Since this work has been chiefly devoted, as the title implies, to the relationship between diet and disease, the amount of space given to the feeding of presumably normal children may occasion some wonderment. But the chief difference between the dietetics of the infant and adult lies in the fact that the bottle infant and the weanling, nominally healthy, have to be dieted to prevent disease. This has now come to be realized on all sides. In classic and mediaeval times an infant which could not get breast milk usually perished. The weaning period was somewhat less trying, but millions of children must have succumbed to the ordeal of changing to solid food. Improvement in feeding means a direct lessening of infant mortality, as modern statistics testify.

Colic and Vomiting (Regurgitation) are almost physiological, so common is their occurrence; they do not arise from any single cause, and the fact that breast-fed infants suffer almost as frequently as the bottle-fed, often more so, shows that such ailments are not entirely preventable by care in feeding. In breast-fed children, these symptoms are best controlled by lengthening the period between feedings. In bottle-fed children, besides lengthening the nursing interval, special pains should be taken in the modification of the milk. These symptoms may occur quite independently of diet. Chilling of the body surface, coughing, improper handling, a too snug binder, etc., may be the true cause of the trouble. Even in breast-fed infants under ideal conditions, the mother's milk may not be well-borne. It may in fact be so rich in fat and protein as to require dilution; which of course in the breastfed may be accomplished only by giving the infant water before or after nursing.

Gavage

Of late years the use of the stomach sound in feeding sick nurslings has come into considerable vogue in foundling asylums and the like. This resource has a considerable range of application. Thus in premature infants (which do not nurse readily); in all infants which refuse to nurse; and in infants sick from any cause, especially when the nerve centers, swallowing or breathing apparatus are involved, or when continuous vomiting is present, the use of the stomach tube may save life. Very young babies are fed much more readily than older ones, since they are less liable to fright. The tube used is a soft rubber catheter, which is coupled with a small funnel. The catheter is first passed down the gullet. In order to have plenty of leeway, it is an advantage to unite the catheter to a second rubber tube with a piece of glass tubing. The second rubber tube is then coupled to the funnel. If the case be one of vomiting, it is often necessary to wash out the stomach before the introduction of nourishment, however given. The term lavage, used for washing out the stomach, must not be confounded with gavage, which means literally forced feeding. Complete details will be found in works on obstetrics and obstetric nursing. Edgar says of gavage, that the infant to be fed should lie on its back in the nurse's arms, its own arms held to its sides, while an extra assistant steadies the head. The tube having been passed, the modified milk or other nutriment is poured, into the funnel, and as the latter empties itself the tube is pinched to prevent escape. While regurgitation may occur and necessitate a repetition of the act, it very often happens that food taken in this manner is much better retained than if taken by nursing the breast or bottle. The exertion required by nursing, the swallowing of air, etc., are avoided in gavage. To recapitulate, the conditions in which gavage has been found life saving, are given by Edgar in the following order:

Prematurity (especially in incubator babies); after operations on the nose and throat; habitual vomiting; pneumonia, diphtheria and scarlet fever. The jaws of the nursling can usually be separated to receive the gavage-tube. But if there is inflammation of the mouth or locking of the jaws (or if intubation has been required for diphtheritic cases) it may be necessary to resort to nasal feeding (see p. 79).