Marasmus is a form of starvation occurring chiefly in artificially fed infants, but also in those at the breast, in whom there is great wasting of the muscular and other soft tissues, and sometimes catarrh of the alimentary canal. The food is either too limited in quantity, is indigestible, or else is supplied in a form in which the ingredients are not properly balanced. Breast-fed children are more apt to suffer from insufficient quantity, and hand-fed infants from improper quality of food and overfeeding. "Food upon which a child has thrived for three or four months, perhaps, can become unsuitable, and consequently lead to wasting if the digestive powers be suddenly reduced by an intercurrent disease" (Louis Starr). The treatment of marasmus is therefore essentially dietetic, and the reader is referred to the general directions for infant feeding. No detail should be considered too trivial for the physician's personal attention. If nursed, the mother or wet nurse's milk should be examined for richness in cream and curd.

If hand-fed, the most scrupulous care must be taken to secure antiseptic cleanliness, and milk or milk and meat juice should be the staple foods, to the exclusion of all farinaceous articles and patent "baby foods." The disease is commonest in the first year of life, but may occur in the second, and its effects in enfeebling the constitution may last much longer. It is just at this period that mothers - for reasons of supposed economy or expediency - are tempted to supplant the only natural infant food (milk) with all sorts of prepared foods. It is because they do not know how to prepare cow's milk properly and adapt it to the baby's needs that they substitute or add artificial foods.

All milk should be peptonised or Pasteurised (p. 79), and lime water or barley water are the best diluents, the former being preferred if there is vomiting or acid eructation. (For the correct degree of dilution according to age, see Infant Feeding.) If good top milk cannot be obtained, one or two tablespoonfuls of cream with a teaspoonful of milk sugar is to be added to each bottle. Some infants do better for a short time upon a cream-and-water mixture.

In other cases all milk should be withheld, and expressed-beef juice, diluted meat broths, and egg-albumin solution must be used. Louis Starr says: "At eight or ten months from two to four fluid ounces of thin mutton or chicken broth free from grease may be allowed each day in addition to the milk; at twelve months the yolk of a soft-boiled egg, rice and milk, and carefully mashed potatoes with gravy; and at the end of the second year a small quantity of finely minced meat".

Cod-liver oil should be given, but never until the digestive functions are well restored, as shown by the character of the stools, the absence of eructation and flatulence, and a clean tongue. It is to be prescribed pure, or in one of the emulsions with calcium lacto-phosphate.

Daily warm baths and inunctions of two or three drachms of cod-liver oil, or, better, olive oil, are to be ordered, with fresh air in abundance.