Third grade: The patient fails even with the smallest amount of nourishment, and it is impossible by artificial means to maintain the weight and improve the stools. The recovery of such children is hopeless unless natural nomishment (human milk) is given in a cautious manner.
In the other diseases cow's milk and its preparations have proved beneficial in some cases. In these cases of decomposition its effects are uncertain and even in the first stages can only partly be depended on. If a favorable reaction does not take place readily, there is no use in further experimenting with diets, as it only hastens the unfavorable outcome. There remains, however, an often favorable means, that of returning to breast milk.
The tremendous superiority of human milk over the most carefully prepared modifications of cow's milk for those suffering with decomposi tion is well shown. The mild eases improve equally as fast on breast milk, in spite of its carbohydrates and fats which cause the disease, as those suffering from dyspepsia and disorders of balance. In advanced cases it must be used with care and in extreme cases even the USC of breast milk fails.
According to Ludwig F. Meyer the inorganic material in human milk plays a part as well as the organic matter. The mineral matter replaces the loss to the body of the cow's milk whey (?) and prepares the ground for a general building up.
Even after successful treatment of favorable cases in the advanced stages, the improvement is not at once noticed. A slow improvement sets in only after a long decline. The earlier breast-feeding is established the better are the chances. By delaying the natural resources are used and the damage cannot be repaired.
In advanced stages it is better to measure the quantity of milk than to give it ad libitum. Finkelstein advises the use of expressed breast milk 200 to 300 cm. in light cases, 100 to 150 cm. in medium cases, and 50 to 70 cm. in severe cases. The deficiency in liquids can be made up by tea, water, normal salt solution, or one of the remedies mentioned on page 135.
L. F. Meyer has shown the favorable influence of salt solution on the pulse and temperature. To avoid the danger of inanition the quantity should be increased rapidly. Children who cannot stand a starvation diet cannot be saved.
During convalescence or if the sickness is not severe, skim milk, whey, sugar, or flour-free buttermilk may be given with the breast milk. The amount should not exceed more than 40 per cent. of the breast milk. In certain desperate situations a trial may be made with human milk, whey, or centrifuged human milk. Certain precautions should be taken when changing to other foods. Symptoms of intoxication, a fall
in weight, and sudden death may ensue if too rich breast milk is given. The administration of too rich fat or carbohydrate buttermilk, malt soup, etc., may in the same way result in collapse.
(b) Dangers of Flour as a Food (Rietschelb—The exclusive and entire administration of flour as nourishment continued for a long time is followed by disturbances which Czerny-Keller speaks of as "dangers of a flour nutrition." As Rietschel emphasizes, it appears to be clue to the combination of the effects of a faulty supply of food and lack of salts. On the one side important nutritive material for the body is lacking, and on the other, through the salts, especially the chlorides, disturbances of mineral metabolism are caused by the flour diet.
The reaction of this one-sided diet expresses itself differently, and Rietschel cleseribes three types.
I. The True Atrophic Form.—There is a continued increase in the appetite which forces the body to use its own fat because of the insuffi cient quality and quantity of the food supplied. There is, often after a short increase in weight, a continued loss in weight and the development of an atrophied condition. The progressive atrophy is explained by the poor amount of salt in the diet which results in a negative balance of the mineral matter. With this also there is a great loss of water.
2. The otrophic-hydrcemic form is the most common, and is observed in children who besides the flour are given mixtures containing salt (mostly in form of milk preparations). For a time good results are given by using this food. The children appear in good health, of normal color. The physical absorption corresponds fully, the growth is sufficient and the stools are formed, acid. and not foamy. This phase, however, does not last long. After a time (one to two weeks) the stools become thin, frequent, and rich in fatty acids. If a change to milk is made, there is a loss in weight. To counteract this, if meal is again given, the wasting ceases and there is an increase in weight. It will be seen, however, that there is a spongy appearance of the body and a peculiar soft character of the musculature which indicates that the increase in weight is due to the retention of water. This may develop to a true (edema and anasarca and then disappear through heavy alkaline withdrawal in consequence of the acid intestinal fermentation. The resistance to infection is low and septic infections of the skin, penurnonia and the like may quickly develop. The kidneys seldom are involved, though albumin and casts appear in the urine in some cases.