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47
the baby's condition. No criticism of their skill is implied. Reference
to the chart shows that in the stage (15-22 weeks) when the child was in
hospital its condition improved rapidly. Unhappily a change of management
became necessary and the child was transferred to another institution
where the improvement was lost. This is exactly the kind of disappointment
which so often occurs in the career of a delicate infant. Perchance
this child suddenly had to give place to some other more urgently ill;
and this at the moment when, possibly, the exactly right understanding
between him and his nurse had been achieved, the feeds correctly estimated
and his digestion suited. And perhaps again, he entered his next "home"
with a slightly exaggerated reputation for robust progress and failed to
fulfil it. At any rate, there is good reason to believe the diet on which
the child ultimately throve differed very little from what he had been
having while his weight was fluctuating or declining. The case of this
infant is chosen rather as being very typical of a fairly numerous class
which seldom thrives while attending the out-patient department of
hospital, because, from the outset, attention needs directing to the mother
and the home conditions as much as or even more than, to the infant.
The Health Visitor, equipped with the appropriate knowledge and the
ability to teach, is the most fitted person, it is maintained, to ensure a
steady and lasting improvement.
The dietetics of this child proved to be a simple matter, though when
he first attended the clinic he was formidably wasted, and his power of
fat digestion was low. A dilute feed of cows milk, citrated and with a
high percentage of added sugar, was well taken. Later this was modified
to one of more normal proportions. The Health Visitor's training and
encouragement of the distracted mother furnished the essence of the
child 's recovery. By one means or another she achieved a better state of
affairs in the house; taught the woman how to handle the child, how to
soothe it when fractious, when to stimulate it to take exercise and when
to insist that it should rest. Faults of clothing and ventilation were
altered, and the day was so ordered that several hours were regularly spent
in the open air. By degrees the mother acquired an air of confidence and
optimism that was of almost as great importance to her baby as the proper
diet. The weight rises rapidly and steadily.
An interesting fact remains to be mentioned, it was obtained when
inquiry was made at the various hospitals where the child had been
treated. The confinement took place in a lying-in hospital and the
baby's birth weight was registered at 91b.; the following day the weight
was found to be 81b. 3oz., and on the seventh day 71b. 140oz. The birth
weight was therefore suspected to have been wrongly calculated, and
there was some speculation as to whether it should have been 81b. rather