336 MEDICAL SECTION 



digestion. Again, if the milk is diluted it becomes neces- 

 sary to add cream to bring the fat content up to that of 

 human milk. This forms a serious objection to diluted 

 milk, for cream is expensive, very variable in its con- 

 stitution, often very rich in micro-organisms, and for 

 the summer months almost always contains some form 

 of preservative. Any form of cream is beyond the 

 means of the majority of hospital patients, while steri- 

 lized cream, the only safe kind in the summer, is still 

 less readily procurable. Another advantage of whole 

 milk feeding is its simplicity. The different degrees 

 of dilution at different ages, and consequently the 

 varying amounts of cream to be added, make feeding 

 with diluted milk a difficult process for the average 

 mother. This is avoided if whole milk is used. Little 

 manipulation is required, a matter of considerable 

 importance from the point of view of contamination, 

 especially in the houses of the poor. A matter of less 

 moment is an absence of that constant soaking of the 

 napkins which occurs when diluted milk is used. 



LIMITATIONS AND DISADVANTAGES. 



It is not claimed for whole citrated milk that it is 

 a panacea for all the digestive disturbances to which 

 infants are prone. There are certain very exceptional 

 children who, from earliest infancy, cannot take milk 

 in any form. In them milk seems to act as a poison, 

 producing symptoms of serious toxaemia. There are 

 others a small proportion, I believe who suffer from 

 fat indigestion. For them citrated whole milk is 

 contra-indicated, for what they need is reduction of 

 the fat content. The discovery that the curds passed 

 by the bowel consist largely of fats and soaps is not 

 necessarily an evidence that fat- indigestion is the im- 

 portant factor to be treated, for if the protein coagulum 

 be tough and firm the fat globules are entangled in its 

 meshes, much like blood corpuscles in a thrombus, and 

 in this way the fat-splitting ferments are placed at a 



