MARASMUS.
This condition must be regarded as a symptom and not as a disease. Only the infantile form need be considered. The primary cause of the error in nutrition should be carefully sought for before treatment upon rational grounds can be commenced; thus the malnutrition or marasmus accompanying congenital syphilis on being recognised will yield speedily as arule to the administration of Mercury.
Pyloric obstruction (congenital) is another primary cause which yields to operative treatment, and obstinate constipation, whether functional or organic, is of the same order. Disease of the mesenteric glands following the ingestion of tubercle-infected milk and congenital heart lesions are causes not to be lost sight of.
In the great majority of cases, however, infantile marasmus and malnutrition are due to catarrhal or other states of the alimentary canal, the result of improper feeding. The unsuitable food in the first instance sets up diarrhoea and gastritis, and the irritated mucosa is still further outraged by a continuance of the improper feeding. The infant may perish from starvation with abundance of food in the stomach or intestines, which no longer are able to digest proteids, fats or carbohydrates.
The condition is very frequently the result of feeding with milk, in which case the child's napkins will reveal tough, putty-like masses of curd which shake off easily almost without soiling the linen. Few therapeutic results are more striking than that which may be witnessed by placing the wasted infant at the breast of a healthy wet nurse, and when such an aid is procurable the problem is at once solved, but in the absence of the natural nourishment the complex question of artificial feeding must be faced.
The mischief may be caused by giving the milk undiluted or over diluted; thus r part of cow's milk to 2 of water or barley water, which is suitable for new-born infants, may produce marasmus if continued till the child is 9 months old; by that age a child fed on cow's milk should be getting the liquid diluted with not more than one-fourth part of its bulk with water.
The addition of Sodium Citrate, r to 2 grs. to each oz., permits of cow's milk being given in an undiluted form to wasted children who cannot otherwise digest milk proteids, and if cow's milk is to be given this_ should be added to it after Pasteurisation at a temperature of F. for 20 minutes, and this food is often digested when weak boiled cow's milk cannot be assimilated. Sterilisation by boiling is unnecesssary under ordinary circumstances, and often is objectionable.
When the marasmus is due to inability of the infant to digest fat, the curds found in the motions will be small and soft, and consist of saponified fats. Under these circumstances the milk must be skimmed before use. Maras mus may be the direct outcome of feeding with cream, especially when the cream is separated by centrifugalisation and contains any preservative like boric acid or salicylates. It is a common mistake to add cream to the
milk used for feeding as soon as the child is observed to be wasting, the wasting being sometimes due to the already high percentage of fat contained in the milk. More than 3 per cent. of fat is, as a rule, injurious. Ass's milk is sometimes resorted to when cow's milk cannot he tolerated. Buttermilk, when scrupulously prepared, meets all requirements in such cases, and is decidedly preferable to the innumerable new-fangled lactic acid compounds in which various strains of the bacillus are added to cow's milk. Carpenter's method of procuring pure buttermilk for infant feeding is simple and easily carried out. A quantity of fresh clean milk is permitted to stand for 24 hours in a glass vessel at F.; the cream is skimmed off and the sour milk churned for is minutes, after which it should be kept on ice. To each pint of this buttermilk I, teaspoonful of wheaten flour and 2 tablespoonfuls of granulated sugar are added before the mixture is brought to the boiling-point.
Where milk proteids cannot be digested, beef-juice, clear soup or veal broth thickened with barley may be substituted till the gastro-intestinal catarrh is combated, after which peptonisation of the milk with a pan creatic preparation, or the addition of gr. Papain to each bottleful of cow's milk diluted with barley water, may be commenced. Desiccated milk food, Benger's, unsweetened condensed milk, Mellin's, Allen and Hanbury's No. r, Clay Paget's and Vacca milk may be tried. Starchy compounds should as a rule be withheld till after the sixth month, though barley water as a diluent may be employed at all stages of infantile life. The writer believes that one of the most valuable methods of improving the nutrition of the body in infantile marasmus is inunction with Cod Liver Oil and the application of a binder saturated with this drug and covered with mackintosh sheeting, as described in the treatment of Mesenteric Diseases.
Drugs are admissible only in as far as they may be useful to combat the gastro-intestinal catarrh, and Grev Powder in minute doses occasionally is a valuable intestinal disinfectant. Thyroid Extract has been extolled, but its modus operandi has not been made clear. Lavage of the stomach and colon has been employed in some cases with advantage, but as a rule it is impracticable as a routine. Diarrhoea will call for the exhibition of Tannalbin, or minute doses of Calomel and the various agents mentioned under Diarrhoea.
Sea-water injected hypodermically has proved of great value in the hands of Robert-Simon of Paris, who states that after a single injection the child may be able to retain and digest a normal meal of cow's milk. Other observers state that ordinary saline injections are equally valuable.