HENRY tf. HELMHOIfZ, M. D. Ill 



There are, however, certain criticisms to be made against the 

 work of Leopold and Reuss. First, their method for measuring 

 the amount of lactose excreted did not include the possibility 

 that a mixture of sugar in the urine gave rise to polarization 

 figures that corresponded to a quantitative figure for the amount 

 of lactose injected; and, second, lactose subcutaneously injected 

 may be excreted by certain channels other than the urine, so 

 that the disappearance of the lactose from the urine is not nec- 

 essarily a criterion for the destruction thereof in the body. In 

 making a systematic study of the relationship of lactose to in- 

 toxication, Dr. Woodyatt and I have had occasion to repeat 

 the work of Leopold and Reuss, using an improved method and 

 laying more stress on the possibility of the existence of a mix- 

 ture of sugar in the urine following injection. We could show 

 that by fermentation a portion of the reducing and rotary sub- 

 stance was lost, after the first injection when less than 100 per 

 cent, of the injected amount was excreted. Repeating the in- 

 jections \ve noted a gradual reduction in the amount excreted, 

 but no consistent absence of lactose from the urine. By suitable 

 experiments on dogs it could be demonstrated that the lactose 

 after parental injection was excreted not only by the urine, 

 but also in the bile, and by the duodenal mucosa, so that it is 

 readily conceivable that instead of an increased destruction of 

 lactose within the body, as shown by the urinary findings, a 

 larger per cent, of it is shunted into the intestinal canal. We 

 are at present engaged in experiments along this line and hope 

 to be able to report on them at some future time. At this 

 time, however, it is apparent that absence from the urine after 

 injection is no indication that lactose is destroyed in the body. 



I have come now to the part which will be of more interest 

 to most of those present, namely, the bearing that all this has 

 on the great question of the reduction of infant mortality. I 

 have tried to show you that the commonest type of gastro- 

 intestinal trouble is caused directly by the food that it is 

 brought on in its most acute form by the lowering or over- 

 stepping of the tolerance for sugar, be that by improper feeding, 

 by infection, by spoiled milk, by high external temperature, or 

 by other causes. The food which, under normal condition 

 nourished the child, becomes a poison as fatal as bacterial 

 toxins. 



As I mentioned before, the purity of the milk, though of great 

 importance, is not the only important factor. The emphasis that 

 is being laid upon pasteurization of a city's milk supply, while 

 it is of great value and if properly understood, leads to much 

 good, has unfortunately overshot the mark among the uned- 

 ucated. Instead of feeding their infants fresh milk, they avoid 



