If we consider the further fact, that the cooling off of the milk, which is hardly to be avoided in artificial feeding, can itself form a source of irritative symptoms, it can easily be understood in view of all the above-mentioned facts, that premature infants often react to these efforts at preserving their fives with severe gastro-enteric symp toms. These soon manifest themselves in the form of vomiting after every feeding, which is of special danger on account of the easy possi bility of fluid gaining entrance to the air-pas:sages, and in the form of diarrlicca, which sometimes shows numerous: green slimy movements, and sometimes light yellow- fatty stools. TI1050 symptoms lead to dis turbance of the mechanism regulating temperature, against which the most careful regulations of the temperature of the infant's surround ings proves powerless. It leads also to relatively tremendous falls in weight, and to the development of secondary infections, for in such children the portals of infection even normally stand half open, and the power of self protection is not enough to guard against it.
For all these reasons the feeding of premature 'infants requires special care. They should whenever possible, be fed only on breast milk, and the active taking of the food by sucking should be furthered in every possible way, such as by stimulating rubbing, or by giving a mixture of tincture of valerian, ether, and distilled water in equal parts, dose 2-3 drops inanediately before feeding. We endeavor as far as possible to reduce the amount of heat required from the food, so that we can get on with smaller additional quantities artificially administered. This is effected by a sufficient and continual supply of external heat, which is best attained in an incubator, out of which the child is never taken even for feeding,. Moreover, for the first 10-12 weeks at least we supply a nurse whose freely flowing breasts and easily grasped nipples are adapted to the requirements of a weak infant. Also we can try, as recommended by Budin, the administration of pepsin, of which a little piece of a tablet is crushed and put in a teaspoonful of alka line water such as Carlsbad or Miffilbrunnen, and given before nursing.
If in spite of every precaution disturbances of digestion have appeared, an especially careful treatment is required. This consists in the first place of a constant supply of heat, and a carefully regu lated diet. As to the latter, I should like to recommend the vegetable broth recommended by :Wry on account of its effective results against loss of weight. Its composition and method of. use will be spoken of later. The treatment also consists in stimulating baths, with the addi tion of powdered mustard, rubbing with alcohol, and subcutaneous injections under strict antiseptic precautions of small quantities of Physiologic salt solution or Hayent's serum, also described later in detail.
No use is made of drugs, except as stimulants. In addition to the valerian drops mentioned, caffeine citrate or sodium benzoate may be given in (loses of .01 Gm. (?,- gr.) three or four times a day.
A further cause of insufficiency of the digestive organs is hereditary weakness from tuberculous, syphilitic, or alcoholic parents.
Their descendants do not necessarily inherit the signs of the disease, but its influence frequently manifests itself in the creation of an offspring, which, although born at full term, is very backward in physical development, and is afflicted with such a deficient function ing power of the gastro-intestinal canal, that the slightest deviation from the strict principles of nutrition leads to severe alteration in its function. These find their expression rarely in acute, more often in chronic disturbances of digestion, which terminate in cachexia. It is important to recognize the inferiority of such children, in order to supervise their nutrition from the start with the greatest rigor, and to offer them at least some prospect of preservation of life. That man ifest hereditary- syphilis leads to weakness of digestion is well known, and it will be considered in detail in another part of this work. In tra-utcrine infectious processes occur, although they are in fact great rarities. If they do not terminate the life of the fcetus, they result in peritoneal adhesions. They can affect the digestive power of the child, partly by obstructing development, and partly in mechanical yvays by the formation of stenoses, kinks, and similar affections of the intes tine. They constitute a source of occasionally acute but mainly chronic disturbances, the treatment of which consists in careful hygiene and well managed breast-feeding. Surgical measures may have to bc added as an auxiliary. We will make further consideration of these forms when treating of congenital intestinal stenosis and atresia. Also cer tain malformations of the digestive apparatus, particularly dilation of the colon (Hirschsprung's disease, or megacolon congenitum) will be treated thoroughly later. Here we will speak only of those affections which influence nutrition by mechanical interference with sucking, and which, perhaps, can have an injurious action through destroying certain protective mechanisms. -Harelip is usually no reason for the inability of the child to take the breast, and it does not compromise nutrition. Also eleft palate, involving shriply the soft palate is compatible with a shutting off of the nasal cavity from the buccal, and permits the art of sucking. On the other hand complete cleft palate forms an absolute obstacle to the active taking of food from the breast, and such children must be fed with a spoon, a tube, or in some similar way. In such eases, catarrhal processes of the pharynx. almost always develop, and these are favored by the absence of filtration of the air in passing over the nasal mucous membrane. These catarrhs soon extend by contiguity- to the stomach and intestine. It is therefore no wonder that such patients show severe disturbances of nutrition, and that in addition to the insufficiency of milk taken, vomiting and diar rhcra supervene, resulting frequently in death in a relatively short time.