

DR. FREDERICK LANGMEAD'S PAPER 335 



I have little experience of citrated milk during the 

 first two weeks oflife, and although cognizant of several 

 instances where citrated undiluted milk has proved 

 satisfactory even at this early age, I should not be dis- 

 posed to use it. In the breast, as Dr. Eric Pritchard 

 has pointed out, "the transition from colostrum 

 to coagulable milk is relatively slow, it may be ten 

 days or more before the mammary secretion assumes 

 the characters of true milk. During this time the 

 stomach has been functionally developing, acquiring 

 tolerance to the presence of coagulated casein and learn- 

 ing to peptonize and liquefy the clot soon after its 

 formation. There can be no evasion or short-circuit- 

 ing of the work." I am informed by Dr. Dicks, who 

 has had charge of infants in a London infirmary, that 

 whilst several infants flourish on citrated milk almost 

 from birth, others fail to do so. The material, however, 

 with which he had to deal was of the poorest kind. 

 Having in view the nature of the breast secretion at 

 this period, the safest plan is to give whey, gradually 

 strengthened by citrated milk during the first fortnight 

 or three weeks, rather than risk promoting early indi- 

 gestion. The objections to citrated whole milk at this 

 period apply, of course, with greater weight to milk 

 which has been diluted merely. 



ADVANTAGES. 



Whole milk, if it can be given in a digestible form, 

 has many obvious advantages. One of these is the 

 small volume of the feed, as compared with that of 

 diluted milk ; for there is no doubt that there are many 

 cases of indigestion induced, not by the faulty com- 

 position of the meal, but by its excessive bulk. We 

 cannot dilute the milk without at the same time dilut- 

 ing the gastric juice; moreover, by distending the 

 stomach we place its musculature at a disadvantage, 

 and, by producing defective motility, militate against 

 efficient mixing of its contents, and so hamper 



