A derangement of the stomach and bowels, occurring suddenly from any of these causes, not only interferes with the infant's nutrition for the time, but often produces much more serious consequences. It may set up. a disorder in the digestive system which is never afterwards recovered from, and start a process of gradual wasting which ends only with the death of the child. It is, indeed, in incidents of this kind that the chief danger of artificial feedino. consists ; for a diet arranged originally with care and judgment ceases to be appropriate in these altered conditions. An immediate change is imperative if the derangement is to be remedied ; and for some time afterwards a careful watch must be kept over the in fant's digestion, lest the disorder return.
Infantile atrophy is seldom seen to any serious extent in infants at the breast, but sometimes a certain degree of malnutrition is observable in babies who take no other food. This may result from different causes. An infant may be consigned to a wet-nurse whose own child is much older than her adopted suckling. It is well-known that, as time passes, human milk becomes proportionately richer in curd and cream. An infant, new born, and with naturally feeble digestive power, put to the breast at a late period of lactation, may consequently fail to thrive ; or may even suffer from indigestion and bowel complaint through the richness of the milk. Again, in some women, the milk, although abundant, is of poor quality, and insufficient for the support of a strong baby, so that the child soon shows signs of deficient nutrition. Hmnnn milk is also affected by dietetic and emotional causes, and the secretion is apt to be influenced by the general state of health. There are many reasons, therefore, why a child, even while at the breast, should be subject to casual derangements. Still, these are usually trifling, and seldom produce any serious effect upon his nutrition.
It sometimes happens that a mother's milk is not well-suited for the nourishment of her offspring, even in cases where the secretion is copious, the child a sturdy boy, and the health of the mother in every way satisfac tory. Some years ago I was asked by a gentleman to go and see his child —a little boy of seven months of age. I found that the child had been suffering for some weeks from severe abdominal pains. He was excessive ly peevish and fretful, and at night would wake up with a scream, and twist about his body under the influence of severe griping pain. His bowels
were very confined, and the motions consisted almost entirely of -curd. He was taking nothing but the breast. Aperients had been found to relieve the child for a time, but the symptoms always returned when the effect of the purgative had passed away. Whenever the breast was stopped for a few days, he immediately improved, but relapsed as soon as suckling was resumed. The child had lost flesh, and was evidently suffering from his inability to digest the curd of his mother's milk. It was therefore a matter of great importance to enable him to do so ; otherwise he would have to be weaned, and fed in a different way. The mother had herself, by taking salines and other medicines, and by making many modifications in her diet under medical advice, endeavoured to alter the quality of her milk, but without success.
Several methods of remedying the evil were tried. The intervals between the times of suckling were increased, so as to give a longer period for di gestion ; but this change had no effect whatever. Alternate meals of barley water were then given from a feeding-bottle. By this means, the quantity of milk taken by the child in the course of the day was diminished, and the interval between the times of suckling was still further increased. No improvement, however, followed the alteration. The griping pains still continued, and the constant fretfulness of the child was most distressing to the mother. The plan was at last adopted of giving the child barley water from a bottle immediately before he took the breast, in the hope that by this means the milk might be diluted directly it reached the stomach. This method succeeded perfectly, and the child had no further unpleasant symptoms.
In this instance, the infant's stomach was in a perfectly healthy state. The fault lay in the mother's milk, which was too heavy for the child's powers of digestion. In the large majority of cases of indigestion in infants reared at the breast, the fault is in the digestive organs of the child, an attack of gastric catarrh having rendered him for the time incapable of digesting his mother's milk. In these cases, the indigestion is a temporary failing, and is easily remedied by suitable treatment. Without judicious management, the derangement may be prolonged indefinitely ; and it not unfrequently happens that the mother is directed to wean her baby under the mistaken notion that her milk is unfit for its support.