725 
to a relatively simple and scientific basis. The principles, briefly 
stated, consist in feeding to every child who must be artificially fed 
a food which, based on the age and weight of the child, will furnish 
it with the energy quotient it requires and no more, and to continue 
the food at- that composition and quantity until a diminution in 
the weekly gain of weight, unaccompanied by symptoms referable to 
the gastro- intestinal tract, informs us that an increase in the diet 
is necessary. 
As we need no longer be deterred by our fears of the indigestibility 
of cow’s milk proteid, in the absence of excessive quantities of fat, 
or changes due to fermentation, undiluted cow’s milk can be given 
from the beginning of the first month on, provided its content of fat 
does not exceed 2 to 3 per cent, nor the daily quantity greater than 
150 cubic centimeters per kilogram of body weight. 
To settle any doubt as to the digestibility of whole cow’s milk in 
the stomach of infants, we have but to turn to the observations of 
Budin, Oppenheimer, Yariot, Comby, Lazard,. Drapier, Ruffle, Bon- 
ifas, Gillet, and others, men of large experience, who have fed infants 
from the earliest days in life on whole cow’s milk in proportion to 
their needs without observing anything but the happiest results.® 
In feeding cow’s milk undiluted to infants in this country our prac- 
tice in this direction must be controlled by the following circum- 
stance : Abroad, owing to different methods in feeding, and different 
grades of cattle, milk containing over 3.75 per cent of butter fat is 
rarely found, and the average is probably not over 3 to 3.50 per cent 
in the majority of cases. In our country it is a milk poor in butter 
fat indeed which does not average 4 per cent, while selected milk sup- 
plied to many of our institutions and hospitals and our “ certified ” 
grades of milk are often nearer 4.50 or 4.75 per cent. Thus Chapin 
found that the average content of fat of the milk used in the Babies’ 
Ward of the Postgraduate Hospital in New York was 4.40 per cent. 
The use of milk of this grade of richness is likely to be followed by 
digestive disturbances and symptoms of overfeeding when fed whole 
to infants, both by reason of excessive caloric value and of the forma- 
tion of large fat-containing curds. 
While agreeing with the experience in France of the digestibility 
of undiluted cow’s milk as an infant food, I am not prepared to ad- 
vocate its use in this country unless the fat content is known to be 
no higher than 3.00 per cent. This condition can, however, be secured 
either by using milk from Holstein cattle, which is normally no richer 
° Budin : The Nursling. Comby : Medicine Moderne, Mar. 14, 1894. Lazard : 
Journal de Cliniques et de Therapeutiques Infantiles, L895,886. Darpier : Rap- 
port sur le fonctionnence de la creche. Ruffle : La Gouttette on la diarrhee 
verte des nourissons et son traitement par le lait sterilise. Bonifas : Le Progres 
Medicale. Gillet : Formulaire d’ Hygiene Infantile Individuelle. 
