the therapeutic stand point. It is only in the feeding of older infants that disturbances of balance due to carbohydrates are observed. In these cases (referred to later under Dyspepsia) there are no reliable intestinal or general symp toms, but there is a decrease in the utilization of nourishment, and on increasing the quantity the so-called "paradox reaction" is observed.