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to eighteen months is the most deserving of close watch and persistent
digestive education.
Prolonged Lactation.—I have been disappointingly unsuccessful
in those children who have continued on breast milk
after the age of ten months. In spite of the most careful and
varied additions to their diet they have persistently remained
below the normal weight line. They become peculiarly anaemic,
and while they are not particularly thin their muscles lack tone,
the skins dry, and there appears to be an undue laxness of ligaments.
To the experienced eye their appearance is typical and
can be recognised immediately; it suggests an abnormality of
internal secretions.
Difficult Nutrition.—With the exception of advice and
education to the mother, coupled with repeated examinations of
the healthy children, the greatest amount of the Medical Officer's
time is taken up with cases of difficult nutrition. This difficulty
is usually established in the early weeks cf life by unskilled
management of breast feeding or by an injudicious management
of artificial feeding. There is still a gap from birth to the end
cf the first month, and this gap is wasteful cf life, time and
money.
Unnecessary Weaning.—It is during that first month that
the most skilful advice is required both by mother and child,
but the fact remains that during that month it is at present
most inadequately provided for.
To take one example only:—It is a common thing for me
to see infants suffering from indigestion who have been weaned
and who have had five different food mixtures within a few weeks;
yet in no instance during my five years in Hornsey have I found
in these cases an insufficient supply of milk in the mothers'
breasts.
The number of these cases is not small, and the amount of
time which must be expended on them by the Medical Officer
and Health Visitors is considerable. With skilled care they regain
the normal, but the expense entailed suggests the advisability
of attempting to bridge the step between ante-natal care
and attendance at the Centres.