108 MILK SUGAR 



It is only within the last few years that our attention has 

 been called to the sugar of the milk as a cause of the acute 

 gastro-intestinal disturbances of infancy. Largely through the 

 work of Czerny and of Finkelstein, an entirely new conception 

 of these acute disturbances has been given us. The idea about 

 which this new conception centers is the nutritional range of 

 the infant from the minimum amount of food which is neces- 

 sary to growth to the maximum amount of the food that it 

 can take without bodily harm. This upper limit is known as 

 the tolerance for any food. The greatest tolerance is manifested 

 for mother's milk; it is harder to render a child sick by over- 

 feeding it with breast milk than with anything else. The same 

 food be it mother's or cow's milk that acts as a food when 

 given in amounts below the tolerance limit, will act as a poison 

 when given in amounts above it, and the disturbances will vary 

 according to which element of the milk is given in excess. The 

 tolerance is lowered (1) by continued overfeeding, (2) by bac- 

 terial contamination of the milk, (3) by parental infections, (4) 

 by external heat. By each one of these last factors, the tolerance 

 may be lowered beneath the amount upon which the child had 

 been previously thriving. In such a case, the toxic action of 

 the food manifests itself by loss of weight and a train of symp- 

 toms that will depend upon the character of the food being 

 given. 



A slight overstepping of the sugar tolerance will lead to a 

 condition called dyspepsia, marked by a slight drop in weight, 

 an increased number of bowel movements and a slight rise in 

 temperature. 



Gross increase above the tolerance or rapid lowering of the 

 tolerance by heat, infection or toxins, give rise to typical cases 

 of cholera infantum characterized by coma, rapid drop in weight, 

 watery stools, fever, slow toxic breathing, leucocytosis, albumen, 

 casts and sugar in the urine. This is the condition in which the little 

 patients are usually brought to the doctor and it is practically 

 impossible then to form a definite conception of the cause of the 

 disease from the history alone. It is only when one can observe 

 the development of such a case that deductions of some value 

 can be drawn. In institutions where there are large numbers 

 of infants to be artifically fed, cases of cholera infantum (intoxi- 

 cation) occur with some frequency. Finkelstein, in charge of 

 140 orphans under one year of age, had occasion to see a large 

 number of such cases and by acute clinical study discovered 

 the relationship of the sugar to this condition. By increasing 

 the amount of sugar, he could bring on an intoxication; by 



