494 PEDIATRICS 



mann and Hamburger have pointed out the importance of this 

 question in infant feeding. 



The thermolabile ferment-like bodies, which are contained in 

 mother's milk, and to the presence of which I have myself drawn 

 attention, also belong to the group of components which differ 

 qualitatively. These substances give the breast-fed child, as they 

 come from the blood of the mother, a part of the antitoxins and 

 metabolic ferments contained therein, while the analogous bodies 

 contained in raw cow's milk are of little or no value to the nursling. 

 Therefore, it does not appear to me justified to give up for this 

 reason the sterilization of cow's milk by heat, an acquisition which 

 I consider one of the greatest advantages in this line, although a 

 general tendency exists to limit the temperature and duration of 

 the heat as much as possible, on account of the chemic changes 

 which it causes. This is the more possible, the more cleanly the 

 method of obtaining the milk has been, and the more carefully it 

 has been handled before sterilization. It appears very questionable, 

 however, whether the recently advocated addition of formalin 

 (Behring), or the passage of electricity (Seifert), will be able to 

 replace sterilization by heat. 



An important difference between natural and artificial nourish- 

 ment exists also in the method of feeding. The child at the breast 

 receives the milk by active suckling, and (presuming feeding by its 

 own mother) in a quantity and composition suited to its needs. The 

 artificially-fed child has at its disposition food in unlimited quan- 

 tity, and as a rule this is poured into its digestive tract in excessive 

 amount, considering its digestive powers. Another practically im- 

 portant step in artificial feeding lies in strict limitation of the size 

 and number of the feedings, in the determination of the amount of 

 nourishment calculated either by the volumetric method or reckoned 

 in calorics, in a word in the avoidance of the habitual over-feeding of 

 the bottle-baby. In spite of the large amount of work done in this 

 direction in the last decades, we must confess that we are still far 

 from the aim of our efforts, the discovery of a substitute for mother's 

 milk, and that nothing can replace it, especially in children back- 

 ward in development or weakened by disease. On the other hand, we 

 can say truthfully that we have succeeded in robbing the feeding 

 with cow's milk of a large part of the danger which previously accom- 

 panied it, so that if the power to assimilate cow's milk is present at all, 

 artificial feeding can be carried on with confidence as to the result. 

 Of course, its proper carrying-out requires a much greater cost of 

 time, care and pecuniary means than does breast-feeding; so that the 

 improvement in artificial feeding is of slight or no benefit to the poor 

 people, where it is most needed. The same difficulty also exists with 

 regard to care, cleanliness, light and air in their dwellings. 



