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indicated by continuous sucking of the fingers and remaining a long 
time (forty or fifty minutes) at the breast. If it stops then, it is 
rather from exhaustion than because it is satisfied. If the insuffi- 
ciency of food has been very great from the outset, it may lie in a 
remarkable condition of apathy (Budin), sleeping most of the time. 
Weighing the child before and after nursing shows- that it gets very 
little. The mother’s breasts are not full and tense at nursing time, 
as they should be, and during the intervals of feeding but little milk 
is present in them. The child’s discharges, both fecal and urinary, 
are very small, and, most important, there is a steady loss in weight. 
Inadequacy of maternal nursing ( overfeeding ) . — This is not so fre- 
quently seen in children at the breast as in those artificially fed. It is 
mainly observed in the case of strong, full-blooded mothers or wet 
nurses, whose milk from rich food and insufficient exercise is highly 
charged with fat. Overfeeding is briefly characterized by the fol- 
lowing symptoms, the cause of which will be discussed in another 
connection: They are irritability, restlessness, and broken sleep, fol- 
lowed by constipation with gray, dry stools. The urine is odorous 
and stains the diaper. A continuance of the cause finally induces 
severe gastro-intestinal symptoms ; vomiting and diarrhea are present, 
with discharges containing curdy masses of fatty soaps. The gain in 
weight diminishes, ceases, or a loss is manifest. 
Value of the examination of the hr east milk when the infant is not 
“ doing well” — -In many cases when the child is not thriving an ex- 
amination of the breast milk may give valuable information. I have 
given elsewhere clinical methods by which an approximate idea of 
its qualities may be obtained. The result of the milk examination 
usually discloses (1) that it is too rich in quality and unusually abun- 
dant in quantity; (2) that it is scanty and poor in quality; (3) that it 
is abundant but poor in quality. 
0 ver-rich milk. — I have already adverted to this condition and 
the gastro-intestinal disturbances it may induce. Clinically, over- 
rich milk is indicated by a high specific gravity (1.032 to 1.036), 
combined with a high percentage of fat. The child should not be 
weaned, but the quality of the milk regulated by less frequent nurs- 
ings, a simple diet, and exercise in the open air to the point of 
moderate fatigue. As the symptoms in the child are caused by the 
continuous absorption of a food far superior in caloric value to his 
nutritive needs, the diminished frequency of the nursings not only 
enables it successfully to rid itself of the excess of nutrient elements 
ingested, but also tends to diminish the richness of milk secreted. 
Scanty milk of a poor quality. — This condition is most frequently 
manifest in delicate and ansemic mothers. The amount present 
in the breast may be so small that the small quantity of milk neces- 
sary to make the examination is secured with difficulty. The clinical 
