The real cause therefore, as proved by exclusion by a trial of nourish ment, is the "milk fat." A low percentage is tolerated, but if increased there is either no change in weight or a loss in weight.
Thus the cause, as before stated, is of the greatest importance in establishing therapeutic measures. For instance, infants not too far advanced in age suffering from this disorder when nourished from the breast (in spite of the fat contained in human milk) show in a compara tively short time a constant gain in n-eight, normal temperature, and a marked improvement in their general physical appearance.
In cases where such EL course can not be followed it is necessary to remove all fat or at least reduce it and to substitute carbohydrates. Excellent substitutes are buttermilk and malt soup.
Malt soup which formerly had been made by J. von Liebig has been improved by Keller as follows: "Mix litre of milk with 50 Gm. of wheat flour (first mix the flour with a few spoonfuls of cold milk to prevent crumbling). Sift this through a fine sieve and then add I litre of luke warm water in which already have been dissolved 100 Gm. of alkaline malt extract. (This is made with potassium carbonate and from the Keller's malt soup extract prepared by Von Loeflund in Stuttgart.) While constantly stirring, this mixture is quickly heated, and then left to cool either covered or placed in bottles. For infants between three and four months old a thinner substance can be made by adding 1 litre of lukewarm water in place of of a litre.
Different modifications of malt soups have been made in the last year. Sevestre takes litre cow's milk, 3 litre water, 25 Gm. sugar or syrup, and 120 Gm. wheat flour, mixes the milk and water, rubs up the flour with cold milk and cooks it. This thick mixture he allows to cool to 70 degrees C. anci then acids a coffeespoonful of malt which liquefies it.
Terrien, whose idea is not to sacrifice strength by having too much liquid, prepares his soup in the following way: First he grinds 20 Gm. fresh barley in a coffee-mill and allows 150 Gm. of water to infuse with it at 60 degrees. Then to to litre of water he adds 70 Gm. of rice flour,
and steadily stirring it allows it to cook over a slow fire. After a few minutes it is taken off the fire and 50 Gm. of sugar is added. This is then cooled to SO degrees and the filtered malt mixture is added. By keeping it covered the temperature remains at 80 degrees. It becomes fluid and then is boiled for a short tirne.
Buttermilk- has been used for a long time in Holland, and, according to reports from many eminent physicians, Jager, Ballot, Teixierade Mattos, etc., has been used with success. Its importance rests, as Tada emphasizes, on its being poor in fat and rich in carbohydrates; however, the acid reaction is the least important, as the researches of Moll show, to produce results. It is essential that the product be absolutely clean and of goocl quality. The safest way is to prepare it from a known cream which is soured (tither by standing or from sour milk bacteria. In any case the acid content should not be over 4 to 5 per cent. Baginsky filters the buttermilk, heats it slowly over a low flame, while 10 to 20 Gm. flour and 80 Gm. beet sugar are being stirred in it. Then it is placed in porcelain flasks and sterilized at 120 degrees.
Moll has an alkaline buttermilk which he prepares in the following manner: To 1 litre of buttermilk is added 52 Gni. of the following powcler (20 Gm. milk sugar, 20 Gni. cane sugar, 9 Gm. diastase rice flour (Knorr), 3 Gm. dry sodium carbonate). This powder should be well mixed by the aid of heat,then added to the buttermilk,heated for five to ten minutes again, placed in sterile bottles and allowed to cool slowly.
There are also many already prepared conserves which are described as "Holland infant's food," and Koeppe, after many favorable experi ences, advises their use. There are also the preparations of the Bieclert. Selter Flour-free Buttermilk Co. which are ready for use on the addition of lukewarm water. I have had satisfaction from their use at the Poly clinic.
The pulverized milk-sugar preparations are less satisfactory to me.