A British Medical Association Lecture ON THE NUTRITIONAL DISTURBANCES OF INFANCY
Authors: B. Myers
Journal: BMJ (1924)

WE lhave all frequently seen infants suffering from con- stipatioin or vomiting, or botlh, yet still not very ill, and we lhave been equlally familiar, on the other hand, with children with the same symptoms.or with diarrhoea and vomiting who are gravely ill.'We have seen infants who failed to tlhrive on any food and simply wasted and died.It is these conditions into which we will inquire to-day, and see if there be now light where not so long since there was only too mulch darkness.Because neither the pathologist nor the bacteriologist in the past was able to demonstrate patlhological states or bacteriological cauises commensurate with the symptoms of these ilnfantile affections, it was ultimately left to the clinician to enunciate, after verv careful observation, certain tvpes of disturbances whichl appeared to be entities occurIing in some infants wvhich corresponded to symptoms and sig11s which w.ere known quite well in the old gastro- enteritis days, buit never properly understood as to actual causatiosi.mSillnore so the relation of the symptoms of one typo of case to another was certainly not clear.It was an immense step forward when Czerny and Finkelstein, after patient and laborious clinical observations and accurate deductions, demonstrated certain states in these sick infants, and Finkelstein finally formulated the nutri- tional or food disturbances of infancy under the four headings: (1) Disturbance of balance, (2) Dyspepsia,(3) Decomposition, and.(4) Intestinal intoxication.It now -became obvious why at necropsv onlv slight or no patho- logical changes were found after the 'very precise symptoms from which these infants had suffered, and opinion is gradually veering round, in the case of bacteriology also, to the point of view that, although doubtless of importance in the nutritional disturbances of inifancy1 it probably plays only a secondary and not a primary part.Before we can properly enter upon the subject of nutritional disturbances of infancy, as described by Finkelstein, it is necessary that we pause and remind ourselves of certain physiological and biochemical facts in order that we can more fully appreciate how errors in the digestion, absorption, and metabolism of food and the cell activity of the various tissues can cause certain symptoms and affect the infant as a whole.Milk is an ideal food and contains the percentages of protein, carbohydrate, fat, salts, and water best suited to the young of the particular species.Human and cow's milk show the following average analysis: Protein., Lactose.P Fat.IMineral Matter.Human milk ... 1.25% 6.75% 3.23% 0.23% Cow's milk ... 3.4% 4.6% 3.65% 0.7%Recent chemical analyses which I have had condu'cted rather suggest a larger percentage of protein in human milk and a variability of the fat content often showing a higher percentage.Milk also contains ferments and vitamins.The analysis of the mineral natter is gi en further on.Food is necessary for the purlpose of the maintenance of tissues and repair of waste, for the production of lheat and energy, and for growth.Food should be administered -to each infant in such quantity that corresponds to the optimum toleranice.If we exceed the maximum the infant will lose weighlt, while below the miniimum it cannot gaiii;* Delivered to the Dtudley Division on March 12tlh, 1924.Vet, if done cautiousy for a very .shortperiod it often increases the toleance.Protcin 1S the great -ody builder, and the amino-acids, formed from it during the process of digestion, have been described as the building bricks of the body.We know that protein acts best in the tissues-in the presence of carbohydrate.The child will not thrive long withoiut carbohydrate, and therefore, in its absence :from the diet, protein can provide a certain amount of