The metabolism of under-nourished infants

The condition known as infantile atrophy, athrepsia or marasmus is found most frequently among babies fed entirely on artificial foods. In an analysis of 100 cases recently admitted to hospital, only 2 had been entirely breast-fed, 19 had been fed completely on artificial foods and the remainder were partially breast-fed. [Parsons (1)] J. Utheim (2) states that of 102 cases studied by her, all but one had been fed artificially. It seems probable therefore, that food may be at any rate an important factor, and that the condition may be to some extent caused by the inability of the infant to digest and absorb cow's milk or its modifications as easily as human milk. Various studies have been made during recent years on the metabolism of atrophic infants. In most records, only a few cases have been observed, and frequently over a very short period. The literature dealing with the absorption of fat is often conflicting and seems inconclusive. Few observations have been made, beyond a series of 17 cases by Utheim (ibid), on the calcium metabolism of definitely atrophic children, and the information on the metabolism of the other constituents of food is vague. Moreover, none of the available records are classified according to the kind of milk, whether ordinary whole milk modified, whole milk dried or condensed, or modified and dried. This has proved to be a very important point in the discussion. This investigation on the metabolism of atrophic infants was undertaken at the request of Dr. Leonard G. Parsons, Physician to the Children’s Hospital, Birmingham, on cases under his care. The infants selected for observation were, with 2 exceptions, under 6 months of age. Two were just 6 months and most of the others were about 3 months old. They were all less than 80% of the expected weight for their age, since Talbot (3) has shown that there is no change in the metabolism of these infants till there is a loss of 20% of the body-weight; and none of them showed other evidence of disease. Preliminary observations showed that there is considerable variation in the composition and amount of excreta from day to day; it was therefore deemed advisable to make the period of observation five days if possible. Since also it was found, as Lesage has said, "Chaque organisme a sa personalite, son coefficient de fixation", it was considered impossible to draw any definite conclusions from a few cases only. Eighty-two cases of simple atrophy and 9 cases of pyloric stenosis have been observed for fat metabolism and the metabolism of many of these for other factors also at the same time, so that the relationship between them could be established. The actual intake was rigidly ascertained by analysis and not by calculation from percentage composition of foodstuffs already published