713 
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. 
Over-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 mod- 
erate fatigue. As the symptoms in the child are caused by the con- 
tinuous ingestion 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 anaemic mothers. The amount present in 
the breast may be so small that the small quantity of milk necessary 
to make the examination is secured with difficulty. The clinical 
characteristics of this milk are low specific gravity (1.024 to 1.027) 
and cream only 2 to 4 per cent. In such cases the quality of the 
milk is so poor and the quantity so small that it is manifestly im- 
possible to nourish the child by it. 
In other instances the variation from the normal is not so great; 
i. e., specific gravity 1.028 to 1.030, cream 4 per cent, with fairly 
abundant quantity. In such cases we may hope to improve the 
quality of the milk by appropriate measures. These are adequate 
rest for the mother at night, fresh air, nourishing food, and gentle 
exercise. The anaemia usually present may be improved by malt 
extracts and preparations of iron. If this condition is dependent 
upon conditions incidental to the hfing-in period, the outlook is 
usually good. If, on the other hand, it is the result of constitu- 
tional debility or neurotic diathesis, improvement may onh^ be tem- 
porary, necessitating the weaning of the child, not only in its own 
interests, but those of the mother as well. 
Abundant milk of poor quality . — This condition is sometimes seen 
in anaemic subjects who have been taking large quantities of malt or 
alcoholic beverages in the hope of improving their milk supply. In 
such cases the quantity may be so abundant that the breasts are pain- 
fully full at nursing times and between them may flow away sponta- 
neously. Clinical examination shows low specific gravity and very 
low fat. 
Owing to the grade of hydremia accompanying these conditions, 
very little improvement can be expected to ensue from treatment, and 
nursing should be discontinued. 
