DR. HENRY L. COIT'S PAPER 307 



also be determined. These extremes represent the 

 possible dietetic limitations of the patient. When the 

 initial formula designed for the condition in which 

 we find the patient is fixed, it greatly facilitates 

 success to arrange a working formulary in a series, 

 one at the left and the other at the right of the 

 chart, inserting intermediate figures for advancing 

 the changeable ingredients, and for diminishing or 

 increasing the diluents. 



In this way it is convenient to write the formulae 

 on a caloric basis, allowing the caretaker to advance 

 on the estimated increase in weight during the interim 

 of the visits for inspection. 



Professional judgment exercised in the accurate 

 employment of the food materials is a factor of great 

 importance. The balanced ration will include the 

 proper amount of protein elements to supply the 

 infant's enormous capacity for nitrogen, to replace 

 that lost in the wear and tear on the tissues, and to 

 furnish the building material for growth. It will 

 include the adjustment of the fat so that it will be 

 utilized and thus avoid fat intolerance, the loss of 

 calcium and fat decomposition with its resultant 

 irritants, acidosis and atrophy. It will include the 

 proper estimation of the energy quotient not supplied 

 by ifat and proteid, by adjustment of the carbohydrate 

 to avoid the chain of changes so frequently seen in 

 the symptom group, for the clear understanding of 

 which we are indebted to Finkelstein. 



Among the extrinsic factors are the temperament 

 of the caretaker, system in the management, and 

 provision for the comfort and hygiene of the baby 

 which may be mentioned together. 



There are as many types of mother as of tempera- 

 ment. Motherhood is poetic and beautiful, but in the 

 vicissitudes of modern life, normal maternal instinct, 

 self-poise and resourcefulness have given place in 

 many instances to apprehension and fear with no 

 capacity for good judgment. 



