If the physician, both as teacher and as adviser, will concentrate his efforts on the prevention of gastro-intestinal diseases, with the conse quent reduction of infant mortality, he may be certain that he will have accomplished a great work.
In addition to the dangers by which, through disturbances of diges tion, the child is threatened in infancy, it is in danger of one particular disease which, although it may occur at any period of life, seems to have a special predilection for the very earliest days of childhood. This is tuberculosis, and particularly tuberculosis of the bronchial glands. Only a small proportion* of infants become infected through germ-laden nourishment, and a still smaller proportion by swallowing the germ of the so-called "feeding tuberculosis" (Fiitterungstuberkulose). In order to prevent this disease, it is necessary that the infant obtain a milk free from tubercle bacilli. Under no circumstances should it be offered the milk of a mother or a wet-nurse suffering from tuberculosis. The greater number become infected through the inhalation of tubercle laden dust, or by direct contact during the acts of coughing, speaking, kissing, etc.
The infant should be kept from the vicinity of those suffering from tuberculosis, even though they be the parents or members of the family, and it should not be permitted to grow up in their society. The separation of an apparently healthy infant from the tuberculous family and its transplantation into a healthy family, although it is an important prophylactic measure, is possible only under extraordinary circumstances. In spite of this, however, the physician should always attempt to separate the healthy infant from the diseased. We11-to-do parents, if they desire it, can readily find a place for their child in a healthy family or in an institution in the country or elsewhere, by pay ing for it. But the poor can also find it possible to remove the child from its unhealthy home influences through the care of modern sani toria and recuperating places. Should it be impossible to carry out this project, however, it then becomes necessary to call to our aid all the prophylactic measures which modern hygiene has created, to prevent the spread of tuberculosis and to overcome it. Special care must be taken to prevent the scattering of tuberculous germs through spray from the mouth or from sputum; these germs, after becoming dry, are mixed with the dust and are then taken up by the air currents. The walls, and particularly the handkerchiefs, must be disinfected. Those suffer ing from tuberculosis should not be permitted to kiss others, to use the same dishes, or to taste the food intended for the infant or to blow upon it in order to cool it off.
We will now leave the infant and take up early childhood, the period before children go to school. During this period the health of the child is threatened principally by two sorts of dangers. The one
passes for a picture of a more or less well marked indigestion ("spoiled stomach"), which is brought about by improper, irregular, or too rich meals. The other danger comes through the usual infectious diseases which show a preference for this age, and which, owing to their fre quency, really make up the so-called children's diseases. In the second and third years the physician will not particularly meet with the fevers, and he will be consulted with regard to feeding much more rarely than during the first year. And yet as family adviser, he can prevent much trouble during this period, by insisting that regularity be still maintained in regard to meals, and that the child must not receive things difficult of digestion, particularly sweets and dainties, which when dealt out in small quantities as a reward after the meal are not harm ful, but which when given in larger quantities act as an irritant, and should be avoided. At this age, through irregularity in the nourishment, there frequently develops that common and stubborn trouble, chronic habitual constipation. This can in many instances be certainly over come by dietary rules and instruction in regard to suitable physical hygiene and exercises.
It will be less easy for the physician to guard the health of the child against infectious diseases. This inability is inherent in the nature of the case. Nearly all our infectious diseases, not only in the large cities but also in the country, have become endemic and therefore can no longer be uprooted. The possibilities of transmission rest not only with the patient himself but also with third persons, and are so many that it is very difficult to guard the child against the disease. The danger of contagion is present every time the child goes walking, goes any conveyance, or plays with other children. Owing to the severity of ninny of the infectious diseases and the seriousness of the situations to which they may give rise, and considering the great weakness of the young organism, it is naturally of importance that we postpone the infections as long as possible, even if we cannot prevent them. Occa sionally one hears or reads of families in which the children were brought up isolated from all other children, and were thereby enabled to reach the age of puberty or beyond without ever having had any of the severe infectious diseases. In most cases, however. stringent precautions are taken only during an outbreak of any one of the infectious diseases. Still we should insist upon the enforcement of the order to avoid persons suffering from infectious diseases, as well as healthy persons who live with or have visited a sufferer from such a disease, so that the child may be spared this danger, the consequences of which, so far as its life is concerned, can never be foreseen.