332 MEDICAL SECTION 



ON ARTIFICIAL FEEDING OF INFANTS 

 BY CITRATED WHOLE MILK. 



BY FREDERICK LANGMEAD, M.D., F.R.C.P. 



Assistant Physician, Great Ormond Street Hospital. 



IN spite of the work of the German school, who 

 ascribe to the fats and sugar of cow's milk the chief 

 difficulties met with in infant feeding, most English 

 observers still hold that the protein is the greatest 

 offender. Fat indigestion undoubtedly occurs, and 

 that more frequently than was formerly supposed ; 

 but the, firmness of the casein curd of cow's milk is 

 still the most important difficulty to be combated. 



A consideration .of the differences between cow's 

 milk and human milk suggests two obvious explana- 

 tions of the greater toughness of the curd of cow's 

 milk. One of these is the greater proportion of 

 protein in cow's milk, and the relatively greater pro- 

 portion of casein to lact-albumin ; the other is the 

 excess of calcium salts. Until recently, the former 

 of these has monopolized the attention of the pro- 

 fession. To eliminate it, cow's milk has been diluted, 

 thus diminishing the amount of casein, and reducing 

 the size and, to a certain extent, the density of the 

 curd. A recognition of these truths has originated 

 the method of feeding infants by diluted cow's milk, 

 a device which, of all others, is most in vogue at the 

 present day. Little heed has been paid to the other 

 explanation of the greater density of the cow's milk 

 curd, namely, the larger proportion of calcium salts. 

 Bunge gives the proportion of lime salts in human 

 milk as 0*03 per cent., and in cow's milk as 0*17 per 

 cent. Remembering the effect which calcium salts 

 produce on coagulation, we have a ready explanation 

 of the tough curd. The question which naturally 

 follows is : " Can the excess of calcium salts be 

 eliminated? ' Sir Almroth Wright, in 1893, showed 



