MILK IN ITS RELATION TO INFANT FEEDING 591 



however, did not prove fruitful either, for investigation of most 

 cases of gastro-intestinal disturbance has not shown the presence 

 of any distinct bacteria in the gastro-intestinal tract. Still an- 

 other opinion was advanced that the diarrheas of infancy were 

 neither bacteriologic nor pathologic entities, but metabohc proc- 

 esses. Pediatric literature for many years has been made the 

 battlefield for controversies regarding the nature of the metabolic 

 process and the character of the food element responsible for the 

 alimentary disturbance. At oae time the protein in the milk was 

 thought to be the predisposing factor, but Czerny and Keller 

 found that animals fed on protein alone showed no intestinal 

 derangement. They therefore suggested fat as the disturbing 

 element. Shortly after Finkelstein and Meyer found that chil- 

 dren fed on the coagulum of mother's milk which had been added 

 to the whey of cow's milk showed intestinal disturbances, whereas 

 children fed on the opposite combination, the coagulum of cow's 

 milk mixed with the whey of mother's milk, showed no intestinal 

 disturbances. From this experiment Finkelstein and Meyer ar- 

 rived at the conclusion that it was the whey in cow's milk that 

 was responsible for the rise of the alimentary disturbance. As 

 for the nature of the metabohc process involved in severe nutri- 

 tional disturbances, the explanation of Czerny, that it is an acid- 

 osis, is the one most generally accepted at present. The entire 

 question is still far from settled, but as we must have some basis 

 on which to work we shall adopt the classification of Finkelstein, 

 which is the one in most general use, for the study of alimentary 

 disturbances: 



I. Nutritional disturbances due to quantity of food : 



A. Overfeeding. 



B. Underfeeding. 



II. Nutritional disturbances due to quality of food or intoler- 

 ance of food : 



A. Light form : 



1. Disturbances of weight balance or failure to gain. 



2. Dyspepsia. 



B. Graver forms : 



1. Intoxication. 



2. Decomposition. 



III. Nutritional disturbances due to — 



A. Primary intolerance followed by infection. 



B. Heat. 



C. Infectious diarrhea. 



D. Congenital defects. 



We shall discuss these points separately in the order of their 

 presentation. 



