Again, more than half of the saccharine ingredient of this preparation is cane sugar, added for the purpose of preservation, and this material is very liable, when in excess, to ferment in the alimentary canal, giving rise to irritant products that impede digestion.

Infants fed upon condensed milk, though fat, are pale, lethargic and flabby; although large, are far from strong; have little power to resist diseases; frequently develop scurvy; often cut their teeth late, and are very likely to drift into rickets. It must be remembered also that condensed milk, when long kept, or when packed in imperfect cans, not unfre-quently undergoes decomposition, and thus becomes utterly unfit for use.

For a temporary change of diet, and as a substitute during traveling or under circumstances in which sound cows' milk cannot be obtained, it may be resorted to with advantage. Again, for feeding very young infants when a sterile food of low albuminoid percentage is indicated, it may sometimes prove useful, but the necessity of adding fat, in the form of cream, must always be insisted upon.

The farinaceous substances so often selected, especially by the poor, to replace breast milk, are not only bad foods, but have both directly and indirectly a deleterious effect upon the processes of nutrition.

They are bad for two reasons. First, they differ materially in chemical composition from human milk. For example, in arrowroot, which is the favorite, the proportion of the tissue-building to the heat-producing element is as one to twenty, while in human milk it is about one to five. Second, the heat-producing principle, starch, must be converted into sugar before it can be absorbed. This change is accomplished in the body by the saliva and pancreatic juice - secretions that are not fully established until the fourth month.

While the starch lies undigested in the gastrointestinal canal, it is subject to fermentation, resulting in the formation of irritant products that rapidly induce catarrh of the mucous membrane - a condition directly interfering with the digestion and absorption of food. Again, perfect nutrition demands rapid waste and removal of effete tissues as well as repair of the same. This is effected by oxidation. Now, sugars are known to have a much greater affinity for oxygen than albuminoids, and when the diet consists of farinaceous material, the small amount of sugar formed and absorbed appropriates oxygen that otherwise would go toward the removal of waste, and so retards the necessary changes. The persistent and exclusive use of this class of food always leads to a condition of malnutrition which may result in simple atrophy, scurvy or rickets, while the irritant products of fermentation often produce sufficient gastro-intestinal disturbance to cause death.

Farinaceous food, as such, is therefore never permissible before the later months of infancy, and then only as an adjunct to properly modified milk mixtures. It may be employed earlier for its mechanical action, with milk mixtures, and in properly selected cases proves very useful in this way. The purpose of this method of employment will be considered later under the head of Atten-uants.

The nutrient value of the cereals and their products, as they exist in so-called "infants' foods," has been imperfectly determined. They are undoubtedly useful as mechanical attenuants, but it 12 is very certain that none of them, unless prepared with milk, can permanently meet the demand of nutrition. At the same time it is quite probable that the albuminoids with the soluble carbohydrates (maltose) obtained by Liebig's process have a food value of their own, making them more serviceable than the starches.

b. The quantity of food to be allowed each day varies with the appetite and age. Some infants habitually eat little, others much; as both thrive, the question of the correct amount in a given case must be answered by observation. So long as the child develops with normal rapidity and keeps well he may be allowed to eat as much or as little as he wants; for, if food of proper strength be given at proper intervals, the instinctive cravings of hunger, since they represent the wants of the system, rarely lead to excess in either direction. Nevertheless, it is well to have some guide.

During the first four weeks, infants generally require from twelve to seventeen fluidounces of food; in the second and third months, about thirty fluidounces, and from this time to the twelfth month from two to two and one-half or even three pints. After the twelfth month the quantity depends upon whether additions be made to the diet, or milk food be used exclusively. When the daily amount reaches three pints, the limit of the capacity of the stomach is usually attained, and the greater demand for nutriment, as growth advances month by month, must be met by adding to the strength of the food rather than by increasing its bulk. These two factors, strength and quantity, are intimately associated throughout the whole period of infancy, and in the earlier months a mere increase in the latter is not always sufficient to maintain the balance of nutrition.

As a rule, infants are overfed, and this opens the very interesting question of the normal capacity of the stomach at different ages. Rotch states that, by actual measurement, the stomach of an infant five days old holds 25 c.c, or six and one-quarter fluidrachms, a quantity very far short of that usually forced upon the baby during the first week. Frowlowsky's investigations show that there is a very rapid increase in the capacity of the stomach during the first two months of life, while in the third, fourth and fifth months the increase is slight. Guided by these data, the quantity of food should be rapidly augmented during the first six or eight weeks of life and then held at the same quantity up to the fifth or sixth month. Another considerable increase is also demanded between the sixth and the tenth months.