Many children are brought to the physician showing marked pallor of the skin; their muscles are flabby, and they perspire easily. Examination of the blood shows a secondary anaemia. There is imperfect metabolism of the fat, protein, and carbohydrate elements of the food. The stool frequently contains mucus, and shows an undigested condition. The weight remains stationary, or there is but slight gain during many weeks.
These infants show symptoms of a disordered nervous system; they are peevish and dissatisfied by day, and restless at night. Something is lacking, and this something must be supplied or a “deficiency disease” develops. Such condition is usually manifested by a structural weakness in which bony and muscular defect is found.
Scientists have for years claimed that scurvy was caused by abstaining from fresh vegetables, or from a too generous use of boiled or canned foods. The absence of a live factor was known theoretically. It remained for Funk and his collaborators to demonstrate experimentally that beri beri could be produced by feeding polished rice, and could be cured by feeding unpolished rice.
They further demonstrated the presence of a crystalline substance which could be isolated, and to which the name of “vitamin” was given. This vitamin when absent from food is responsible for the development of scurvy. Funk further found that when the vitamin necessary for the proper metabolism of food, and especially of carbohydrates, was absent there results therefrom a condition described by his as a “deficiency disease.”
Vitamin can be supplied to the body by giving autolyzed yeast. This has been the subject of clinical and experimental study, and was published in American Medicine, November, 1916, by Stark and Edelman.
To determine whether or no the active substance was a complicated product of a protein or phosphatide nature, Funk subjected yeast to the hydrolyzing action of 20 per cent, sulphuric acid for twenty – four hours. It is known that this concentration of acid acting for the above – mentioned length of time hydrolyzes all the ascertained existing complex products, as, for instance, proteins, polysaccharids, nuclei acids, and
lipoids. The work done by Funk in conjunction with Cooper* [*Cooper and Casimer Funk, The Lancet, May 4, 1911.] showed that yeast treated in this way possesses very nearly the full action of the original yeast. At the same time this gave a hint as to future procedure and led to the introduction of autolyzed yeast as a curative agent by Cooper+ [Cooper, Biochemical Journal, June, 1914.]
My personal experience with autolyzed yeast in liquid form and with vitaphos in dry form dates back one year. My results were published in the New York Medical Record of July 7, 1917.
The following series of cases will show the types of cases selected wherein deficiency disease of one or another form existed.
India H. was seen by me in consultation with Dr. Wrenn at the Ossining Hospital, in March, 1917. The infant was asphyxiated at birth, cyanotic, and resuscitated with the aid of a pulmotor after fifteen minutes, Forceps delivery; external traumatism slight facial palsy. Weight, 52 pounds at birth. No food was taken during the first four days; later food was refused.
When first seen the infant was emaciated, and there was marked icterus neonatorum. Temperature, 98.6* by rectum; respiration, 72. To sustain strength gavage was ordered. There was marked dulness on the right side, lower lobe, and rigidity of the extremities. The stomach was lavaged with bicarbonate of soda, 1 drachm to a pint of warm water, and the infant fed by gavage every three hours, one – half drachm of condensed milk in two ounces of water, gradually increased to 1 drachm in 3 ounces of water. One drop of adrenalin was given morning and evening. Colonic injections of saline solution were given at a temperature of 105*, two times a day.
Convulsions were present. Intracranial pressure was relieved by means of lumbar puncture, and 10 cc. of slightly opalescent spinal fluid withdrawn. The infant relaxed and convulsions ceased. The appetite improved, and the infant gained in weight about 4 to 6 ounces a week. This rate of gain continued during the summer. During the first two months skimmed milk and peptogenic milk powder were given. The feeding was then changed to whole milk, granum, dextri – maltose, and water. In conjunction with this restorative diet, 1grain of vitaphos was given three times a day. Spinach juice was given for its antiscorbutic effect. The dose of vitaphos was increased until 22 grains were given three times a day.
Liza S., born December 24, 1916, at the Lutheran Hospital of this city, weighed 4 pounds at birth, First baby, full term. Was breast – fed about four weeks; later fed on milk and barely water; still later granum was given.
When seen by me the infant had marked signs of rickets, beaded ribs, asthmatic wheezing, seborrhoea capitis, a tendency constipation, head sweating, and a bulging fontanel. The tongue protruded, and there was marked backwardness in development. A restorative diet, consisting of cereals, vegetable and fruit juices, was given. The weight increased and a general improvement was noted. Owing to the low weight at birth it was thought advisable to aid the assimilation of food by supplying vitamin in the form of autolyzed yeast. Endomycin was accordingly given in doses of 10 drops three times a day. This dose was gradually increased until the infant received 50 drops three times a day.
Owing to the rachitic condition the intestinal and other internal secretions were very sluggish, and accordingly laxatives were frequently administered. In the beginning of treatment 1 grain vitaphos powders were given twice a day, later three times a day. This was continued for two months. As the infants development increased a larger dose was given, until at six months of age 22 grains were given three times a day. In addition to stimulating the internal secretions, it had a mild laxative effect.
After several weeks of treatment a better tone was noted and the general nutrition was improved. Cod liver oil in 5 to 10 drop doses distressed the stomach, causing eructations and very loose stools. Vegetable juices acted as an excellent restorative. Spinach juice, and later, spinach pulp, was given at six months of age, also mashed carrots and baked potato. Orange juice was given for thirst. One month after this diet was begun the profuse head sweating ceased, the hard and dry scybalous stools improved, and the vomiting gradually ceased. This treatment was continued about five months.
Eleanor L., born October 24, 1916, was seen by me when five months old. She then weighed 9 pounds and to ounces. She had had colitis, jelly – like and long mucous shreds in the stool, and evidences of intestinal catarrh, such as excoriation at the anus, a slight prolapse of the rectum, and the appearance of general emaciation, due to malnutrition. The muscles were soft and flabby, and the infant was not thriving. Skimmed milk was given; later maltose was added. Six teaspoonfuls of spinach juice gradually increased to 12 teaspoonfuls was given daily. After one week spinach pulp was given and whole milk was substituted for the skimmed milk.
Baked potato and spinach pulp were alternated daily. Vitamin was supplied by giving 2 grains of vitaphos three times a day. This was continued for one month. The colitis improved after one weeks treatment. The infant gained steadily, both n appearance and weight. In June, two months after treatment was begun, the weight was fourteen pounds. Two teeth appeared at the age of seven and one – half months, and there has been a general improvement in growth since that time. The vitaphos was gradually increased until; during the third month, 5 grains were given three times a day. It was then discontinued.
Sylvia G. was referred to me by Dr. Harry Goldmann with the following history: Forceps case with convulsions soon after birth. Breast – fed eleven months and weighed at the age of thirteen months 17 pounds. Has always suffered with torpid internal secretions; always had dry scybalous stools. Cannot stand nor talk, and shows no evidence of intelligence. Is backward in both mental and physical development.
Lumbar puncture was performed and the cerebro – spinal fluid examined by Dr. Frederick E. Sondern. His report follows: The specimen consists of approximately 15 cc. clear fluid without coagulum, but containing a few small fine grayish specks believed to be debris. The cell count is within the normal limits, being 3 per cu. mm. The cysto – count shows the usual mononuclear cells of the cerebro – spinal fluid. The globulins are not increased. No organisms of any type can be found.
Because of the peculiar backwardness and the possibility of a tumor in the cella turcica, an X-ray was taken. This proved negative, but a thickened condition of the cranial bones was noted. The report of Dr. Wm. H. Stewart follows: Stereoroentgenographic examination of the head of Sylvia G., January 17, 1916, reveals a distinct abnormal thickening of the cranial bones; particularly is this noted in the vertical plate of the frontal bone and in the posterior portion of the orbital and the occipital.
Upon examination of the roentgenograms it can be readily appreciated how a definite interference with the normal expansion is present. It is this, I think, which gives the peculiar form to the childs head.
The ophthalmoscopic examination showed a pallor of both optic nerves, the fundi otherwise normal.
Lecithin was ordered, one drachm of Fair childs solution given three times a day. This was continued for over two months with no apparent improvement. One grain of thyroid extract with one – half grain of the pituitary extract was given for the following three months with decided advantage. The stool became more regular and the scybalous character gradually lessened. The general condition, such as circulation, intelligence, and strength, improved. At this time the diet consisted of vegetable puree, such as baked potato, spinach, peas, and carrots.
The yolk of hard cooked eggs was given for its fat and lecithin content, and was well assimilated. Dentition, long delayed, made rapid progress; likewise the child, then at the age of three years, commenced to speak and also to walk. Vitaphos had been given in 22 grain doses three times a day with exceedingly good result. But my greatest reliance in this case has been on the persistent use of the internal secretions and the diet. The child hss been a source of considerable anxiety as the prognosis was hopeless fro the beginning, and various opinions given all agreed that nothing could be done.
Frances G., born November 27, 1916, was three months old when seen by me. Weighed 5 pounds at birth, 7 3/4 pounds when three months old. Was premature five weeks. Had had alternate feedings of breast milk and Nestles food. The infant was restless, had head sweating, and greenish stools containing mucus and occasionally yellowish – white casein particles. The circulation was stagnant; arms, legs, and face markedly oedematous. The urine contained albumin and traces of sugar. Nestles food was discontinued, and in its place skimmed milk 2 ounces, maltose 1 drachm, and water 3 ounces was given alternating with the breast.
The substitute feeding improved the stools and satisfied the infant, but did not increase the weight. Autolyzed yeast (endomycin) was ordered, 10 drops were given three times a day. This was continued, in all, about five weeks. The infant appeared brighter and gained in weight. The food was increased 2 ounce more very two weeks until 4 ounces of skimmed milk, 2 ounces of water, and 12 drachms of maltose were given. At six months the infant was weaned, and whole milk substituted for skimmed milk in the formula. The faulty metabolism of both fat and protein seemed to improve after two weeks of the Autolyzed yeast treatment; likewise the gain in weight was steady, the stools became more homogeneous, and contained less mucus and fewer curds.
When we feed food deficient in vitamin, be that the human breast or cows milk, such feeding will result in structural deficiency which may remain throughout life. The earliest manifestations and symptoms to watch for are profuse sweating, restlessness, irritability, wakefulness night and day, stationary weight or slow gain, and constipation with hard, dry, scybalous stools showing imperfect digestion. In these stools fat curds and casein lumps can frequently be seen.
This class of cases if seen early and the symptoms carefully noted will rapidly improve under the influence of restoratives such as the vegetable juices, especially those containing iron, like spinach, lettuce, salad, Romaine and Swiss chard; also small doses of cod liver oil, but it must be the pure oil, undiluted, 3 to 5 drops morning and evening, gradually increased. Autolyzed yeast in liquid form, or vitaphos in tablet or powder form, is an excellent restorative.
Milk to which is added the crushed yolk of hard cooked egg, or milk to which several teaspoonfuls of baked potato is added, can be given with advantage to correct the above – named symptoms. Orange juice should be given as early as the second month if these symptoms appear. When they are neglected, then such deficiency diseases as rickets and scurvy in a susceptible body usually result.