The picture of still another disease, sclerema, depends, in part at least, on the above causes, the relatively greater body surface of the infant and the resulting difficulty of maintaining an exact regulation of the body heat. In consequence of a pronounced lowering of the tem perature, a partial stiffness of the subcutaneous fat takes place, which is due to the fact (shown by lin5pfelmacher) that the fat in the tissues of an infant has a higher melting-point than have the fats of the adult, owing to the small amount of fatty acids present.
What has been said in regard to the skin of the nursing infant, has been accepted for some time in relation to the mucous membranes as well, which are weaker than are those of the adult, and more sensitive, so that they cannot, act as they should. While this hypothesis has cer tainly been proved true of the skin, it is not so of the mucous membrane, and one can merely speak of an especial sensitiveness of the mucous membranes of the infant. We think that this sensitiveness of the respira tory tract tends to catarrh, pharyngitis, bronchitis, and bronchopneu monia. This is borne out by what \vas mentioned in the paragraphs on general pathogenesis.
Diseases of the Digestive Tract. — Of the different affections seen among babies, those of the digestive tract. stand out most promi nently, for the reason that no other organs of the child are so undevel oped. The digestive tract of the infant is dependent on a particular kind of nourishment, even with this nourishment, which represents certainly the best possible for the digestive cells of the baby, derangements of the intestinal tract appear. 'They are of a much milder type, however, than those in ()tiler CaSes. Profuse bacterial life, to which the intestine of the infant is not accustomed, forms sub stances in the chyme which irritate the digestive cells and prodnee catarrh. As a result, an abnormal production of gas stretches the intes tine and causes pain.
Artificial Feeding. Disturbances of digestion occur much oftener in artificially nourished infants than in those naturally fed. People have tried to explain in different ways this frequent appearance of intestinal troubles and their results in the artificially fed baby. Sinne have said that they depend on the different composition of woman's and cow's milk, especially on the richness of the latter in the casein element. Even with a modification of cow's milk resembling perfectly
that of woman, with the proper intervals of feeding and the physiolog ical quantities of food, there always appear relatively more derange ments than when the child is fed on human One can only con clude from these facts that cow's milk is so different front that of the mother that one may never hope to make the one in any way equal to the other. The foreign albumins of cow's milk irritate the mucous membrane of the intestine of the child. This unaccustomed and thus aphysiological stimulus, damaging the digestive apparatus through continued use, indirectly affects the whole organism. What other things take place our imagination can well conceive. Schlossmann is correct in saying that cow's milk is an unnatural food for the infant. This unnatural and aphysiological stimulus harms the baby and espe cially its intestine, which not yet being fully developed, easily gets deranged. Such derangement happens oftener in the artificially fed than in the breast-fed child. One does not go far astray in calling the direct and indirect results dependent on cow's milk the "cow's milk diseases." Although cow's milk call seldom if ever be said to be the direct cause of death, it is doubtlessly a great contributing, factor to the high mortality seen during the first year of life. We can readily see how cow's milk is a predisposing cause, for it may lower the normal resis tance not only of the digestive tract but even of the entire organism. Many examples support this idea. Furunculosis is an example of a disease, the frequent appearance of which is due to the lowered vitality consequent upon artificial feeding.
We should like to take this opportunity to say that we do not consider that the only harmful influence of artificial food lies in the difference of the albumins. The varying percentages of the elements, especially of the fat (particularly maintained by Czerny), play a promi nent part in the injury, without taking into account the different bac teria due to the dirt in the milk. long as we know so little of the quantitative composition of these elements in milk, we can say merely that the injurious results of artificial feeding are produced by the aphys iological stimulus of the milk of other animals. It is utterly impossible to copy the physiological stimulus of the mother's milk by means of other foods.