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nursing is going to fail, it should not be allowed to continue because 
the mother desires it from mistaken notions of her duty to the child. 
Inadequate nursing , insufficiency . — During the first few days of 
life the temperature of the child furnishes a very important indica- 
tion, not so much of the nourishment as of the amount of fluid it is 
receiving. Very few children who are receiving a sufficient quantity 
of fluid from the breast during the first few days of life present ab- 
normalities in the temperature. 
Fever of inanition. — Many of those who get little or nothing dur- 
ing this time have an elevation of temperature of 38.4° to 39.1° C. 
(101° to 102° F.), while in exceptional cases the temperature rises to 
40° or even 41° C. If no other obvious symptoms of disease are 
present, such a temperature observed on the second to the fourth day 
may be considered evidence of insufficient ingestion of fluid or even 
of starvation. Supplying the needs of the infant in this respect 
rapidly causes a disappearance of the fever. 
If the milk of the mother’s breast be insufficient to supply a greater 
energy quotient than 70, the child ceases to gain in weight; if below 
this, a loss ensues. The child is fretful and seems always hungry, as 
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 sysmptoms, 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 breast milk when the inf ant 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 
