A very interesting article by Dr. Prospero Sonsino, of Pisa, in the September, 1872, number of the "Practitioner," "On the Physiological Dyspepsia for Starchy Food in Infancy," revives an intention, from which I have been diverted by other occupations, of publishing a few words on an allied subject.

I propose to speak of the class of cases constituting that wretched form of "atrophy and debility" and " marasmus" in children, in which every part of the body wastes away except the abdomen; the state described by Dr. Druitt, in the last edition of his "Vade Mecum," in the following few and graphic words: - Emaciation and voracity; the belly swelled and hard; the skin dry and harsh; the eyes red; the tongue strawberry-coloured; the breath foul; the stools clay-coloured and offensive, sometimes costive, sometimes extremely relaxed; the patient usually dies hectic."

I wish to bring prominently forward the fact that this state, provided there is no advanced lung disease, is rapidly cured by Pancreatic Emulsion given in doses of a teaspoonful every four hours, and regularly persisted in till fat and flesh are restored. It is, of course, necessary that a proper diet should be insisted on at the same time; but proper diet without the Pancreatic Emulsion will not do. This I have found over and over again in cases where everything judicious in the way of feeding and cod liver oil had been carefully and perseveringly tried without avail, but which, on the addition of the Emulsion to the previous diet, began at once to improve.

This fact has been familiar to me for a long time; and considering how largely Pancreatic Emulsion is now used in the wasting diseases of adults, I am surprised to find that it is not even referred to in the latest works (1875) on the diseases of children. Looking through these works and examining their indexes, one is led to the conclusion that their authors are not aware that there is such an organ as the pancreas, or that pancreatic juice has ever been used in any form in the treatment of disease. Yet scarcely a week now passes but some general practitioner relates to me cases of the successful use in his own practice of Pancreatic Emulsion in the wasting of delicate children.

Dr. Prospero Sonsino's paper will, I hope, excite more general attention to this important subject. He, however, has laid all the stress of his observations upon the influence of the salivary and pancreatic juices on the digestion of starch. This is unquestionably a point of the greatest importance in the case of very young children brought up by hand, as showing the absurdity of attempting to nourish them upon starchy food, not artificially digested, before the period of life at which the saliva and pancreatic juice attain their functional activity. And even then, as Dr. Sonsino afterwards remarks, " good reasons make us now believe that really it is not proper to feed infants with copious starchy matters, however these may be rendered digestible." The principal results of Dr. Sonsino's investigations are summed up in the two following conclusions, which, however, are not new: - 1. "Pancreatic juice in dogs, cats and rabbits, in the first week of life - perhaps for some days more - -is devoid of any digestive action on starch." 2. "In the early life of man, probably till the beginning of dentition, infants offer a true physiological dyspepsia for starchy aliments, caused by the inactivity of one at least - possibly of all - the humours that concur in the digestion of those aliments" (saliva, gastric juice, pancreatic juice, enteric juice).

No doubt, when wasting occurs in these early periods of life, it is very often due to foolish attempts to nourish children upon farinaceous foods, by which dyspepsia and diarrhoea add to the exhaustion of partial assimilative-starvation. But, as a matter of fact, farinaceous food is seldom depended upon without some addition of cow's milk, or some assistance from lactation; and we see children suffer from wasting who are fed entirely upon cow's milk, or nursed by their mothers, and in such cases the "physiological dyspepsia for starchy food" will not account for their decline. Therefore we must not forget, that although normal saliva only acts upon starch, normal pancreatic juice acts also upon fats; and it is probable that these two functions of the pancreas are sufficiently independent of each other that they may exist separately. This I pointed out in my paper to the Royal Society in 1868, "On the Special Action of the Pancreas on Fat and Starch." (See Appendix.) It is there stated as the results of my experiments, that "in addition to the influence of the pancreas upon fat, it has the power of converting starch into glucose by simple mixture. This property remains to a certain extent after the pancreas has exhausted its property of acting upon fat The quantity of pancreas which before mixture with fat will convert about eight parts of starch into glucose, after saturation with fat will still convert about two parts of starch into glucose." It is possible, therefore, that in different states of depraved health, one or other of these properties of the pancreatic juice - that for the digestion of starch, or that for the digestion of fat - may be deficient. And thus the depraved nutrition due to such deficiency will not be limited to the period of life anterior to that at which, under normal conditions, the proper functions of the pancreas should be developed. It is evident that when the power of digesting fat fails to be developed at its proper time, the defect must tell with double force upon children already suffering from deficient digestion of starch.

The children who become the subjects of the kind of wasting of which I am now treating are especially: (1) those who are suckled by mothers whose milk, though abundant in quantity, is extremely deficient in nutritive properties; (2) those who are brought up by hand; and (3) those who, at a later period of childhood, have been subjected to similar chronic defects in diet. Now, it is especially when the mother's milk is poor in fat and lactin that the child becomes "dissatisfied" and "craving," and in the majority of cases it is this which leads to the introduction of farinaceous food, under the popular nursery belief that it is "satisfying;" and, as Dr. Sonsino states, if this is given before the power of digesting starch is established, of course nothing but mischief can result.