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. I 
A^Tiile, 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 i 
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,^ and others have shown that fat-free buttermilk, or equal parts 
of buttermilk and malted cereal broths, are in many instances di- i 
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 i 
established, it must, however, be suj)planted by a gradual return to 
whole cow’s milk, as both buttermilk and skimmed milk are too poor i 
in nutritve elements to furnish the basis for any long-continued i 
scheme of artificial feeding. 
It should not be forgotten that atrophic infants require a greater i 
energy quotient than the normal child of the same weight. This is 1 
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 t 
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 i 
® Teixeira de Mattos. Die Bnttermilch als Sauglingsnahrnng, Jahrbiich f. 
Kinderheilk., 1902, pp. 1-61. • ■ 
^ B. Salge. Buttermilcb as Sauglinsnabrung, Jabrb. f. Kinderbeilkunde. ! 
1902, 157-164. j 
