Infant feeding and its influence on life : or, the causes and prevention of infant mortality

Front matter

22101662465

INFANT FEEDING ITS INFLUENCE ON LIFE

INFANT FEEDING

Preface

many ways. Much, however, remains yet to be done. In England alone, since the year 1847, over 341,000 babies have died from developmental diseases of children, and nearly 2,500 from want of breast-milk. Even since my last edition in 1863 nearly 146,000 children have died from the former diseases and 12,000 from the latter cause, and unfortunately these numbers are on the increase. Compared to a million of persons living, the numbers which for these two classes were, in 1847, respectively, in the proportion of 653 and 46, are now in that of 695 and 53. France, from similar causes, is actually diminishing in population. There is still, therefore, ample room for improvement. The minimum of good done should urge us to more active measures still. The first step towards reform is to be fully cognisant of the evils which exist ; the second is to trace the causes that favour their development. Then only may reform be safely urged and begun. Our Eegistrar-General, of whom England may well be proud, has by his unparalleled reports done much to clear the mists in the vista before us. Hundreds of men of science in every land, actuated by the noblest and most generous im-

PREFACE.

vii pulses, have spoken with decision and judgment. It is for us to enter the promised land and take possession. I hope, therefore, for better things yet. I look forward to a day when the full benevolent intentions of the originators of Foundling Hospitals will be carried out, because better understood. When woman, instead of beingoutraged in the day of her distress, will be effectually helped, and infanticide will cease to be the plague-spot of this land. When true and unprejudiced religion, walking hand in hand with a morality — not merely sensational, but real — will be based upon the precepts laid down by our Great Exemplar, and arranged on the side of our helpless babes ; then, like Him, " we shall be working while it is to-day;" like Him, "be ever going about and doing good : " and then of us it may be justly said, " Mercy and truth have met together," and " glory may dwell in our land."

52, Montague Squaee, September, 1876.

PKEFACE TO THE SECOND EDITION.

When the views first propounded in these pages were put forth, I anticipated considerable opposition. The voice and practice of the profession were against me. I looked for no favour on the part of the press, and I expected the public would not be more propitious. My opinions, however, had been formed after mature thought and reflection, and I felt urged to set forth what I believed was truth, and to expose what I estimated as error. I am thankful to feel my misgivings, in regard to what I have said, have not been verified.

The fundamental doctrines I sought to prove have been in great measure admitted. The dogma, that it is imprudent to mix two milks, or to allow a mother both to suckle and feed a child artificially at the same time, now meets with few advocates. The great mortality of

A 2

X

PREFACE.

infants is now no longer attributed so much to hand-feeding, as to the injudicious manner in which it is generally conducted. Lastly, the full bearings of the hiring of wet-nurses upon the spread of illegitimacy, upon the death of the children so deserted by their mothers, and indirectly upon infanticide, are becoming daily more appreciated.

It is true, that in putting forth a second edition I am anxious to give more development to the views enunciated, and to make more converts to my opinions ; but I have also another object, — I desire to influence public benevolence in another and an analogous direction. There is a sphere of usefulness open, and one in its accomplishment well calculated to benefit the masses. I long to see our Foundling Hospitals,- and other analogous institutions, with their large prospective revenues, extend their philanthropic operations, and open wider their doors of relief. There are many honest, hardworking mothers whose circumstances as to money and health prevent them from fulfilling their maternal duties to the advantage of their children. The overcrowded and overburdened workhouse is surely

PREFACE.

XI not a fit place for them. Why should not these rich institutions hold out a helping hand to the offspring of these poor mothers, without necessarily neglecting the children of our more frail and unfortunate sisters ? It would be a glorious thing to see all these children taken up and fed upon those plain, simple, common-sense principles which the knowledge of the day has developed, and thus rescued in many cases from disease, deformity, and premature death. Some of these rules I have endeavoured to point out; others will become matured in the course of experiment, and I hope the day is not far distant when they will be put into full operation.

Let me be clear, however. I do not presume to say that I have done even a tithe of what may yet be done, for I feel progress will not stop here. But I believe soberly, that the measures I have ventured to recommend are a step, however feebly made, in the right direction. All I can say for myself is that my heart is in the cause, and that the views herein set forth are, so far as I am able to judge, founded on practice as well as science.

Humbly, yet hopefully, I look to my profession xii

PREFACE.

and its many ardent workers to develop more clearly any doubtful points. Confidently and brightly I look to the time when the benevolent public will, by extended and continuous experiment, consolidate our work, and all by common consent carry out our Heavenly Master's injunctions, when He said, " It is not the wish of your Heavenly Father that even one of these little ones should perish ! "

52, Montague Squake, May, 1863.

PKEFACE TO THE FIKST EDITION.

The influence of injudicious feeding upon infantile disease and mortality has occupied my attention for some years. Accordingly several of the divisions of the subject, now given collectively, have from time to time appeared as separate papers in the medical periodicals. They are put forth in a more connected form — it is hoped also in a more matured shape. Like most other subjects, however, the question has grown under consideration, and this must be my excuse for the length to which these remarks have been necessarily extended. Possessing, moreover, a strong affection for little children, and for this reason much interested in the well-being of mothers to whom they are naturally confided, I have wished to develop the subject in its double phase. In the hope of effecting this, I have xiv

PREFACE.

spared no pains in the investigation, and have given myself heartily to the work. I may also say that I have not intentionally allowed myself to be biassed by preconceived opinions : I have honestly sought out trnth ; in proof of which I may add, that many of the results obtained have taken me by surprise. I was not prepared for them.

I could scarcely have supposed that the ignorance of the masses of the proper manner of feeding infants was so great — that the constituted authorities in the realm could permit so much dishonesty in those who have to provide food for infants ; still less that the whole question was so intimately connected with the development of much social evil and moral crime ; yet beneath the careless sanction of the community these are gradually yet certainly attaining alarming proportions. Fortunately for me, the public have begun themselves to see the danger. Mothers in high position are exerting themselves to remove this ignorance. Already the Ladies' Sanitary Association has done good service. If the Government be slow in carrying out the work of reformation, those high in authority and con-

PREFACE.

XV nected with it, united in sanitary associations, are bestirring themselves to stem the torrent, and preparing the ground for future legislation.

The medical profession and the clergy, always foremost in works of charity, are heartily cooperating in the work. This is a cheering aspect. Ere long we may hope to see this land, blessed with so much spiritual and general knowledge, also stand pre-eminent for sanitary improvement in this direction. "We may soon see the movement ripening, to the salvation of many lives now annually sacrificed before the shrines of ignorance and vice. For myself, I pretend to no knowledge superior to that of my compeers, but I have some zeal to acquire it ; and it is impossible for even an ordinary mind to look closely on any subject without obtaining from the very application some useful information.

In the wish to follow in the public wake, and to communicate the lessons I have learnt, I have been led to publish my views. In doing this I may have erred in two ways. Perhaps my style is not so popular as some have wished ; still I trust the majority will understand my meaning. Others, on the other hand, perhaps think I have xvl

PREFACE.

spoken too plainly ; but on so important a social question to speak too scrupulously from a mock attempt at prudery, would be puerile. I have a higher game to play than merely to court the popularity of the fastidious. In either case my fault will only tend to bring out, by the clashing of different opinions, that which I should scorn to obscure — the plain, incontrovertible truth. Notwithstanding, to contribute in any way towards the elucidation of so complicated a question, or to assist in the smallest degree in unravelling laws, which in their future development may insure public weal, is in either case a difficult task ; but, from the magnitude of the good hoped for, it becomes a pleasing duty to the active philanthropist.

52, Montague Square, June, 1860.

Contents

FAGK

Iktroduction . 1

PAET I.

Chapter I

General Division of Causes of Mortality and Viability. — Classes of Disease.- — General Comparison of these, showing the great Influence of Diseases which may be produced by Injudicious Food and Defective Hygiene .... 8

Chapter II

Conditions which favour Mortality. — First, Nature of Food, particularly — Want of Breast-Milk — Results obtained in London — Foundling and Parisian Hospitals — Late diminution of Mortality in France — Evidence from Facts and Figures that other Causes are in operation — Calculation on Registrar- General's Return for England and London . 14

CHAPTER m.

Mortality dependent on Nature of Food, continued. — Hand-feeding as practised by the mass of population. — Conclusions in favour of Breast-milk from Drs. Merei and Whitehead's Tables — From Brighton Cases. — Breast-milk from a Mother generally agrees better than from a Stranger — Chateauneuf's Experience — Foundling Hospital. — Private Cases. — A Mother's Breast-milk, however, occasionally disagrees 24 xviii

CONTENTS.

Chapter IV. Pagb

Mortality in connection with Defective Hygiene. — Influence of Hospital Atmosphere and Close Habitations. — Remarkable Exception of Ireland. — Greater Mortality in Towns for Infants — England — Ireland — French Foundlings. — Fearful Effects of Exposure. — France and England. — Influence of Removal — Of Abuse of Recumbent Position. — Violent Deaths among Infants 34

CHAPTER, V.

On some peculiar Physiological Relations which Influence the Mortality of Infants. — Mortality greater in early periods both for Foundlings and Children in a General Population. — Season. — Influence varies with Locality in Public Institutions as compared with Private Residences. — The Mortality is greater for Male Children than for Females 54

CHAPTER, VI.

Conditions which favour Viability.' — Tables of Viability up to Five Years. — Positive Influence of Breast-Milk, despite Injurious Hand-Feeding combined, proved by Foundling Hospital Returns. — Case of Wales. — Positive Beneficial Influence of Light, if not too stimulating. — Of some Colours 73

CHAPTER VII.

Conditions affecting Viability, continued — General Remarks on the Characters of Food — It should be Animal for a Young Infant, and supplied by the Parent, as proved by Analogy among Animals and the Anatomy of Infants — The Food should be given to a Child in semi-erect position, and Warmth required by an Infant 84

CONTENTS.

xix

PAET IT.

Chapter I. Pagb

Lactation. — Quantity of Milk normally Secreted. — Three kinds of Wet-Nurses : — First, the Healthy Nurse ; second, a Nurse affected with Galactorrhoea ; third, a Nurse affected with Defective Lactation. — Also Three Varieties 100

Chapter II

Disadvantages to a Healthy Woman if she does not Nurse. — Sore Breasts — Nipples. — Development of Cancer, or other Uterine Diseases. — A Diseased Oif spring . . . .115

CHAPTER, III.

Causes and Treatment of Galactorrhoea. — Causes : A peculiar Temperament — A Menorrhagic Tendency — Patients who suffer from Breast Symptoms duriog the Catamenia — Suppression of some Habitual Excretion — Over- Suckling — Hypertrophy of Breasts — Treatment : Dietetic ; Medicinal ; Iodide of Potassium ; Belladonna ; Colchicum ; Iron — Other Remedies 122

Chapter IV

Defective Lactation. — Causes — Age : Atrophy of Breasts : Obesity of Mamma : Insufficient Use of Organ : Bad Air: Torpor of Organ : Influence of Terror : Malformation. — Treatment — 1. Mechanical : Suction : Electricity : Becquerel, Althaus, and Skinner. — Conjugal Life to be maintained.— 2. Hygienic. — 3. Dietetic: Animal Soups, Vegetable Aliments, Galactagogue Drinks, Beer, Wine, etc. . 144

Chapter V

Medicinal Treatment. — Remedies : — Laver — Borage — Lettuce — Sow - Thistle — Rocket — Castor - Oil Leaves — Tapioca — Partridge Berry — Cytisus — Milk-Weed — Mallow — Gith — Pulsatilla — Common Salt — Crystal — Sakeik — Fesire — Iron and Cod-Liver Oil 182

XX

CONTENTS.

Chapter VI. Pagb

Circumstances under which a Mother should not Suckle. — Specific Disease in the Mother — When the Mother's Milk disagrees — When the Mother can only Suckle with One Breast — When the Milk in both Breasts is Diseased — In Exhaustion from Hyperlactation — Sore Nipples . . . 214

Chapter VII

Reasons which Influence Selection of a Wet-Nurse from among Fallen Women — Benevolent and Selfish. — Difficulties of Selection — Injurious Influence on a Household — It is an Incentive to Crime — Workhouse Experience — It is an Encouragement to Infanticide. — Returns. — Mr. Acton. — Registrar-General. — Danger from Substitution of a Wet- Nurse for the Child's Mother — Danger from Nurse's Misconduct 225

Chapter VIII

The Physical Qualifications of a Wet -Nurse to be Selected — 1. Should have Good Milk : Characters of good Human Milk — 2. Hereditary Predisposition Good — 3. Age not to exceed 30. — 4. Near the Age of Milk of Mother — 5. Melancholic Temperament — 6. Milk in Sufficient Quantity . . 253

Chapter I

ON SOME GENEBAL DEDUCTIONS IN EEFEEENCE TO ALIMENTATION MADE FBOM THE COMPOSITION OF MILK AND ITS SUBSTITUTES .

Saline Ingredients of Milk. — Phosphate and Carbonate of Lime — Uses. — Phosphate of Soda. — Phosphoric Acid. — Important Relations of Chloride of Potassium . . . 270

CONTENTS.

xxi

Chapter II

Of the various kinds of Animal Milks to be substituted for Human Milk. — Composition of Human Milk at different Ages. — Ass's Milk. — Goat's Milk. — Cow's Milk. — Difference of Milk, Town and Country, Summer and Winter, Morning and Evening. — Results of various Foods on its Composition 293

Chapter III. On Some Of The Objections To The Use Op Animal Miles

Ass's Milk : Excess of Sugar and Salts. — Goat's Milk : Advantages from its Employment. — Cow's Milk : Difficulties in its Employment — Adulteration chiefly with Water — Acidity. — Meyer's Experiments. — Unhealthy Sheds for Cows. — Revolting Filthiness of some in London. — Necessity for Parliamentary Interference 307

Chapter IV

Of other Animal Substitutes — Cream — Desiccated Milks: Moore's and Grimsdale's — Eggs — Bone Soups and Jellies — Beef-Teas — Sweetbread-Tea — Raw Meat — Caution in Employment of latter 327

Chapter V

Mode of Correction of Impure Milks, and of Preparation of Artificial Milks to resemble Human Milk .... 350

Chapter VI

Vegetable Substitutes for Human Milk —Inferiority of the Vegetable as Aliment. — Indigestibility of Starch. — Injurious Qualities of Arrowroot — Of White Bread. — Objections to White Bread Pap — Generally contains Alum, and no Chloride of Potassium — An Insufficiency of Phosphoric Acid. — Advantages of Aerated Bread — Is Rich in Cerealin. —Adulteration of Flour.— Good Effects of Tea.— Period when a Child should take Vegetable Food .... 360 xxii

CONTENTS.

Chapter VII. Page

Vegetable Substitutes for Milk — Lentil Powder or Revalenta — Baked Flour — Mrs. Wells' Vegeto - Animal Food, — Nestle' s Milk Food. — Liebig's Malt Extract Food — Dr. Hawaii's views of it. — Dr Hassall's Milk Food. — Yorkshire Food. — Tea. — Cocoa. — "When Vegetable Food should be given .378

Chapter VIII

On the Method of bringing up Children by Hand. — Advantage of allowing Children to Suckle Animals directly — The Volatile Principles of Milk are thus not lost. — Difficulties in Conveying Milk. — Error in our Foundling Hospitals . 399

Chapter I

General Remarks on Prevalence of Abdominal Diseases. — Defective Assimilation. — Forms of Disease — Three Stages — Malignant Variety — Post-mortem Appearances — Nature of the Disease. — Principles of Treatment. — The Dietetic Means of ensuring Digestion of Nitrogenous, Fatty, and Saccharine Aliments — Need of Pancreatic Juice. — Vegetable Aliments. — Mineral Aliments.' — Water ; Lime Water. — Advantages from the Combination of Milks — Precautions necessary in Using. — India-Rubber Nipples — Advantages of Using for a time other Animal Milks . . . .411

Chapter II

Dietetic Treatment, continued. — Of the Nature of Aliments to be given, and the Mode of their Administration. — Cow's Milk, adjuncts to. — Necessity of Using Test-paper. — How some kinds of Diarrhoea which supervene are to be Treated. — The Exhibition of Soups. — Raw Meat. — Dr. Leveret's Cases. — Examples occurring in Dr. Morris's Practice. — Analogous Experiments with Adults. — Underdone Meat. — Cases. — Vegetable Remedies to be Conjoined. — Frequency of Feeding 446

CONTENTS.

Chapter III. Page

Hygienic and Preventive Treatment of Defective Assimilation in the Appointments of a well-regulated Nursery. — Extent and Ventilation of a Nursery. — Cleanliness of a Nursery. — Impropriety of keeping Dirty Liaen in them. — Temperature. — Curtains. — Ablutions. — Warmth of Water and Variety of Soaps. — Exercise, Clothing, Perambulators. — Early Rising and Going to Bed. — External Light. — Cleanliness of Wet-Nurse 468

Chapter IV

On the Medicinal Treatment of Defective Assimilation. — Carminatives, Purgatives, Cod- Liver Oil. — In the Diarrhoea, Nitrate of Silver and Sulphate of Copper — Opium. — Febrile Excitement best quieted by Inunctions — Rationale of their Operation. — Nutritive Injections. — Aphthae, Malignant Variety. — Treatment. — Conclusion .... 484

Appendix A 503

Introduction

" A child in a house is a wellspring of pleasure." So said Tupper, and he spoke truly. The mother has suffered in her travail, and the husband has grieved over his wife's sufferings. But even in her weakness it is an unalloyed pleasure to gaze on the little babe that sleeps by her side. First, helpless to a degree, it commends itself to her protection ; and gradually, as the stream of life acquires power, new feelings of love expand her maternal heart. Soon the infant by a smile rewards the fondling look, and by its little exclamations of pleasure makes her rejoice also. A part of herself, so long as it continues a suckling, it is first loved by those who love her, or by those who see in the little innocent the image of their own present or expected babes. And thus it

B

INTRODUCTION.

grows daily, and daily by more distinct childish prattle gives evidence of opening intelligence ; it enlivens all around, and, twining itself round the hearts even of the sterner sex, it is loved by all who know it for itself.

How different the picture when illness creeps in ! How sad the looks are now of those who loved it : the little babe in itself, how changed in aspect ! It is sorrowful to behold its now haggard, now excited, restless look, and to hear its pitiful moan. The wellspring of pleasure has become an occasion of grief and despondency, and who knows how soon, like the blighted floweret, it may droop beyond recovery ? The mother still tends upon it with unceasing love ; self is forgotten in watching over the tender one, but "who can tell whether God will be gracious to the child that it may live?"

It is laid down by Quetelet that a tenth of the children born die in the first month after birth, and one quarter before the year is completed. This is a fearful fact to contemplate, and one well calculated to alarm parents. In England, in 1872, there were 825,907 births. The number of children that died under one year old was 123,596, so that there was 1 death out of every 6 births ; while in London there were 118,440 births, and 18,740 deaths of children under one — i.e., 1 in 6. In the ( Jity of London, the mortality is fixed at a higher

INTRODUCTION.

rate by Dr. Letheby.* " Twenty per cent., or just a fifth, of all the deaths in the year were among infants of less than a twelvemonth old. In the eastern union, the proportion was much larger ; it amounted to one-fourth of all the deaths. If these facts are examined from another point of view, it will be seen that in the eastern and western divisions of the City about 1 in 5 of all the children born die before they are a year old ; whereas in the central division of the City the proportion is only 1 in 7. The first of these numbers is greatly above the average in the country, and the second is below it. Again, nearly 41 per cent, of all the deaths were among children of less than five years old, and as children up to this age constitute about one-tenth part of the population of the City, it is manifest that they die at the rate of about 10 per cent, instead of rather less than 7 per cent., which is the average for the whole county. In fact, in the eastern division of the City, the proportion is rather more than 11 per cent., and in the western nearly 14. It is this large mortality of children which swells the death-rate."

In 1876 the account given is more terrible still for some places ; for " turning to the great manufacturing districts of the North, we are startled at the extravagant cost at which the battle of life is

INTRODUCTION.

fought and won. It is, for instance, absolutely shocking to read that in the East Eiding of Yorkshire more than one quarter of the infants born die under one year of age. In Leicester the case is still worse, more than 4 infants in every 10 being thus swept off in the first few months of their existence ; " while the case is far more terrible for France. M. Bertillon has shown that a child just born has less chance of living one week than a man of ninety, and less chance of living one year than an octogenarian. In France more than onefifth of infants (21*7 per cent.) die by the end of the first year. Of the 54,000 born annually at Paris, the half die ere they reach four years, and if we include infants sent out to nurse, half die before the year is over. Among the • lasses in circumstances of poverty, the mortality is 75 to 80 per cent. (Lacassaque, Annates < T Hygiene, 1876.)

Now is this mortality a necessary evil ? I 1 >elieve not ; and it shall be my endeavour to prove that it arises in great measure from preventable causes, and the improper manner in which children, speaking more especially in reference to food, are 1 nought up. Man, it is true, is born to sorrow as the sparks fly upward ; but many of these sorrows are of his own creation.

To prevent by any means the great infant mortality in these realms is a work well worthy of a

INTRODUCTION, philanthropist. The first step is necessarily to obtain statistics upon which we can reasonably argue, and from which we may deduce the vital laws which regulate and control this mortality. Unfortunately, however, although there is an outcry everywhere against red tape and routine, yet both are still very prevalent among ourselves and our medical institutions. Most of the latter, except a few which stand out in honourable contrast, do not give us the benefit of their experience ; and thus it is that, in England, much information which, if regularly published, might lead to a just comprehension of many difficult questions in science and in medicine, is lost to the world. The subject of this work is in this category. The books and pamphlets that have been written on it are legion. De Watte ville enumerates a hundred and thirty ; yet all this foreign and British experience lias, after all, effected but little practical good.

To what cause is this failure due ? Chiefly to a very general, if not universal, influence. It is a fault with many authors, first, to take up peculiar theories, and then upon these to work out their facts. The direction of these theories is guided by the fashion of the day, or the popularity of particular schools ; and thus, as a great variety exists in these influences in different places and at different times, we seldom have data given in one

INTRODUCTION.

country in such a form as to admit of comparison with those of another. The facts are good, but worked out in a different way, or in a sectarian manner; and so those great truths, which as belonging to the one family of man, should be applicable to all nations, can only be imperfectly deduced — occasionally only glanced at. In other words, we have, as it were, a host of weights, but we possess no means of reducing them to a common scale. True, the Eegistrar-General's statistics of England are invaluable ; but in many points they cannot be compared with those analogous tables which set forth the experience of Europe. Even England, Scotland, and Ireland, in this respect, have no common language.

From sheer necessity, therefore, I have been compelled chiefly to use French returns, although of course wishing to make them bear almost exclusively on England and Ireland. Upon this point, however, I wish to say, and that explicitly, for I have been already misunderstood and misrepresented, that from the very nature of the data used, strict exactitude in the figures given is not to be expected. At most, I can only bring out results which shall be true relatively ; and this I hope I have done. Stating this much as a caution — I am bound, however, to add that, in many cases, my conclusions may be also true absolutely. Vital statistics, in the present day, are found to be

INTRODUCTION.

governed generally by the same common laws ; and, although the actual figure of percentage does occasionally vary to a small degree, the difference is not by any means so great as it may at first appear, even where the populations of different countries are taken. Hence it is often allowable to deduce from data which we do not possess for our own country, conclusions which, nevertheless, are perfectly true when applied to ourselves. Take, for instance, Paris and London. The mortality may vary by one or two per cent., but, nevertheless, it is still governed in the two cities by the same general laws.

With these few remarks, necessary as an introduction, I proceed at once to the consideration of my subject.

Chapter I

GENERAL DIVISION OF CAUSES OF MORTALITY AND VIABILITY — CLASSES OF DISEASE — GENERAL COMPARISON OF THESE, SHOW- ING THE GREAT INFLUENCE OF DISEASES WHICH MAY BE PRODUCED BY INJUDICIOUS FOOD AND DEFECTIVE HYGIENE.

In the present inquiry I propose in a first part to consider the causes of mortality and viability of infants. In a second, the subject of wet nur singin its physiological as well as social relations. In a third, the general principles and practice of alimentation ; and in a last and concluding part, the symptoms and the treatment, dietetic and hygienic, and medical, of such diseases as are likely to shorten life or impair their well-being through defective assimilation.

The causes of mortality among infants may, in the first place, be considered under three heads : First, the actual mortality which prevails in a general population and taken as a whole among infants and young children. Secondly. The

CLASSES OF DISEASE.

especial conditions which favour the increase of this mortality. Thirdly. Those which, on the contrary, favour the viability of children.

First, then, what is the actual mortality of infant population ?

Under the able direction of Dr. Farre, the Registrar-General, a series of tables has been devised in which the causes of death are so tabulated and classified as to admit of their being readily understood. These diseases are —

1st. Zymotic, or diseases which are either epidemic, endemic, or contagious, induced by some specific body, or by want, or the bad quality of food.

2nd. Constitutional sporadic diseases affecting several organs in which new morbid products are often deposited, sometimes hereditary.

3rd. Local sporadic diseases, in which the functions of particular organs or systems are disturbed or obliterated, with or without inflammation, sometimes hereditary.

4th. Developmental special diseases, the incidental result of the formative, reproductive, and nutritive processes.