TONICS AND STIMULANTS.

13

treatment of the different diseases. The important point to remember is the uselessness of tonics so long as any derangement of the digestive organs remains uncorrected. In order that tonics may be beneficial, the stomach and bowels must be in a healthy state. It is only when digestion is restored that these remedies are admissible; they will then prove of extreme service, increasing the vigour of the stomach, and improving the tone of the whole body.

To the general list of tonics, cod's liver oil is an important addition. It is, indeed, more a food than a medicine; but for this very reason it should not be given in too large quantities. If more of the oil is being taken than can be digested, the surplus passes down through the bowels, and is seen unchanged in the stools, where it is at once recognised by its appearance and smell. In administering the oil our object should be to give as much as can be readily digested, but no more. For a child under two years of age ten drops will be a sufficient dose at the first. The quantity, after the first few days, can be gradually increased, but a careful watch must be kept upon the stools, and the appearance of any oil unchanged in the evacuations is a sign that the quantity must be reduced. For a child of this age we can seldom go beyond thirty drops for the dose, three times in the day.

With regard to stimulants; they are always required when the fontanelle becomes much depressed. The best form is pale brandy, of which a few drops (five to ten) may be given in cold water or a little milk, as often as circumstances seem to demand the repetition.

CHAPTER I.

SIMPLE ATROPHY FROM INSUFFICIENT NOURISHMENT.

SIMPLE ATROPHY FROM INSUFFICIENT NOURISHMENT.-An exceedingly common condition.-Causes-Insufficient supply of food-Varieties of breast milk-Effect of preponderance of butter in the milk-Test of a good nursee-Unsuitable food-Dependence of nutrition upon power of digestion-Over-feeding-Varieties of food required for perfect nutrition-Differences between woman's and cow's milk-Cow's milk cannot always be digested.

Symptoms. Two classes, according to cause-Food suitable but insufficient -Food unsuitable-Wasting-Constipation-Cause of inactivity of bowels-Flatulence-Colic-Ravenous appetite-Eruptions on skin, strophulus and urticaria-Thrush, its importance in prognosis-Inward fits-Attacks of vomiting and diarrhoea-Convulsions-Aphtha -Danger of secondary diseases-Mode of death.

Treatment. Suckling-By mother-By nurse-Rules for choosing nurse— Directions for efficient suckling-Advantages of putting child early to breast after birth-Times of suckling-Artificial feeding-Directions— Feeding-bottle--Importance of cleanliness-Different infants' foodsLiebig's food-Cow's milk may disagree-Weaning-Usual timeMust sometimes be anticipated—Method of weaning-Reason why a child may refuse the breast-Diet after weaning-General management of infants.—Treatment of-Constipation-Flatulence and colicConvulsions-Thrush-Aphthæ-Diarrhoea and vomiting.

THIS is the commonest form of disease, and the most frequent cause of death in infants. Many thousand children die yearly in London alone for the simple reason that they are fed systematically and persistently upon food which they cannot digest. And so long as the children of the poor are allowed to leave their schools utterly uninformed as to duties which in after life they will be called upon to fulfil, so long this dreadful mortality may be expected to continue.

Causes. The supply of food may be actually insufficient. This is found in cases where the child is nourished entirely by the breast, and the milk of the mother is poor and

VARIATIONS IN WOMAN'S MILK.

15

watery; or in those cases where the breast has remained the sole support of the child after the time when some other food ought to have been given in addition. When the mother is weak, anæmic, and evidently ill-nourished, her milk no doubt always suffers from the impoverished state of her blood; but the converse of this is not always the case, for the milk of a woman may still be of very inferior quality, although in her health and general appearance she may present no sign of weakness. From the researches of MM. Vernois and Becquerel * we find that the richest milk is far from being secreted by women of the greatest muscular development. On the contrary, their investigations tend to show that a robust figure is inferior in milk-producing power to one slighter and less apparently vigorous. The following table, formed after an analysis of sixty-three cases of the former, and twenty-three of the latter, will make this apparent. Under the first head (strong constitution) they place brunettes, with well-developed muscles, fresh complexions, moderate plumpness, and all the other external signs of constitutional strength. Under the second head they range fair-complexioned women, with light or red hair, flabby muscles, and sluggish muscular contraction.

It will thus be seen that in women ranked under the head of strong constitution the deficiency in the amount of the

*Du Fait chez la Femme." 8vo, Paris, 1853.

sugar and the casein is very remarkable, while in those of apparently weaker constitution these elements very nearly attain the normal standard.

There is another condition of the milk which appears to exercise a great influence upon the health of the nursling. Out of 89 infants suckled by women in apparently good condition fifteen were found by MM. Vernois and Becquerel to be inefficiently nourished. On a careful analysis of the milk it was found that in all these cases the relative proportion of the butter was raised considerably above the normal standard, being on an average 33.22, against 26-66, the healthy amount, while the proportions of the casein and the sugar remained unaltered.

For practical purposes, we may make a guess at the quantity and quality of the milk by inspection of the breasts of the mother or nurse. They should be pear-shaped, hardish, and mottled with blue-veins. On pressure of the gland the milk should squirt out. The milk itself should be opaque and of a dull white colour: under the microscope it should present fat globules of medium size, not too small. As a rule, the number of the fat globules is a rough indication of the quantity of casein and sugar, although this, as has been said, is not always a trustworthy guide.. The best test, however, of the goodness of the milk is derived from observation of the child. He should be watched while at the breast, and if he sucks vigorously, finishes the meal with the milk running over his lips, and requires suck but a few times in the day, we may infer that the milk is sufficiently abundant. If, on the other hand, he constantly requires the breast, sucks laboriously and with effort, occasionally desisting and crying peevishly, the milk is probably scanty. As an additional test the infant may be weighed immediately before and after taking the breast the increase in weight should be from three to six ounces, according to his age.

Besides the above cases, where the quantity of the food is at fault, there is another class of cases where nutrition is

UNSUITABLE FOOD.

17

equally unsatisfactory, although the supply of food, as food, is liberal enough. These cases occur where weaning is premature, or where the child has been brought up by hand, and the kind of food chosen to replace the natural nourishment is injudiciously selected, so that the limited digestive power of the child is unable to convert it into material necessary for the growth and development of the tissues. Here the diet substituted for the mother's milk, although nutritious enough in itself, yet supplies little nutriment to the infant. A child is not nourished in proportion to the bulk of the food he receives into his stomach. He is only nourished by the food he can digest. Weakness in a child otherwise healthy, while it shows a deficient degree of nutrition, and therefore calls for an increased supply of nourishment, yet at the same time calls for increased care in the selection of the kind of food. There is a difference between food and nourishment. A child may take large quantities of food into his stomach, and yet from weakness of his digestive organs, or from the indigestible nature of the food swallowed, may derive no nourishment from it whatever. On the contrary, it may cause great irritation and pain in the alimentary canal, and, setting up a febrile state, still further reduce the child whom it was intended to support. The tendency of mothers is to overfeed their children,—to mistake every cry for the cry of hunger. Consequently, as the peevishness and irritability of the child increase in proportion to the pain excited in the bowels, the food is made more and more "nourishing;" the louder the cry the thicker the " sop," until at last a violent attack of vomiting or of diarrhoea takes place, or a convulsive fit warns the parent that it is time to desist. Cases of steady emaciation will be constantly found due to this cause, especially in children who are brought up by hand. Amongst the poorer classes they are commonly fed upon farinaceous food as soon as they are born. This, of course, they are totally unable to digest. As a consequence, they dwindle and rapidly die, or, if of