In other cases the atrophy, infantile marasmus, or wasting away, appears after the child has begun to thrive. In these the symptoms are various; sometimes the food is rejected as soon as swallowed, or presently after; sometimes it passes from the bowels in an undigested condition; and sometimes there is diarrhoea with whitish-colored stools, – indicating deficient action of the liver. But in all cases of infantile atrophy, the child is restless, peevish, -fretful, crying, as if continually distressed, and always growing thinner and thinner, whatever the other symptoms may be.
In some instances the mischief may be occasioned by the severe derangement of the digestive apparatus incidental to dentition. Here the loss of sleep and the exhaustion of the nervous forces in separable from difficult and painful dentition, cannot but weaken the stomach. Thus the food is in part rejected; in part it becomes sour and curdled, and thus by its very presence and influence adds to the original gastric irritation; and finally, in an imperfectly prepared condition it is transferred to the intestines only to extend the same distressing irritability throughout their entire tract. The indigestion, thus commenced in the stomach and continued through the intestines, becomes in the next stage of physiological disorder, a non-assimilation, and confirmed atrophy is the necessary consequence. In other cases, the seat of the difficulty may be an original disorder in some portion of the digestive apparatus, -such for example as enlargement and induration of the mesenteric glands. This is the most common form of atrophy in scrofulous children. And even where this constitutional miasm is not present in sufficient force to develop such disease of its own accord, the irritation occasioned by diarrhoea from indigestion, or by worms, or by the destructive effects of calomel may combine to give rise to such tuberculous affection of these glands as shall become an actual phthisis intestinalis, or fatal consumption of the bowels.
The following are given by Leadam, as the principal symptoms which precede or accompany atrophy: “Frequent belly-ache, with irregular bowels, the motions being too frequent and variegated, or clay-colored and watery; acid odor, not only of the evacuations, but also of the breath and perspiration; fickle appetite and much thirst; the urine often turbid and white; the child is fretful or quite sullen and indifferent, less playful than usual and cries peevishly. The countenance changes color frequently, and the tongue is creamy, or morbidly clean and red. There is swelling and hardness of the belly, with emaciation; sometimes irregular, small tumors are to be felt, through the parietes of the abdomen; the skin becomes shriveled, the complexion earthy, the appetite voracious; diarrhoea supervenes, if it has not existed throughout; there is slow, continued or remittent, fever, augmenting towards evening, with flushing of the cheeks, a hot, dry skin and incessant cough, extreme restlessness, increasing debility, and finally hectic. In this form of scrofulosis, the bowels and the secretions poured into them require to be regulated, not by purgatives, however, but by remedies which are consonant with the general state of the patient.
The irritation occasioned by dentition is peculiarly apt to develop the morbid enlargement of the glands just described, in which the little sufferer emaciates just in proportion as its abdomen grows larger and its appetite more voracious. This affection, usually termed tabes mesenterica, is indeed hardly ever fully developed in the first few months of infant life; still the foundation is early laid for it, in the profound debility resulting from insufficient food and still more from injudicious nourishment; from the close, foul air so common in the sleeping rooms in cities and even in the country; and from the deprivation of light. “Children confined in badly-lighted and ill-ventilated apartments, are uniformly unhealthy; so those brought up by hand, in a city, seldom do well; in the country their chance of living and thriving is much greater, because the purity of the air renders their digestive powers more vigorous. (*Warren on Scrofula.)
Treatment. – In the treatment of cases of atrophy, or failures of nutrition, the very first indication will of course be to seek the special cause of the difficulty. And if there is any thing about the diet, regimen and care of the child itself, or any thing in its habitation and surroundings, which seems capable of exciting an injurious influence, this must be amended first of all. Thus removing, so far as possible, all the external causes of the marasmus, we shall the more readily succeed in promoting that recovery of the little patient which might otherwise defy all our skill. Where the cause of the malady appears in the quality of the food, -whether it be that of the mother, of the nurse, or some artificial substitute and preparation of cow’s milk, -such change should be advised as will secure the most healthy nourishment possible in the circumstances. Sometimes the mother’s milk is unwholesome; the milk of a particular cow may disagree; or the milk served by the milkmen in the large towns may be and indeed often is adulterated with lime or chalk. The long continued use of any of these unhealthy articles of food cannot fail to develop, sooner or later, what may easily become fatal disorder of the digestive apparatus. Nor is the artificial food at all improved by mixing lime-water in the diet, as is sometimes done in hospitals for foundling infants, for wherever this course is long pursued the little ones will all die. In fact observation shows, in this case just what the Homoeopath would predict, that these calcareous additions to be food, while they may indeed render the stomachs of the infants more tolerant of it, -do but cause still severer disorders in the bowels, -just such disorders as the Homoeopath is accustomed to cure with the dynamized preparation of the same drug.
Finally, therefore, as a most essential adjunct to the appropriate remedy in these cases, -always serious, often apparently hopeless, -the utmost care should be exercised to give the little patient every possible advantage in the way of light; fresh air; suitable food, and, -what is often entirely overlooked, -sufficient quiet to enable it to take its natural and necessary rest undisturbed. Then the remedy, should be selected with the most particular reference to all the symptoms and conditions of the child, -and even with regard also to the peculiar form of psoric or scrofulous dyscrasia which it may be possible to discover in the constitution of its parents.
Aethusa cynapium. The child throws up its milk soon after nursing, with great force, suddenly, -then falls asleep as if from exhaustion, to awaken for a fresh supply.
Aloes. The child passes substances looking like jelly-cakes, – sometimes small, at other times large, -but they adhere together like congealed mucus; they may be green-colored, or transparent.
Argentum nit. Diarrhoea of green fetid mucus, passing off with much flatulency.
Arsenicum. The stools are painful, offensive, and contain quantities of undigested food; there is much debility, and a pale, waxy look.
Belladonna. Particularly for precocious children with blue eyes and fair hair. They do not sleep much, but are drowsy; half- sleeping and half-waking.
Benzoic acid. The urinary odor is very strongly ammoniacal.
Bryonia. The food is thrown up immediately after eating, and there is constipation; the lips are dry and parched; the mouth is dry; and the child wishes to keep very still.
Calcarea c. Clay-like evacuations; dry and flabby skin; enlargement and induration of the mesenteric glands. Large open fontanelles; much perspiration about the head in large drops, – which wets the pillow far around when the child is sleeping. Cough, with rattling of mucus in the bronchia.
Chamomilla. The child must be carried all the time, for it is only quiet then. Diarrhoea, green and watery, and slimy; or like chopped eggs and spinach. Odor like decayed eggs. One cheek red, the other pale.
China. Offensive, painless, undigested stools; abdomen distended with flatulency.
Cina. The child picks its nose very much is very restless; cries; and is very unamiable.
Conium. Hardness and distention of the abdomen; with frequent sour evacuations.
Ferrum. Frequent vomiting of food; stools undigested; redness of the face.
Graphites. The child has moist blotches on its skin, that exude a transparent glutinous fluid.
Hepar. The child has a sour smell, and white, fetid evacuations.
Iodine. A brown color of the face, and copious and papescent stools.
Ipecacuanha. Nausea is the most predominant symptom.
Kreosote. Fetid evacuations, and excoriation of the mucous surfaces generally.
Lycopodium. Much commotion, rolling and rumbling in the abdomen. The child is worse after four P.M., and gets better at eight or nine in the evening.
Magnesia c. Green, watery, very sour-smelling diarrhoea, and great emaciation.
