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and vitamin content. Breast milk should in some cases be replaced by
cows' milk for in a number of instances the child refuses to take
adequately its new food until it has ceased to be suckled. The poverty
of muscle tone which is largely responsible for the lethargy, improves
if the proper food is obtained. It has frequently been noticed that in
infants' treatment by a combination of dietetics and exposure to a mercury
vapour or carbon arc lamp, this atonia is abolished rapidly and the
headsweating ceases coincidentally. The growth begins to improve and
progress is again satisfactory.
Nevertheless, there remains a group of children who, despite the
application of these measures, do not respond. Their weight charts,
after recording a steady curve for eight or nine months, begin to show
sharp depressions and slow recoveries. The notes contain frequent
mention of naso-pharyngeal infection and disordered digestion and loose
stools. Their attendance perhaps begins to be irregular and the explanation
is commonly an attack of bronchitis and that the weather was not
suitable for a visit to the clinic. Otorrhcea, pneumonia following or
complicating measles or whooping cough, are other reasons for prolonged
absences and there is dismay, when on its return, the infant's weight
is found to have shown no advance or an actual retrogression in three
or four months. Dietetics and ultra-violet radiation fail disappointingly
to control the infective catarrhs; the general condition remains definitely
subnormal; headsweating c'uring sleep may be a prominent and constant
feature and pallor, lack of muscle tone and abdominal prominence are
evident; the child is labelled constitutionally delicate by parents and
neighbours, its frequent attacks of feverishness giving rise to the suspicion
tkat tuberculosis is the underlying cause. It becomes a great
question whether these children should continue to attend clinics for
the welfaring, and in London, at any rate, the mothers, with or without
the doctor's recommendation, frequently transfer them to the hospital
out-patient departments.
In these children, great hypertrophy of adenoid tissue and repeated
infection of the tonsils, with enlargement of cervical glands, is an outstanding
feature, and it does not seem possible to dissociate their general
debility from the tendency to recurrent infection in this region. It is
commonly held that two years of age is unduly early to remove tonsils
and adenoids. Welfare Centres are not equipped or staffed for the
undertaking, and operations on out-patients at a hospital situated far
from the infant's home involve considerable risk. Moreover, the
anresthetic and surgical technique in the very young present somewhat