734 
than it desires at the time, and its wishes in this matter should be 
treated with respect. Any portion of food left after a feeding should 
be thrown away, and on no account should it be used again. 
While, as a rule, it may be postulated that no infant is born with 
a digestion congenitally weak, still, as the result of inadequate feed- 
ing, both maternal and artificial, we do encounter infants whose 
digestive processes are a law unto themselves. The efficient nutri- 
tion of such infants often presents a problem which must be attacked 
upon individual lines. The investigations of Teixeira de Mattos,® 
Salge, 6 and others have shown that fat-free buttermilk, or equal parts 
of buttermilk and malted cereal broths, are in many instances di- 
gestible with apparent satisfaction by such infants. As skimmed 
milk, also, is closely related to buttermilk in its composition, its use 
as an article of diet (sterilized) under these circumstances is warmly 
recommended. As soon as tolerance for cow’s milk in this form is 
established, it must, however, be supplanted by a gradual return to 
whole cow’s milk, as both buttermilk and skimmed milk are too poor 
in nutritve 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 
a Teixeira de Mattos. Die Bnttermilcli als Sauglingsnakrnng, Jakrbnck f. 
Kinderheilk., 1902, pp. 1-61. 
1 B. Salge. Buttermilch as Sauglinsnalirung, Jahrb. f, Kinderheilkunde, 
1902, 157-164. 
