dency to-day, to care for from one hundred to two hundred patients. In sanatorium construction it is estimated that the cost per capita approximates one thousand dollars. The tent plan will produce better results at less cost and care for more patients than any building with which I am familiar. Dr. Pettet, of the Ottawa Tent Co., Ottawa, Ills., recently visited Nordrach Ranch, and we had a long discussion upon the tent plan, versus the building plan. He heartily endorses our ideas upon the subject. In large institutions too many patients are congregated, necessitating too many rules, and not enough personal supervision and attention to individual cases. Abroad the small places are curing the largest percentage. On this plan a sanatorium can be established for fifty patients at a cost of ten thousand dollars. With the prevailing appropriation of one hundred to two hundred thousand dollars, which seems to be made by various States, many of these small places could be established, accommodating many more patients and gaining better results. Whenever tents have been tried and compared with the costly buildings, the many advantages have been apparent and I see no reason why tents, such as we have here, are not practical in any climate. In closing, I would say, that climate is a most valuable aid to those who can afford it and that a sanatorium life should be led. The home physicians are the powers behind the throne and it is left to them to send us curable cases. Send us appropriate cases and the results will come up to your expectation. Tell your patients that they are tubercular, and, if possible, send them to sanatoria where they can be taught the lesson upon which their life depends. They learn the lesson imperfectly, or not at all, outside. Ascertain the patient's financial condition, and have them make their arrangements for a long vacation before leaving home. They are going among strangers. They must have the best of care and must not worry over remittances, as they will have all they can do to get well without worry. A cure rests upon the tripod, good sense, early diagnosis and finances, and if we hope to completely exterminate the disease we must educate the profession, educate the public, and educate the patient. All of which can be accomplished by more sanatoria. : There be three things that trouble the physician, yea four, that he cannot bear the neighbor that is always meddling, the attendant that is unfaithful, the druggist who practices substitution, and patient who insists that he is the best judge of his own case and needs. THE PRINCIPLES OF FEEDING IN CHILDHOOD AND INFANCY.* By E. V. Gray, M. D. A healthy infant spends most of its time in sleeping and growing. Its muscular efforts are confined to a little sucking, more or less crying and some kicking. Hence it follows that the diet of an infant should contain relatively more of the tissue builders (proteids and mineral matters) and relatively less of the energy producers (carbohydrates) than one finds in the food of the adult. Like all small animals, too, the infant has a large extent of surface in proportion to its bulk, thus it tends to lose heat rapidly, and requires an abundant supply of the chief body fuel-fat. If these different ingredients are not supplied in due proportion, disorder of health inevitably follows. If the tissue builders are not sufficiently represented, the muscles, blood and bones are not properly formed, and the child becomes flabby, pale and rickety. On the other hand, if the supply of proteid is in excess of the child's digestive and assimilative powers, it suffers from disorder of the stomach and bowels. If it be an infant, curdy stools will be passed, and there will be a tendency to diarrhea. Older children will suffer from indigestion, irritability and restlessness. A sufficent supply of fat is of even greater importance. Indeed it may be said that an abundance of fat should be the main characteristic of the diet of infancy, just as an abundance of carbo-hydrates is the chief feature of the diet of adult and laborious life. The fat serves as fuel. Without it the child has difficulty in maintaining the proper tempera-. ture of its body, and is liable to catarrhs of the lung or bowel. In addition to this great use, fat seems, during the period of great growth, to be itself a tissue producer. The infant is laying down a considerable amount of tissue rich in fat in the marrow of its bones and in its nervous apparatus, and it may well be that the fat of the diet aids in the production of such tissues. Of this at any rate there can be no doubt, that a child whose diet is deficient in fat rapidly loses vigor and is extremely prone to suffer from rickets. The frequent connection between rickets and deficiency of fats in the food is an undeniable clinical fact, of which however it is difficult to give a satisfactory explanation. Experiments have been made in which young animals were fed on separated milk practically free from fat, but although the absorption of phosphoric acid by them was found for some reason or another to be much interfered with, yet they did not suffer from rickets. Important though an abundant supply of the fat is, one must take care not to give it in excess, for under these circumstances, it is a fre * Graduation Thesis presented to the Faculty of the Cleveland Homeopathic Medical College, 1905. quent cause of vomiting and diarrhea in young infants. A milk which contains more than 62% of fat may always be expected to produce these results. Carbo-hydrates are, as we have seen, not of so much importance in the dietary of infancy as in that of older children or the adult. They are important, however, not only in their capacity as proteid sparers, but also as making provision for what muscular effort the child does display. If there is a due supply of sugar in the diet, it is reasonable to suppose that less proteid will suffice. The carbo-hydrates, however, are the ingredient of the diet which is least likely to be represented in too small amount. On the contrary there is much greater danger of supplying them in excess, or of making them a substitute for fat. Ant infant which is the victim of such an error may be plump enough, but its muscles are flabby, its skin pale, and its bones often rickety. It is the false appearance of good nutrition which such infants often possess that is apt to deceive the uninitiated, and such children have been. known to take prizes at baby-shows, when all the time they were undoubtedly the subjects of rickets. It must be remembered, too, that carbo-hydrates, especially when given in excess and in unsuitable forms, such as starch or cane-sugar, are very prone to undergo fermentation in the stomach and intestine of the infant, whereby acids are produced and griping and diarrhea result. The mineral ingredients of the food in infancy are equal in importance to the proteids. Like these, they are concerned in the building up the child's body, and deficiency of them will produce much the same symptoms as deficiency of proteids. Salts of lime, potash and phosphoric acid are especially important, phosphate of lime is wanted for the bones, and phosphate of potash for the muscles and blood. It must not be supposed that it is a matter of indifference in what form these are supplied. It would seem that these salts are of much greater use when they enter the body in combination with organic matter than they are in a free mineral form. Milk, and especially human milk, is peculiarly rich in organic combination of these salts, and for this reason lime water or chemical preparations of salts can be no proper substitute for it. On the other hand, there is no reason to believe that the presence of an excessive quantity of mineral matter in the food of an infant does any harm; the child simply does not absorb or assimilate more of each compound than it requires for building or other purposes. The importance of water to the infant will be evident when one recollects that more than 34 of the whole body consists of it, and that it constitutes about 4-5 of the milk, which is the natural diet of infancy. Water has also local uses in the stomach and bowels, promoting as it does the processes of absorption and secretion. One is apt to forget that an infant may suffer from thirst as from hunger, and that water will allay the former better than milk. The effect of a drink of cold water is certainly well worth trying if a child is suffering from evident but unexplained discomfort. We have spoken on the one hand of a due supply of each nutritive ingredient in the diet of the infant, and on the other of the danger to health which results if any one of them be present in excess. One naturally turns to human milk, the natural food of infants for guidance as to the proper quantity of each ingredient to be supplied, and for this reason the study of the exact chemical composition is of the first importance. The following represents the results of the latest and most trustworthy analyses of human milk, taken about the middle of the second week of nursing: A healthy woman produces from 12 to 4 pints of such milk daily,. although the former figure would be much nearer the average than the latter. I should like to direct special attention to two points in the above analysis: Firstly, to the small amount of proteid which human milk contains, and secondly, to the presence of a considerable proportion of "extractive" matters. These are admittedly of unknown nature, but they contain nitrogen. Furthermore, the above analysis must only be taken as representing the average composition of human milk. Considerable variations are met with the causes of which may be considered under the following heads: I. Variations dependent on the period of suckling; one might naturally expect an infant a few days old would not require the different ingredients in exactly the same relative proportions as one of some weeks, and chemical analyses of milk at different periods of lactation verifies the expectation. The milk secreted during the first two or three days after the birth of the child is called colostrum, and has some peculiar characters. It is more watery looking than ordinary milk, and contains a special form of proteid, which causes it to clot on boiling, for the first day or two. The actual amount of proteid which it contains is greater than in ordinary milk, though the exact figures vary, some analysts placing the proteid as high as 8%. Colostrum may contain a number of peculiar microscopic cells called colostrum corpuscles, the number of which is variable. As they consist of proteid, they must be of some nutritive value to the child. One of the uses of colostrum appears to be as a laxative causing the expulsion from the intestine of the child of a quantity of waste matter with which it comes into the world. After the third day the ordinary milk begins to be produced. A study will show that on the whole the building material (proteid and mineral matter), tends to become less in amount as lactation proceeds, the sugar rises rapidly up to the end of the second week, and after that more slowly, while the fat, after reaching a maximum about the second. month, tends to fall off again in the later periods. A little consideration will show that these variations are very much what one would expect from the physiological requirements of the infant at different. ages. During the first few weeks of life the child grows much faster than subsequently. Obviously, then, the infant will require more building material at the former period than the latter. The gradual increase in the proportion of carbo-hydrate is also just what one would expect in view of the daily increasing muscular activity of the child. A general consideration shows that the milk of the mother certainly does not get richer as the child grows older, but that the increasing demand for nutriment by the growing infant is met by supplying an increased quantity of milk, and not by providing an improved quality. This fact should be noted by those who have to provide artificial substitutes for human milk. It follows, also, that there is some scientific justification for the popular view that a wet nurse should not suckle a child which is much younger than her own. The difference, however, of the composition of the milk of the third week and third month is not sufficiently great to make such a difference between the ages of the two infants a bar to the employment of the nurse. II. Variations dependent on the individual differences in the mother or her child. These are of comparatively little importance. It has been found that as a matter of fact the milk of any given woman will show greater variations from day to day than one finds on comparing the milk of different women on any one day. Weak women, |
