DISCUSSION 113 



low bacterial count for infant feeding. On the other hand, of 

 equal importance is the appreciation that improper dosage of 

 even the purest milk is a serious danger to the life of the 

 infant. 



DISCUSSION 



Dr. Abraham Jacobi, New York: I certainly beg your pardon, 

 Mr. President, for taking a few minutes more of your time. There 

 is one paper that struck me as if it deserved discussion, at least at 

 my hands; that is, the paper of Dr. Helmholz on "Milk Sugar." If 

 I understood him correctly, he is of the opinion that nothing is 

 easier than to overfeed with milk sugar. I understood him to say 

 that milk sugar was the frequent cause of intestinal disorders. If 

 that was not in his paper, I have misunderstood him altogether. 



Only today I had an opportunity to repeat what I have said a 

 number of times, which is that the better class of American phy- 

 sicians are very much better informed than the better class of 

 European physicians. When you see a French or German book 

 you will find that they quote French or German literature. That 

 is not so with Americans. I am positive that the better class of 

 American physicians and writers know foreign literature very much 

 better than the people in the old country. For that reason I appre- 

 ciate highly the fact that the doctor who is American like all of us 

 quoted German authors who have done very meritorious work in 

 connection with infant feeding. The same thing, however, might 

 have been said of American physicians. Tomorrow morning, for 

 instance, your session will be governed by one of our great American 

 pediatrists, who is one of the few whom they happen to know in 

 Europe. He has written a good deal on the subject of infant feed- 

 ing; I know his practice and I know that he does not overwork 

 infant intestines with milk sugar. The changing of milk sugar in 

 the same way in which the doctor has spoken of it has been taught 

 in this country for the last 50 years, so it is quite natural as it has 

 been taught 50 years ago that it should have been forgotten. It 

 has been written about, too, and it is quite natural that the Ameri- 

 can literature not getting to Europe very often has been over- 

 looked on the other side. The fact is that the danger frequently 

 accompanying infant feeding often depends on the excess of milk 

 sugar given; that only one danger is greater; that is the excess of 

 fat feeding. Fat feeding has been a fad in America for some time. 

 The worst cases of destructive indigestion I meet are those of over- 

 generous fat-feeding doctors. People are beginning, however, to 

 retrace their steps and to learn that cow's milk fat is not easily 

 digested, that it gives rise to intestinal disorders. As far as milk 

 sugar is concerned, there are those in America who do not give it at 

 all. They think that in "modified" milk there is enough milk sugar 

 contained for the purpose of digestion, and that if more is added the 

 milk sugar will be changed into lactic acid with all its local and general 

 disagreeable results. What I meant to lay stress on is that the Doctor 

 is perfectly correct, that I approve of his method of applying his 

 knowledge in practice among babies. I do not believe much in prov- 

 ing his theory of knowledge by experiments on pups. We do not 

 practice on pups; we have to deal with infants. A very great experi- 

 ence in the treatment of babies is very much better than experiments 

 of this kind, but his experiments and our practice have certainly led 



