Dietetic Causes

The dietetic causes of diarrhoea in infants and young children may be classed as due to - 1. Too frequent or irregular feeding.

2. Overfeeding.

3. Feeding with improper or "spoiled" food.

The first and second causes are commonest in early infancy, and the third is commonest in childhood, although any or all of them may operate at any age.

Children brought up in the country are much less subject to diar-rhoeal disorders than those raised in cities, owing to the relative purity of their milk and other foods, and the greater resisting power with which their better general health and vigour supplies them.

In a series of nearly two thousand cases among infants of fatal diarrhoea, collected by various observers (Hope, Meinert, Ballard), only 3 per cent received the breast exclusively. These are very significant data, and point to the conclusion that the vast majority of cases are due solely to the use of improper or contaminated food.

Differences in the mere chemical composition of the cow's milk used for feeding are not sufficient to account for the frequency of diarrhoeal diseases, and the further conclusion is reached, and has been sustained by bacteriological research, that the harm is caused by noxious germs.

Diarrhoea occurring in nursing infants must be accounted for in other ways, although germs may readily have access to the child's mouth from an unclean nipple or from sucking its own soiled fingers.

Aside from this, anything which disturbs the mother's digestion may excite diarrhoea in her baby, as, for example, improper food, menstruation or pregnancy (rarely), strong nervous influences, such as grief or worry, great exhaustion, extreme anaemia, the use of certain powerful drugs.

Evidently the intestine becomes stronger or less susceptible to bacterial poisons after the first two years or thirty months of life, for the frequency of serious diarrhoea lessens, although the child often gets worse milk to drink than it had when fed upon the bottle.

It has been suggested that water may excite diarrhoea by hurriedly washing germs into the intestine which are ordinarily killed in transit by the acid of the stomach. The bile is reputed to be antiseptic, but Booker has found that all bacteria will grow in a 10-per-cent solution of it, and it easily undergoes fermentation from decomposition of its mucus. Its antiseptic reputation rests upon the fact that it stimulates peristalsis, keeps the bowels moving, and thereby prevents food from accumulating and fermenting abnormally.

In large cities, where women among the poor are obliged to go out to work by the day, they, as a rule, suckle their infants for only the first six months, or if for a longer period, they add other food or have their babies bottle-fed by a neighbour or in a "day nursery " during the hours in which they themselves are away from home. Such hand-fed children are often given more than they can assimilate.

As the infant grows older it is brought to the family table, and when a year and a half old it is not seldom stuffed with any articles from it. Beer, sausages, bananas, potatoes, tea, and coffee - all are given.

Overfeeding and the use of such harmful food maintains almost constant dyspepsia, and if it does not itself cause diarrhoea it predisposes to it by keeping the alimentary canal in a constant state of irritation or hyperaemia, so that slight additional factors excite the condition, and bacteria find a fertile soil in which to develop.

In older children foods which are among the commoner causes of diarrhoea are unripe or overripe fruits of all kinds, berries with seeds, vegetables having a tough outer envelope, such as old peas, beans, and green corn, imperfectly cooked cereals, like coarse hominy, rice, or oatmeal, nuts, raisins, and dried currants. Generally speaking, diarrhoea is more apt to be caused by fruits and tough meats imperfectly masticated than by vegetables.