The difficulty is usually overcome by providing a healthy wet nurse, but as this is often an impossibility for many reasons, the physician is driven to the selection of substitutes, the most obvious of which must be the milk of the cow in some form or other associated with accessory feeding.
If the precipitation of the casein in indigestible curd is visible in the motions much may be done by the employment of drugs which will promote active digestion in the stomach and bowel. The following mixture may be given to a child under 22 months old, and / gr. Hyd. cum Creta should at the same time be administered night and morning for a few days: Glycerin. Papain. 3iij.
Syntpi sintpticis 3vj.
Aqua Chlorof. ad 5ij. Illisce.
Fiat mistura. Cpt. 3j. pater in die post cibum.
Many physicians still adhere to the time-honoured combination of i gr. powdered Rhubarb with 4 of Bicarbonate of Soda.
Predigestion or peptonisation of the milk is indicated when the in testinal or gastric irritation is acute, but this must not be pursued for long periods.
The cow's milk must be diluted with water or lime water or barley water r to 3 or 4 at first, according to requirements. A small quantity of cream is to be added and enough beef juice to increase the amount of fat and proteids; occasionally a little sugar may be necessary when the milk must be highly diluted.
Where cream is not well borne, no food or drug is so serviceable as Cod-Lver Oil, which not only supplies sufficient fat, but unquestionably assists in the absorption of the proteids and lime salts in the food, and in many instances its administration meets every requirement in the management of rickets when the child is able to take cow's milk. Its internal administration may often be advantageously supplemented by inunction and the employment of the cod-liver oil binder applied to the abdomen under mackintosh where the wasting is extreme.
The use of hypodermic injections of Sea-Water Plasma when the pre cipitated casein has caused gastro-enteritis is a valuable aid in some cases.
Later on starchy foods should be administered, but the promiscuous use of these in young infants before the development of the glands whose secretions digest amylaceous substances often leads to the dyspeptic condition which produces rickets; hence the serious objections to many of the popular patent foods containing starch. A little carefully boiled
wheaten flour mixed with the milk may be tried at first, after which oaten flour, fine sago or arrowroot may be permitted, and finally well boiled oaten meal porridge can be safely used.
A very valuable addition to the milk dietary may be had by permitting the child to suck a large piece of undercooked or almost raw meat held in the nurse's fingers; when carefully administered in this way, there is no danger of the solid parts being swallowed. As soon as possible it will he most advisable to vary the diet, and egg-yolk with a little stewed fruit or a spoonful of freshly expressed orange-juice may be given. In the case of the children of the poor a well-made mutton broth with the vegetables strained out before use and the fat carefully skimmed off affords a most valuable addition to the milk and farinaceous food.
Drug Treatmeitt.—This must be considered as always taking a secondary place in the management of rickets if we consider Cod-Liver Oil as a food and not as a drug in the ordinary sense of the word. The pathological fact of the deficiency of calcium salts in the softened bones led formerly to the administration of the phosphate and other salts of lime, but as these pass unaltered through the system the practice has been wisely abandoned by all who recognise the difference in the pharmacology of the mineral phosphates and of the free clement or organic phosphates.
Free phosphorus exerts a specific action on the growth of bone, and by many authorities is regarded as the ideal drug treatment of the disease. It should never be administered in doses exceeding gr. i min. of the Bt. Phosphorated Oil is supposed to contain about I gr. of the pure substance, but owing to oxidation usually old specimens of the oil are much weaker; nevertheless min. is quite enough for a child six months old, and it should always be prescribed in Cod-Liver Oil as in the follow ing: Oki Phosphorat 111. xx. Olei 111 orrItuce 3iv. Misce.