(1) "Wasting" is common amongst poor-class infants.
The careful management of pregnancy, labour, the early days of
infancy, and of breast feeding, is a factor of vast importance
in prophylaxis.
(2) The main cause - unsuitable feeding - is preventable
by lay and medical education.
(3) It is essential to diagnose between a "functional"
and an "organic dyspepsia ", since wasting may result from a considerable number of organic conditions.
(4) Persistence in unsuitable feeding leads to "dyspepsia ",
which form a large group of infantile "upsets ", and which is a frequent cause of wasting.
The causation, pathology and treatment of "dyspepsia"
(including "summer diarrhoea ") are discussed.
(5) Congenital pyloric stenosis is not a rare condition
and should be constantly born in mind. The age and general
condition of the infant, and the length and type of history, vary
very considerably. Visible gastric peristalsis occurs to a slight extent, in certain other, less common conditions.
(6) "Pink disease" - the cause as yet unknown - may lead
to a considerable degree of wasting, even in the breast fed.
The diagnosis is usually easy.
(7) In childhood, there is a very important interdependence
between the absorption and utilization of fat,
calcium and phosphorus. Thomson considers the three main causes
of wasting to be:- inanition,
fat dyspepsia,
parental infection;
even in the second of these however, namely cases in which there
is a reduced tolerance to fat as shown by the passage of large
crumbly and pale motions (the "mìlehnáhrschaden" of Czerny, and
Finkelstein's "bilanz.storung "), the digestion and absorption
of fat are quite normal.
(8) Fat splitting and absorption is normal in infantile
atrophy and in pyloric stenosis; but in atrophy, fat indigestion
occurs under two conditions: - (a) if diarrhoea develops, and
(b) with the use of the high fat content
dried milks.
(9) Starvation is a frequent cause of wasting and the
"mehlr_áhrschaden "of Czerny and Keller is due rather to a deficiency of protein, vitamines and minerals, than to an excess
of carbohydrate. Such defieiency syndromes may be superadded
to the picture of malnutrition.
(10) The effects of a high protein intake are little
to be feared.
(11) The presence of infection is an important factor
in reducing the carbohydrate tolerance.
(12) It is suggested that the estimation of the urinary
creatinine of wasted infants, would, by indicating the extent of
tissue breakdown, at least be of assistance in prognosis.
(13) In infantile atrophy, no characteristic lesions are found post -mortem, even in the most severe cases.
(14) Animals vary greatly in their susceptibility to
the various vitamin deficiencies, a fact which necessitates the
very cautious interpretation of animal experiments in relation
to human. disease.
(15) In some animals, the health of the gastro -intestinal
tract depends upon the presence of accessory food factors in the
diet.
(16) The thyroid gland is very sensitive to food conditions,
and especially so in early life.
(17) The pathology of idiopathic oedema is uncertain,
but the condition requires thorough dietetic treatment.
(18) The important and common "nutritional anaemia" of
infancy, is preventable.
(19) A slight degree of vitamin A. deficiency is not
uncommon in poor children. LIilk is a poor source of A. and D,
and supplementary dosage of these vitamins is necessary in
infancy, especially at the time of weaning.
(20) Egg yolk is the only known foodstuff containing
anti- rachitic power, to any extent.
(21) Some workers are investigating the possibility of
a relationship between the phenomena associated with rickets,
malignant disease, and sex activity.
(22) Vitamin D. prevents tetany, as it prevents Rickets;
it also promotes perfect tooth formation.
(23) Several important points regarding the etiology
and pathogenesis of Pellagra, remain obscure. The conception
of the presence of "toxamins" in the normal basic foodstuffs
should be thoroughly tested or abandoned.
(24) Certain factors in acidosis and alkalosis are discussed. The pathogenesis of "cyclical vomiting" is still
obscure. Ketosis is, in all probability, not the cause.
(25) Of 146 infants below 1 year of age admitted to the
Sheffield Childrens' Hospital from 1.2.34. to 1.6.34, 91 were
"medical" cases. Of these 91, 41 were "dyspeptic ", and 11 had
congenital pyloric stenosis (including twin brothers). These
two groups are discussed in greater detail.
(26) The importance to the infant, of an adequate diet
for the mother, and instruction and perseverance in breastfeeding,
is obvious, but neglected. Only thus is the subject
of artificial feeding one of the most important in the whole
field of therapeutics.
(27) The great benefits of special dietaries (including
the administration of vitamin preparations) will be more
extensively enjoyed when time and intensive teaching increases
the faith in them.
(28) Factors in the failure of breast -feeding are discussed.
(29) Every hand fed baby should be raised, as quickly as
is compatible with its digestion, to a diet of full (boiled or pasteurised) cow's milk, with an added one ounce of sugar daily.
The majority consider that full milk should be reached by three
months of age; others consider this too strong for those below
nine months of age.
(30) The more digestible modifications required by
special cases (especially in wasting and in prematurity) are
discussed. The dried milks ( "h ìf- cream"), which cost a little more than fresh milk, are acceptedly the next choice.
(31) "Partial vitamin deficiency" is no vague theory and
the employment of the vitamins (especially in infancy) abounds with
practical applications, which are of vital value to the practitioner,
but which are by no means fully realised. The fault of this lies
partly in the mal- organisation of society.
