With this purpose in view, it is advisable to place both mother and child in a nursling's home, or some similar institution. Wet-nurses advantageously continue nursing their own children along with their charge, thus keeping the milk supply up to the highest point. In select ing a wet-nurse for a premature child, the greatest care should be exer cised to detect the possible existence of a latent syphilis. Occasionally a skilfully directed "allaitement mute" accomplishes the desired result.
The child, thus strengthened, attacks the breast more vigorously and thereby increases the secretion of the mother's milk. It is of great importance to know the daily amount of nourishment necessary, and thereby avoid both overfeeding and underfeeding. Both are harmful. Nevertheless the great est danger in practice seems to he the underfeeding of small prema ture children. They seem to re quire a relatively greater amount of food at this time than in the later nursing period. The volume of food each clay to be deter mined by either the scale or grad uate, for the first ten days of life equals V=n+10 (in c.c.; number of days) per ipo Gm. For example, a child weighing 1500 Gm. requires on the fifth day of life about 5+10=15 per cent. of the body weight, which equals 225 Gm, of mother's milk. Later a premature child should drink about one-fifth of its body weight per day, and at full term one-sixth.
The amount of energy, in this volume of food, required by a flour ishing infant varies from 130-120-110 calories per kilo of body weight, diminishing with the increasing weight and age of the child.
Technique of it is not possible to feed large quanti ties at a single meal to small premature infants (often only 10-20 Gm.; 5iiss-5v) it becomes necessary to nourish them every two hours or even at shorter intervals, i.c., ten to twenty times in twenty-four hours. Czerny and Keller only give six, sometimes five meals in twenty-four hours. In feeding according to this schedule, it seems impossible to avoid underfeeding.
In very small premature infants the nourishment must be intro duced (gavage) by means of a Ne'Eaton catheter, or allowed to slowly trickle into the mouth or the nose by means of a pointed spoon. The glass flasks depicted in the accompanying illustration Fig. 16 (Undine's) have proved very useful in oral and nasal feeding.
Before feeding, small premature infants must often be stimulated by means of slapping. pinching, etc. A short bath of 37-39° C. (9S.6° 102° F.), or a cool sponging is often useful. Many children immed:ately eject their nourishment and it requires great patience and skill on the part of the nurse to make them retain it.
The artificial feeding of premature and debilitated children will always come into account only as a last resort; the result will always be uncertain and it is difficult to recommend any one method. The formula must be controlled by the general condition and by the stools, and must resemble mother's milk as nearly as possible in amount and caloric value. Overfeeding with its harmful results must be strictly avoided in the artificial feeding of premature infants. Self-prepared whey—milk mixtures of 2:1. and 1:1; also milk diluted Avith an equal quantity of calf's broth, are indi cated. There is a division of opin ion as to the amount of cream neces sary for premature infants. I have no experience with the carbohydrate mixtures, lately recom mended by Finkelstein. Budin and Michel praise a mixture in which the albumin has been peptonized by the action of a fresh extract of ealf's pancreas. Although there are many references in the literature recommending peptonized milk for the feeding of premature infants, I cannot conscientiously recom mend the use of the factory preparations of milk.
The prevention of infection, of every sort, is most successfully accomplished by skilful attendance. The cord should be carefully dressed with hydrophilic gauze, moistened with 1-2000 bichloride solu tion. Cleansing the mouth should be omitted as it is useless and moreover harmful since the oral epithelium is very easily injured. The bath water should be boiled. Sponge baths with warm water and very fatty soap are preferable to tub baths at first. The new dusting powders, or talcum with the addition of boric acid 1:2, should be used. Ointments as a rule are very poorly tolerated. The customary cloth ing is used and shduld always be previously warmed; only very small premature infants should be wrapped in cotton. All chilling and the too early airing of the premature child are to be avoided.
Of the remaining therapeutic measures for premature and debili tated children, we will only mention the following: The use of oxygen (Bonnaire and Ceneay recommend its use as a prophylactic as well as in cyanosis, asphyxia, infections and vomiting).
Blood-letting. (Del6stre recommends repeated bleedings of 2-3 c.c. in children who do not gain sufficiently; also a single bleeding of a larger amount, 18-20 cm.).
Injections of artificial serum (20-30 c.c.) are also recommended by Delestre and other French authors. Budin regards massage with hot oil, repeated 2-3 times daily as very useful.
Complications are to be treated accordingly.