721 
bottle or glass. The stools, hitherto of normal odor, color, and con- 
sistency, become pale-gray, hard, and dry. In fact, they are of the 
color and consistency of putty, and may be rolled off the diaper with- 
out even soiling it. Their odor is strong and suggests decomposition. 
The urine becomes charged with ammonia salts and stains the diapers. 
Systemic effects are shown by the pallor of the child ; the tissues lose 
their firmness and solidity, becoming flabby and relaxed; the child 
also fails to gain in weight on the same food or a greater quantity of 
the same food which has hitherto produced a gain in weight. A 
persistence in this course of feeding not only does not increase the 
weight, but occasions a loss. Two results follow the continued exhi- 
bition of such a diet. The body tissues waste, the belly distends with 
gas, and we have the atrophic or marantic child, or a gastro-intestinal 
catastrophe results with vomiting, diarrhea, fever, and prostration, 
accompanied by an inability to take cow’s milk for a period often 
extending into weeks. Such, then, are the symptoms in the more ag- 
gravated cases. In those more chronic the anorexia and constipation 
go hand in hand, the former and the latter being almost constant. 
Outbreaks of eczema are common, from small roughened patches on 
the cheeks to eruptions invading large areas. As the child grows 
older the symptoms of rachitis are observed. 
The firm, pale-gray stools so characteristic of this condition are 
composed largely of fatty soaps (Seifenstuhlen) . Czerny and Keller 
ascribe the pathology of this condition to the action of fat in extract- 
ing the alkaline bases already alluded to, as shown by the increased 
elimination of ammonia in the urine. They regard this elimination 
of ammonia salts due to the fact that the alkaline bases are so largely 
drawn upon from the body to saponify the excessive amount of fat 
accumulated above the needs of the organism in the intestine, that in 
order to satisfy the normal acid products of metabolism the ammonia 
salts are drawn upon. 
Percentage system of artificial feeding . — In this manner we see di- 
vergent points in this view of the whole question of infant feeding 
as compared to that in vogue on this side of the Atlantic. The per- 
centage system of modification of milk rests upon the following 
premises, two of which are certainly faulty : 
First. That a substitute for mother’s milk must resemble it in the 
relation and chemical composition of its ingredients ; 
Second. That this condition is fulfilled only by some milk ; 
Third. That cow’s milk is the only practical substitute; 
Fourth. That the chief difficulty in the use of cow’s milk is the in- 
digestibility of its proteicl by infants ; and, consequently, 
Fifth. The composition of cow’s milk must be so altered by appro- 
priate manipulation as to -provide those relative proportions of pro- 
1414— Bull. 56—09 46 
