A British Medical Association Lecture on the RELATION OF EARLY MISTAKES IN INFANT FEEDING TO THE DYSPEPSIAS OF LATER INFANCY AND CHILDHOOD
Authors: E. Pritchard
Journal: BMJ (1929)

professor of lpae(liatries at the University of Lausanne, gave a ver-initerestingaddress on the same subject as that wlich I have clhosen for this lecture-that is to sav, " The dyspepsias of childhood."Professor Taillens claimed that these dyspepsias often took a miiisleading form and produced symptoms of general weakness, wasting, pyrexia, anid even coughing, wlhich vere fr-equenitly mistaken for those of tuber culosis.He further stated that gastric hypercihloracidity, or, as we usually call it, hyperchlorhydnria, was the m11ost frequent cause of these dyspepsias.Owing to the limitationi of time, Professor Taillens did niot explain exactly lhow hIyperchlorhydiria developed inlto the above group of symptoms, and although I agree witlh him that hyperchlorhydria may ultimately pr-oduce suclh results, I am nlot sure that I should agi-ee withl him as regar-ds the explanation.His address, however, created so mucht interest that I thought that the same subject might it-ell for-m the basis of this lecture.If hyperellorhydria, or the excessive secretion of lhydro- chloric acid in the stomiach, is accompanied by a corre- sponding supply of pepsin, there must be a gieat capacity for digestinig protein, anid, as a matter of fact, there is usually in cases of lhyperchlorhydria a considerable appetite or craving for nitrogenous foods.Individuals who are the subjects of suich gastric hypel-acidity do not, as far as my expelrience goes, suffer at first fi-om any of tile recog- nized symptoms of dyspepsia.They are usually at least during tile early years of life, individuals Nith a healthy appetite.Thiey elnjoy their food, are impatient for their meals, anid appear to, be well niouirislhed.They sometimes feel a so-calledl " sinking of the stomach " if tlheir Ci-avings for food are not immeliately satisfied, buit thlese dliscomforts pass off rapidly after a meal.Such inidividuals deserve to be regarded as " cupeptics " atiher than dyspeptics.None the less, if these individuals, as they grow oldler, continue with full meals, they begin to lave epigastiic pain about two hours after food-a pr emonitioni of duodenal ulcer.Similarlv, infants and quite youlng children with various degrees of hyperchlorhydria do not suffer from ordinary dyspeptic symptoms, but they do suffer fioml pei-iodic attacks whichl, according to my own interpretation, depend on a disturbance of liver function.Among the several functions whiclh the liver performs, one of the clhief is the de-aminization of amino-acids, and their conversioni into urea or ammonia.There is a limit to the toleran-ce of all organs with respect to each of their functions, and when these limits of tolerance are overstepped they will show signs of fatigue and cause the development of various sym- ptoms which are the direct result of such breakdowns; the liver is no exception to this rule-with overw-ork its power to de-aminize amino-acids begins to wane.Now with hyperchlorhlydria there are stronig inducements to consume excessive quantities of proteini foods, wlhichl, if indulged, will impose on the liver the duty of de-ailiinizilg very large quantities of amino-acids.The result is easy to predict.When hepatic function fails and the de- aminizing process is feebly conducted, it follows that the amino-acids in *an unchanged condition will gain access to thie systemlic circulation.Ill a very illteresting paper2 contributed by Dr.