just thought this was Interesting
DIET AND GROWTH IN INFANTILE
By Alfred F. Hess, M. D.,
Doctor Hess had noted a gradual falling off in growth at about the seventh or eighth month in babies that had been fed on pasteurized milk, and had made an experimental study to find whether this might not be due to a lack of the elements essential for growth in this diet. Many of these infants did not show typical symptoms of scurvy, the disease being in an obscure or subacute form, which he considered the most common and the least frequently recognized. Tachycardia was, however, an early and typical symptom.
He found that growth in both length and weight was greatly affected in infants fed exclusively upon pasteurized milk, both finally ceasing. When orange juice, orange peel juice, or potato water was added to the diet, there was often a supergrowth, which continued until the normal weight and length for the infant’s age was reached, when the growth became normal. Aftei^discontinuance of this antiscorbutic food, although the infants sometimes continued to gain for’a month or two, there was a gradual flattening of the curve of growth. As soon as orange juice was again given, however, a sharp gain was manifested, showing that the babies were receiving some essential constituent of the diet that had been lacking.
Doctor Hess also found that putting these children on unpasteurized milk had the same effect as giving fruit juice with the pasteurized milk. He then investigated the effect of boiling on both milk and antiscorbutic foods, and found that orange juice and orange peel juice did not lose their antiscorbutic elements by being boiled, although milk did. He concluded that while pasteurized milk should be recommended, on account of the security that it afforded against infection, it should be considered as an incomplete food, lacking the elements essential to proper nutrition and growth. He thought it probable that this was why so many infants failed to gain at about the seventh or eighth month of life, and began to grow better as soon as fruits and vegetables were added to their dietary. He thought that during the early months of life the infant was protected by the antiscorbutic elements inherited from its mother, and recommended orange juice at the age of one month, so as to prevent the development of the scorbutic state.
The doctor admitted that there might exist a number of causes for lack of growth; insufficient food, lack of proper elements in the food, etc. He thought, however, that other elements than lack of growth were concerned in the production of infantile scurvy, and did not consider stunting and scurvy as the same; as the diet might possess growth-promoting qualities, and yet be unable to prevent the development of scurvy or afford a means of curing it.
Doctor Holt thought that Doctor Hess had
•Abstract of a paper read at the Twenty-Eighth Annual Meeting of the American Pediatric Society. Washington, D. C.? May 8-10, 1916.
proved the point that had been under discussion from time to time, whether pasteurized milk could be held responsible for scurvy. It had been his observation for several years that such was the case, and a number of instances had come under his observation during the last year to confirm his earlier position. While they all admitted the great advance which had been brought about by the introduction of pasteurized milk in securing safety in cases in which doubt existed as to the way in which the milk was produced and handled, the disadvantages of pasteurization had sometimes been denied and sometimes ignored—and, on the part of the dealers supplying pasteurized milk, disputed. Unless they who were interested in the production of good milk and certified milk made strong their disapproval of the general pasteurization of all milk, it would not be many years before they should be face to face with the fact that it was impossible to secure any but pasteurized milk. In one city in New England, the health department was about to issue an order that no milk but pasteurized should be sold in that city, regardless of the conditions of production or certification. In a number of instances, certification had been done by irresponsible persons, and was later shown to have been a fake. Physicians had been in part responsible for this; and even they, perhaps, had been negligent. He believed, however, that in the matter of pasteurized milk, they must admit that scurvy, every now and then, followed its use—and many other conditions. In some persons there was a predisposition to scurvy which they could not ignore; and while comparatively few children on pasteurized milk got scurvy, some did. When they saw groups of dealers banding themselves together to get legislation through State legislatures or health departments forbidding the sale of any but pasteurized milk, they should show that there were dangers in the use of the latter. They saw bad results from its use less frequently among the babies of poorer people, because this class gave food other than milk to their infants much earlier than had been customary among the better class of people. It had been his observation, that, while nearly all the cases of scurvy used to come from the use of proprietary foods, they now came from employing heated milk, either pasteurized or boiled. It was also his observation that the number of cases of scurvy in the community was increasing, and it was a good thing that the matter had been brought before the society ; because the number of cases was large. They had four instances in the hospital last year, cases that had been under medical treatment until there was epiphyseal separation at both knees, both shoulders, and both ankles. A vast number of the profession had not had their eyes opened to the dangers lurking in pasteurized milk, and the antiscorbutic treatment to counteract this must be begun early and continued.
The amount of orange juice necessary in these cases was a point of interest. It had been his fortune to see a case develop in the wards in a baby who was taking a good many meals a day and getting a pretty large quantity of carbohydrate food. Nevertheless, scurvy developed.
If Doctor Adams were to select an epitaph to be placed on his tombstone, it would be, “He opposed the commercial pasteurization of milk.” He had fought this, and was going to continue to fight it as long as he had breath in his body. What Doctor Holt had said, he hoped the society would back Up; i. e., that commercial pasteurization was dangerous and detrimental to the health of children. No institution should be advised to use pasteurized milk, just because some sentimental and erratic persons in the community had banded themselves together and decided that all children would be killed with tuberculosis unless their milk was pasteurized. With Doctor Hess and Doctor Holt, he had, within the last ten days, had cases in children that had been fed on the best pasteurized milk delivered in Washington city. That dairy was constantly furnishing him with work on antiscorbutic lines, yet it passed as one of the best dairies in the entire country. He could not understand why Doctor Herrman had asked if the essential antiscorbutic elements were destroyed in the cooking, they were restored by orange juice. To put the children on raw milk and let the orange juice go would settle the question. He hoped that the matter would be thoroughly discussed, and would tell them of an instance in his own experience. He was attending a patient in a certain house, and the father asked the dairyman why he had not sent raw milk, as Doctor Adams had ordered. The dairyman said he had not done so because the milk was not fit to deliver raw. That was the whole secret. It was rotten milk cooked that was being foisted on the community. He hoped that the members would come come out strongly against the commercial pasteurization of milk. He was not opposed to home pasteurization under proper supervision, but was opposed to commercial pasteurization.
Doctor Blackader wished to say one thing to emphasize the importance of this subacute phase of infantile scurvy. This winter he had two cases in which children were brought to his office at the request of the attending physician for obscure symptoms, partly nervous, and associated with defective growth. There was no sign that he could find of infantile scurvy—none of the classical signs; but he felt convinced, from the history, that these children were suffering from defective nourishment in some form. He was remarkably pleased with the rapid disappearance of all the symptoms under the use of orange juice and unpasteurized milk, at the time. It was something new to him, and he intended to bring it before the profession. He thought that it was an original observation, but he must give Doctor Hess credit for first describing this subacute form with defective vitality owing to insufficient nourishment.
Doctor Hessj in summing up, did not feel that the conclusion to be drawn from this paper was that pasteurized milk was not of any advantage. In fact, in his conclusions he prefaced his remarks by saying that it was of advantage. The conclusion to be drawn was rather that pasteurized milk was an incomplete food—that it was inadequate. If this fact was realized, and acted on, it would be a boon to pasteurized milk producers; because there would be fewer cases of scurvy after its use and better results would be obtained with this heated
milk. All that was necessary was to give with it, either orange juice or potato water. They could make potato water instead of barley water by using one spoonful of mashed potato to a pint of water. The commercial potato flour had no effect.
Everyone realized that there was a predisposition to scurvy, whether infantile or adult, in certain persons. That was realized a few years ago, when they had so much scurvy aboard ships. It was known now, also, that this was true in connection with beriberi. Some persons got beriberi and some did not, although they had been on the same food and had been to the same places. As regards infantile scurvy, the susceptibility depended partly on the amount of essential substances that the mother had and the food that she took during her pregnancy, as well as upon how long the infants were nursed. Doctor Herrman had asked how it was that boiling the orange juice did not destroy its essential substances, whereas boiling the milk did so. That was well known of various substances. A great deal depended on the medium. Certain substances would stand boiling in a watery solution (for instance, orange juice), where they would not stand boiling in a medium rich in fats and proteids, such as milk. The brain substance made from the hypophysis lost its coagulability after boiling, if undiluted; but if diluted, it would stand boiling. So it had to do with the medium in which the essential substance was.
The symptoms of scurvy were hemorrhages of the periosteum, petechial hemorrhages, hemorrhages of the gums, subperiosteal hemorrhages, hemorrhages into the muscles, enlargement of the heart, tachycardia, and the other various symptoms that he had detailed in two previous papers. The control cases, of which there were as many as those that had pasteurized milk, obtained no orange juice; yet in no instance did any of them have scurvy. When either orange juice or raw milk was given in the cases with scurvy, there was a sharp reaction in weight and in the clearing up of the symptoms. As to what was a vitamine, that was difficult to answer. Funk, who devised the term, thought that he had it isolated; but he found that it was not pure. It was a nitrogenous substance; and this was a good name, because it helped to designate the substance essential in scurvy, beriberi, pellagra, etc. He wished that Doctor Coit would come over to their institution and satisfy himself in regard to the vitality of the children there. They were institution children; but they looked as well as those in their homes. It was a model institution, and had plenty of fresh air. The weight of the children had been taken every day for six months previous to the beginning of the test. It was not as if they came to the institution just as they would to a hospital. Doctor Freeman had asked whether the speaker had tried the effect of orange juice in cases other than those on pasteurized milk. No, not especially. He could look up the charts and see what happened, but he had not made that particular test.
[Initial cleanliness and early uninterrupted refrigeration are the essentials to be insisted upon in any milk supply. Rotten milk is never made harmless by pasteurization.—Editors.]
Food and Feeding in Childhood.—Dr. J. Epstein, of New York, in the Medical Times for October, 1916, states that, beginning with the second year, the period of infancy ends, suckling or bottle feeding is over, and the active life of childhood asserts itself. The gastrointestinal tract which during infancy is in an immature state with its physiological functions of digestion not yet fully developed, is now able to digest and absorb a variety of semisolid and solid food. At this age the child usually has a number of teeth already cut through and is able to masticate the food, preparing it for the action of the digestive enzyme. As the child grows older, the articles of food suitable for its digestion multiply, and the simple, uniform, monotonous diet of infancy which consists of milk only, is now changed to a mixed diet.
I am in no way saying anything against pasteurized milk and against raw milk. I just thought this was cool. To me it also explains why we push solids on babies so soon.