I speak of that wretched atrophy and debility and marasmus in children, in which every part of the body wastes away except the abdomen. Dr Druitt describes it in his Vade Mecum thus: “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.”

This is rapidly cured by pancreatic emulsion given in doses of a teaspoonful every four hours, and regularly persisted until fat and flesh are restored. A proper diet without the pancreatic emulsion will not do. This I have found repeatedly in cases where everything judicious in the way of feeding and cod oil had been tried without avail, but which, on the addition of the emulsion to the previous diet began at once to improve.

Pancreatic emulsion is  now widely used in the wasting diseases of adults, but is not even referred to in the latest works on the diseases of children. 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; showing that in this respect the rank and file of our professional army are in advance of some of their generals.

The results of my experiments1 on the emulsion  have shown that in addition to the influence of the pancreas upon fat, it has the power of converting starch into glucose by simple mixture.

The children who become the subjects of the kind of wasting of which I am now treating are especially:  those who are suckled by mothers whose milk, though abundant in quantity, is extremely deficient in nutritive properties; those who are brought up by hand; and those who, at a later period of childhood, have been subjected to similar chronic defects in diet. 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 first leads to the introduction of farinaceous food, under the popular nursery belief that it is “satisfying”. If this is given before the power of digesting starch is established, nothing but mischief can result.

Organs, like individuals, do not rise to the full performance of their duties unless called upon by the necessity for their activity.   A child that has been long fed upon a diet deficient in fat fails to develop the fat-digesting properties of the pancreatic secretion, and thus, when proper food is at last presented, cannot make use of it for nutrition. It is probable that it is due to this conjunction of circumstances that these wretched cases of fatal infantile wasting occur.  One might expect, a priori, that they get rapidly well when pancreatic emulsion of fat is added to their diet, for by this means they are enabled to assimilate both fat and starch.

 One of many cases

A poor woman came to the Royal Hospital for Diseases of the Chest with a child presenting the most exaggerated features of emaciation of every part, except the abdomen which was large and hard. She was very excited at having succeeded in gaining admission, and explained in great haste that all she wanted was “some pancreatic emulsion” which she had just learned could be obtained at the Royal Hospital.

She said her little girl had been in even worse state than I saw her now, and that everybody told her then it was a hopeless case. She had carried her child to her mother’s home in the West of England, where the girl appeared to be slowly dying, when a charitable visitor came in and gave her a bottle of emulsion, saying that he had seen just such a case cured by it. She gave the emulsion, and the child began to improve so wonderfully that she was able to bring her back to London, where the girl continued to mend till her bottle of emulsion was finished. At this point, the child rapidly fell back and was now nearly as bad as ever.

The child had diarrhoea, but the mother said she knew that would stop if I gave her emulsion, as it had done so before.  I did as she asked – let her have as much emulsion as she wished – and the child got absolutely well. I have seen her this year, a well-grown, plump, hearty little girl.

This woman has since had two other children, each of whom has  shown signs of marasmus like their elder sister; in one, when brought to me, the lungs presented small crepitation from end to end; but both of these children were put upon emulsion at an early stage of their wasting, and made easy recoveries.

1. Dobell. On the  special action of the pancreas on fat and starch. Proc Royal Soc No.97 1868