Syphilis and tuberculosis having been excluded, the diagnosis is easy. The wasting must be due to chronic digestive derangement, or to unsuit able food, or to both of these causes combined. In the case of either chronic vomiting or chronic diarrhoea, the characteristic symptom of these derangements will be present. Still, in many oases of malnutrition, where the wasting is extreme, there is no irritability of stomach, and the bowels are habitually confined. In these cases the child is peevish and fretful. His belly is distended, and his skin dry and dull-looking. The nasal line encircling the corners of his mouth is well-defined. His feet are often cold, and the bodily temperature in the rectum is sub-normal (97°-97.5°). His stools consist of hard light-coloured balls, or of unformed putty-like matter. The child is subject to attacks of abdominal pain, and is very noisy and troublesome at night.
Prognosis.—Unless the infant be reduced to a state of extreme weak ness and depression, the prognosis is not unfavourable. It is often surpris to mark the immediate improvement which takes place when the child is put to the breast, or is supplied with a food he is capable of digesting. If signs of spurious hydrocephalus have been noticed, if the mouth be the seat of thrush, or if a chronic diarrhoea have been established, the sis is more serious, and, indeed, these cases often end unfavourably. Chronic vomiting, however, can usually be arrested by judicious treatment, if the infant retain sufficient strength to respond to the restorative meas ures adopted.
Treatment.—In endeavouring to improve the nutrition of a child who is suffering from infantile atrophy, we have to take into account the degree of weakness of the infant, and the more or less disordered state of his diges tive organs. If a wet nurse can be procured, a return to the breast, if the child can be persuaded to take it, usually arrests at once all unfavourable symptoms ; especially, if the alteration in the mode of feeding be aided by an aperient dose of castor-oil, followed by an antacid and stomachic mix ture. In many cases, however, this method of treatment is not within our reach, and we have to trust to a judicious revision of the child's dietary and general management.
The successful rearing of an infant by artificial means is not a 'difficult matter. It requires intelligence and tact ; but, above all, it requires watch fulness. If we are vigilant to detect the first signs of discomfort and acid ity, and at once modify the diet accordingly, we may be sure of preserv ing a healthy tone in the stomach, and warding off all the accidents to which a child less carefully nurtured might possibly succumb.
During the first month after birth, the infant usually is able to obtain some milk from its mother's breast. This, however, may have to be sup plemented by other food, and sometimes the babe is forced to depend entirely upon artificial feeding from the beginning. For the first six weeks he maybe fed with condensed milk diluted with water, or thin bar ley-water, in the proportion of one teaspoonful of the milk to the half bot tle. Preserved milk at this time almost invariably agrees well. Care must, however, be taken to use only milk from a tin which has been newly opened ; for when exposed to the air,• the milk, although still apparently fresh, rapidly breeds bacteria, and becomes unfit for the child's consump tion. In hot weather, too, the barley-water should be freshly made twice in the day. Like the condensed milk, it must be kept in a refrigerator or other cool place, and should never be heated to the boiling point after it has once been made, as to do so excites rapid fermentation.
After six weeks, or, at the most, two months, have elapsed from birth, the child should be put upon cow's milk. It is important, especially in warm weather, that this should be perfectly fresh. If slightly acid from keep ing, as it often is when delivered at the house, the acidity should be neutral ised by the addition of a little carbonate of soda.
To make this milk an efficient substitute for human breast-milk, it will not be sufficient to sweeten it with sugar and dilute it with water. It is necessary, in addition, to prevent the firm clotting of its curd under the action of the gastric juice. This may be done by using lime-water to di lute the milk, adding it in sufficient quantity to partially neutralise the gastric secretion, and thus in a great measure prevent coagulation in the stomach. To do this effectually, at least a third-part of the mixture should consist of lime-water. To two tablespoonfuls of fresh milk, add an equal quantity of hot filtered water, and alkalinise by two tablespoonfuls of lime water. The infant should suck this food from a feeding-bottle. Its tem perature wheil taken should be 95°. If too cool after being prepared, the feeding-bottle should be allowed to stand for a few minutes in a little basinful of hot water.