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whole cow’s milk, as both buttermilk and skimmed milk are too poor 
in nutritive elements to furnish the basis for any long continued 
scheme of artificial feeding. 
It should not be forgotten that atrophic infants require a greater 
energy quotient than the normal child of the same weight. This is 
due to two reasons, first, by reason of the greater radiation of heat 
on account of their deficiency in bodily fat, and second, because 
their proportion of living body cells is greater in respect to their 
weight than is the case in infants of normal nutrition. In the 
latter, 8 to 12 per cent of their weight consists of fat, whose function 
in the metabolic processes of the organism consists only in furnishing 
a storehouse for energy and in conserving the bodily heat. In the 
emaciated child of the same weight, the body consists almost entirely 
of cells performing vital functions, all of which require nutriment 
for their proper performance. In view of these facts, in such cases 
the food given may be increased above the normal both in quantity 
and in caloric value, taking care, however, not to provide such an 
excess that the digestion is thereby embarrassed, and to reduce the 
nourishment to amounts appropriate to the weight and age of the 
child as the normal average of weight for age is approached. 
It is also important to remember that cow’s milk when compared 
with human milk is essentially an alien food. Both its fats and its 
proteids are different in composition from those of human milk and, 
being adapted to the nourishment of an animal on a different zoolog- 
ical plane, must of necessity be regarded as substances foreign to the 
human, infantile digestive tract. As a consequence, greater energy 
is required for its digestion and assimilation, and it is of the highest 
importance that the infant metabolism be not further strained in this 
connection by the imposition upon it, in addition to this task, of the 
conversion of a milk whose digestibility is further impaired by fer- 
mentative changes due to its improper preparation and preservation 
as a food. 
TVliile we can never hope to vie with natural nursing, an applica- 
tion of the principles briefly expounded in this paper will go far. I 
am convinced, toward eliminating the excessive complexity and 
uncertainty which have hitherto characterized the whole subject 
of infant feeding, and. in the main, be productive of better results 
than we can obtain by other methods. 
