The results of improper feeding may display themselves as acute or as chronic symptoms, e.g. acute or chronic gastro-intestinal catarrh. Such conditions may be brought about by other causes also, but, as improper feeding is by far the most common cause, it is convenient to consider the dietetic treatment under this heading. When the condition is acute, one must recognise that the alimentary canal of this infant is intolerant of food; its digestive power is disordered and, for the time being, inactive; its gastrointestinal tract is unduly irritable, and constantly irritated by obnoxious contents; digestion is at a standstill; diarrhoea and vomiting constantly drain away the strength; vitality is at a low ebb. The two primary indications are to sustain the infant's strength, and to remove the irritating contents of the alimentary canal. No attempts to administer food are, for the time being, permissible, and the length of time during which the administration of food is refrained from, and the nature of the food first given, must depend upon the age of the child and the severity of the condition. A purgative and an enema are always called for; it may be necessary to wash out the stomach; transfusion with saline solution is always advisable, and brandy well diluted (30 drops in 1/2 ounce of water) may be given by the mouth.

In commencing nourishment the steps must be very gradual by which we regain the dietetic normal. At the commencement, albumin water and brandy (5 m.) are given to the infant freely - hourly. With improvement in the condition - diminution of diarrhoea, absence of vomiting, disappearance of felled, toxic facies - whey is substituted for the albumin water. The period during which all milk or cream is excluded from the diet of the young infant in severe cases lasts several days, and it is always prudent to wait for marked improvement in the facies and number of stools before making such addition. On the other hand, it must be remembered that an infant on a diet of whey and brandy is apt to pass numerous liquid stools, and if the general appearance is otherwise satisfactory some more satisfying form of nourishment is called for. A small amount of cream is now added to the food, and an infant of about three months of age now gets 2 1/2 or 3 ounces of whey with 1/2 dram of cream every two hours, brandy being continued if necessary. The amount of cream is slowly increased day by day for two or three days, and this mixture is then replaced by dilute fully citrated milk (1 part of milk, 2 parts of water, 2 grains of sodium citrate, to each ounce of milk), or by dilute peptonised (forty minutes) milk. Thereafter the normal diet is gradually regained.

In cases, however, where in spite of acute digestive disorder the general condition of the infant is fairly satisfactory, after six, eight, or ten hours of abstention from milk food, feeding may be recommenced with a dilute milk.

When the symptoms are chronic, gradual correction of the causal dietetic impropriety may suffice, but usually more than this is necessary. The digestive powers have, in some manner, been over-taxed, and they must, consequently, be partially and temporarily rested. To this end the food must, in the first instance, be restricted in all its elements, and only gradually strengthened. Many of these cases are extremely intractable, and marked malnutrition occurs. The term marasmus is sometimes used to denote a condition of extreme malnutrition whatever the cause may be; it is frequently used in connection with cases of extreme malnutrition due to prolonged improper feeding or long-standing -tivc disorder; it also, however, appears to apply to a condition due to inherent weakness of the digestive powers, and in these latter cases it is occasionally found that small doses of thyroid extract (1/4 grain to 1/2 grain) thrice daily give beneficial results.

In all cases of malnutrition or marasmus, to enable us to judge of the dietetic means most likely to restore or improve the infant's health, we have first of all to seek by all means in our power to discover any underlying cause for the condition. The history must be fully entered into; syphilis, tuberculosis, empyema, etc., carefully excluded, the previous diet of the infant closely considered in conjunction with his present condition, the nature of his stools, vomit, etc. The history may supply us with a hint as to the foodstuff probably at fault, or it may be impossible to lay our finger on any one factor which more than another seems to have brought about the condition. We consequently strive to find the directions in which the infant's digestion is stronger, and to avoid those in which it is weaker. To do so we commence with a food likely to be well within his digestive capacity - it may be whey and brandy - gradually strengthen and add the various milk ingredients to this, keeping a careful eye on the nature of the stools. In many cases 1/2 grain of grey powder, given night and morning, proves of great value.

It is well to allude here to the condition of scurvy. The infant suffering from early scurvy not infrequently shows no marked physical signs, and displays no definitely characteristic symptoms; it, however, refuses food, or is unable to digest it. In these cases arrangement of the diet is of no avail unless the scorbutic condition is first treated with fruit juices, when digestive difficulties will greatly diminish (see also p. 392).