The treatment of this condition consists of three parts, prophy lactic, eausal, and symptomatic, and although these three efforts, as may easily be seen, are interlocked one with another, we will speak of them separately.
The prophylaxis accords with our modern point of view as to the appropriate natural feeding of the infant. It avoids giving any food on the first day of life, except perhaps weak tea to boiled water, and from tbe second clay accustoms the child to 31 to 4 hour intervals between feedings, with an interval of 5 to 6 hours sleep at night. The quantitative conditions are regulated by the nursing mother herself, because the stimulus exercised by the child upon the breast in sucking causes a transition from the stage of colostrum secretion to that of milk production. The quantity prepared, if a normal digestive function he assumed, is exactly fitted to the requirements, while the sticking efforts rock the child to sleep, from which, as the observations of Czerny show, it wakes after three or four hours to the need of taking more food. Meanwhile the transition of the movements from meconium to the normal milk stools is normally completed. Uraler these conditions, the undisturbed quiet of the house, the rosy color of the child, its lively and vigorous condition when awake, its looking around and active kicking, the firmness of its flesh, and its regular gain in weight, are certain evidence that we are on the right road toward a thriving growth. With judicious directions on the part of the physician and their proper comprehension on the part of the mother, although indeed the directions frequently have to be carried out only after a tiresome conflict against the various influences ruling in the nursery, every thing goes well, and, with a few exceptions still to be spoken of, the dangers of overfeeding are avoided.
It is more difficult with children fed by a wet-nurse, who is pro vided too soon with a full dinner-pail, instead of having to earn her living by her own work, and all the more as rustic breasts usually- flow very abundantly, and every physician takes a certain pride in seeking out as especially desirable a wet-nurse with a lot of milk. Consequently
a holding back is called for in the first few days, and the child should be only- infrequently- nursed. Consequently it is of advantage for the wet-nurse to bring with her her own offspring, to drink up the super fluou.s milk. Also if the normal number of breast-feedings has been attained, as is usually the case by the eighth or tenth day, the amount taken at each feeding can be controlled by weighing. By comparing this with the average amount the child should take daily (according to Marfan, 13 per cent. of its body weight, according to de Rothschild 125 grams per kilo), one can judge if the proper amount is being much exceeded. If this is the case, the intervals are lengthened, or if this cannot be done because the longest intery-als are already being observed, the amount taken at each nursing is: reduced, by leaving the child at the breast for a shorter time, or, if the flow is especially abundant, by partially- emptying the breast beforehand with the breast pump. The opinion that every cry of the infant is synonymous with hunger is easily combated in the mother by arguments based on reason, but in the wet-nurse must be especially strongly counteracted, and all the people around the child must be instructed to Watchfulness in this direction. Except in severe disease, the breast is always taken eagerly. It will frequently happen that the nurse will give the breast to a cry-ing child sooner than undress it to convince herself that it is not ly-ing in a wet or soiled napkin, or that the clothes are not press ing on it, or something similar.
Just as we have few really, efficient measure,: beside the sucking reflex of the child, to increase the activity of an insufficiently secreting breast, we can as easily dispose of the medicinal and dietetic measures directed to the opposite result. If the nurse were made to suffer thirst in order to reduce the quantity of her milk, it would result in failure, because it is an utterly useless torture, and also the influence of diet upon the quality of the milk has been much exaggerated.