MODE OF FEEDING.—It is the experi ence of every physician who has kept a record of his cases that fatal, or even severe, cases of diarrhoea among infants fed entirely at the breast are extremely rare. Bolt emphasizes this, when he says that, of 1943 fatal cases of which he has collected the records, only 3 per cent. were breast-fed exclusively. He refers the partial immunity which, according to his statistics, infants under six months enjoy to the fact that the great majority of such are breast-fed, and in this way obtain a sterile and digestible food. With the commencement of artificial feeding, gastro-intestinal disorders at once ac t, quire prominence. Too often the food substituted for breast-milk is more or less difficult of digestion, defective in composition, and liable to he supplied to the infant too frequently or in too large amounts, in this way setting up indi gestion: the most important predispos ing cause of infantile diarrhoea. But, as we all know, the materials supplied as food to the infant may be of the most faulty character, inducing indigestion, colic, and malnutrition in one or other of its various forms, and yet during the cool season we meet with either no diarrhoea or diarrhoea of a temporary and easily controlled form.
Healthy infants have a normal tend ency to loose, liquid, and semiliquid evacuations from the bowels: (1) 'partly from the condition of the intestinal tract; (2) partly from the nature of normal food: i.e., breast-milk. Peristaltic movements in the healthy child are very active. Young blood- and lymphatic vessels are very permeable and the trans formation of the surface-cells active and rapid. The peripheral nerves are very superficial, more so than in adults, whose mucous membrane and submucous tissue have undergone thickening by both normal development and morbid processes. Besides, the action of the sphincter ani is not very powerful. Traces are not retained in the colon and rectum, and little time is afforded for the reabsorption of the liquid or dis solved fraeal contents. Frequency of acids (sometimes normal) in the small intestine gives rise to formation of al kaline salts with purgative properties.
Free acids when found in the intestine show that (1) the quantity of food is too large; (2) the quantity of digestive fluid is too small, causing fermentation instead of normal digestion. Louis Fischer (The Post-graduate, Sept., '92).
Of 5S deaths among children entirely raised by mothers' milk none had un cooked fruit given them. In 6 of these eases the mother herself had eaten un cooked fruit. In 2 instances 1 of the mothers had eaten boiled apples and the other cauliflower; so that there were S out of 58 cases in which fruit might be regarded as connected with the child's diarrhcea. Of 135 children under 3 years of age, not at the breast, whose deaths were inquired into, 2 ate fruit; the re maining' 133 are distinctly stated not to have had any.
Of the G05 fatal cases of diarrlicea in Leeds in 1893, GG per cent. occurred in houses either without drains or with drains not properly severed from the sewer, and one-fifth of the remainder (making 73 per cent.) had other sanitary defects. It is to the feeding-bottle and to the infection of its contents rather than to fruit that attention must be most especially directed in the preven tion of autumnal diarrhoea. J. S. Cam eron (Lancet, June 30, '94).
Defective water-supply appears to af fect the children over 5 years of age, but infants are swept away in hundreds by milk which is infected or contami nated. The greater number of fatal diar rhceas are doubtless due to artificial feeding. All organisms grow and flourish in milk. Symes (Brit. Med. Jour., May 8, '97).
Infective diarrhoea sometimes rages as an epidemic. It practically never occurs in breast-fed children (at least in only 3 per cent.). Neglect or deficiency of ventilation seems to be a very important cause, and the bacteria in question ap pear to inhabit the superficial layers of the earth, becoming wide-spread when the temperature reaches 5S° F. Lang ford Symes (Dublin Jour. Med. Science, June, '97).