788 W. McKIM MARRIOTT 



When breast milk is substituted for cow's milk in amounts of equal 

 caloric value, a gain in weight usually occurs. The character of the stools 

 changes and the other symptoms disappear. Breast milk contains as 

 much fat as cow's milk, but- the fat is composed of a smaller proportion 

 of glycerides of the volatile fatty acids and less of the difficultly absorbable 

 palmitic and stearic acids. Breast milk contains less protein and has a 

 low buffer value. The feeding of breast milk results in a change of the 

 flora of the lower intestine. The absorption of mineral salts is better 

 despite the fact that the salt content of breast milk is lower than that of 

 cow's milk. 



Certain modifications of cow's milk are also very effective in treat- 

 ing the condition. If cow's milk is so diluted that only a relatively small 

 amount is given in the course of the day and if sugar or starch or both 

 are added in relatively large amounts, the mixture may be fed with ex- 

 cellent results, as far as the symptoms are concerned. The dilution of 

 the cow's milk lowers the fat and protein content and also the buffer 

 value of the mixture. The relative excess of carbohydrate leads to a 

 change in reaction of the contents of the lower intestine from alkaline to 

 acid and as a consequence the absorption of calcium is much better (Sato, 

 Usuki). Furthermore, the bacterial flora of the lower intestine change 

 from proteolytic to fermentative types. 



Almost equally successful as a means of treatment are mixtures of 

 buttermilk or whole lactic acid milk with the addition of starch or sugar. 

 Here the fat may or may not be low, the protein is not reduced but the 

 carbohydrate is high in relation to protein, and the buffer substance is 

 partly neutralized by lactic acid. 



Every type of food which has been found to be successful in the 

 treatment of these infants has a low buffer value and results in a change 

 in the reaction of the contents of the lower intestine from alkaline to acid. 

 Better retention of mineral salts occurs with each of these alterations. 

 In the light of our present knowledge we may, therefore, state that the 

 condition of stationary weight in infants when fed considerable amounts 

 of cow's milk is in all probability the result of a disturbed mineral metab- 

 olism brought about by abnormal conditions in the gastro-intestinal tract. 



Metabolism in Infantile Diarrhea 



The effects of overfeeding are not always the same. In the metabolic 

 disturbances just described a stationary weight with constipation and 

 the passage of alkaline soap stools were the prominent symptoms. If 

 overfeeding with cow's milk is continued for too long a period, and es- 

 pecially if excessive amounts of sugar are added to the diet, diarrhea 

 instead of constipation is the result. The stools become acid in reaction 



