Nutrition of mother and child

Front matter

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COPYRIGHT DEPOSEIi

Preface

During the past decade, and especially dur¬ ing the past five years, important discoveries in nutrition have been made which have revolu¬ tionized our ideas of dietetics. Constant requests from mothers, librarians, social work¬ ers and nurses for books containing these newer facts of nutrition presented in a form suitable for the laity, has led the author to feel the necessity for this volume.

The ideas here presented are not such as are advanced by faddists who, without occasion, advocate some erratic and unbalanced ration, but are facts of nutrition accepted by schools of accredited standing everywhere.

The author has personally superintended various experiments corroborating or supple¬ menting the work of others along these lines, and the results thus obtained have been success¬ fully applied in clinical practice. Emphasis has been placed upon breast feeding, vitamins, and the mineral content of the diet. In the chapters on breast feeding, nothing is included which has not been tested and proven of practical value in personal experience.

The sick child has been only casually con¬ sidered, as this volume is not intended to replace the physician in the home. In all illnesses, acute or chronic, medical advice should be sought. The purpose of the book is to teach mothers how to render their families less subject to disease.

PREFACE

As prevention is better than cure, our ideal should be the avoidance of unnecessary ills by proper diet from infancy. The author sends forth this little book with the hope that it may be of assistance to anxious mothers who are seeking to feed their families intelligently and scientifically.

As the subject matter has been designed pri¬ marily for persons without medical training, the language employed has been made as untechnical as is feasible in the presentation of scien¬ tific facts. The book has been so arranged that it may be employed by nurses and social workers for instruction of mothers in the homes, and in conducting short courses in nutrition.

For his initial interest in breast feeding and much of his knowledge of the subject, the author wishes to express his indebtedness and grati¬ tude to his friend and teacher, Dr. Julius Parker Sedgwick of the University of Minnesota. For many of the scientific facts here presented, use has been made of recent publications by Dr. Alfred F. Hess and Dr. E. Y. McCollum of this country, and by Dr. J. C. Drummond, Dr. Edward Mellamby, and Dr. E. T. King of Eng¬ land; also of current publications in scientific and medical journals of both countries. For suggestions on the subject matter regarding teeth, the author is indebted to Dr. Percy P. Howe of Boston and Dr. Guy A. Woods of Portland, Oregon.

December 29,1922.

Foreword

This text book for young mothers, and for social workers and nurses who have to advise them, is rich in the three vitamins: Scientific temper, common sense, and that sense of reality which comes naturally from a large specialized medical practice. Like the three known vita¬ mins of the author’s third chapter these essen¬ tial elements are not to be weighed or measured. They are not mechanically separable. If they are present in our mental diet we thrive on it. We digest and assimilate it. We relish and enjoy it.

The scientific temper, which is not to be con¬ founded with indigestible accumulations of facts, protects the author and the reader against gullibility and also against the sterility of the closed mind. It insures holding fast to the older knowledge, such as is summarized in the first chapter. It inoculates against the errors of vegetarian enthusiasm and at the same time rejects the old errors, such as that drinking water is dangerous in measles, typhoid and other fevers. The special contribution of this first vitamin however, this scientific Soluble A, as we might call it, is to put the newer knowledge of nutrition in its right relation to other know¬ ledge and the practical needs of mothers and

FOREWORD infants. Here in a few pages we have the estab¬ lished and applicable results of modern re¬ search into the accessory food factors. It is fascinating; and it is not fantastic but directly useful. The past ten years have given an opportunity to see the sad effects of inadequate war diets on children. Dr. Moore had an unus¬ ual opportunity in Italy and in France to study and to counteract these deficiencies. He has had further opportunity in his private and hospital practice and in “well-baby clinics” of the Co¬ operative Infant Welfare Society of Oregon, to push such studies and to coordinate his obser¬ vations with the results of the researches of Funk, McCollum and others. A conservative but open minded scientific temper has made these opportunities fruitful to the advantage of the mothers who may read and study or hear at second hand what he has to tell them.

The second vitamin, what we may call Com¬ mon Sense Soluble B, comes by nature. Neither university study nor experience by themselves will conjure it into those who do not have it. The absence of it is fatal and its presence is not difficult to detect. It guards against fads and exaggerations. It is an ally of the scientific tem¬ per and is very useful in the laboratory, but unfortunately it is sometimes left out of the academic diet. If it had not been present here, Dr. Moore would hardly have devoted a whole

FOREWORD chapter and innumerable incidental references to the subject of breast feeding . This is indeed his central and indispensable message. Others have advised it and some have emphasized it. Dr. Moore insists upon it, and what is more to the point, he shows that it is possible for every mother. He has a technique for it. The chapter on this subject, while amply forti¬ fied by science, morals and the experience of co¬ operating patients, whether prosperous or of restricted means, will be recognized as the very embodiment of common sense.

The third imponderable factor in this treat¬ ment of the nutrition of mother and child is in some respects the most reassuring and indis¬ pensable of all. We may call it the sense of reality Soluble C. We do not read far without seeing that this is not merely a scientific report for specialists. Dr. Moore has indeed experi¬ mented for himself. He is thinking however not of his rats and puppies, but of the mothers and children whom he has known in their homes, in his consultation office and clinics. We see, too, that he has not relied on his common sense unduly. His mind is turned outward on realities, not inward on possibilities. Nothing is here merely because it is in books or has been projected by some academician. What appears here has to do with the life and health of mothers and babies. What is offered to us is

FOREWORD a diet, appetizing, digestible, balanced in essen¬ tial information, old and new, not over sea¬ soned, free from faults and fallacies; in other words, one that can be whole-heartedly recom¬ mended to all who are or ought to be interested in the welfare of mothers and children.

Edward T. Devine.

New York.

Introduction

For a generation past physiology and hygiene have been taught in our schoolSo As a result the average mother has a general under¬ standing of the physical needs of her child. She knows that he must have fresh air; that if he is confined in close, stuffy rooms he soon pales and sickens. So much has been said and pub¬ lished as to the benefits of fresh air that the screened sleeping porch is a common sight. Exercise, too, has come in for its share of emphasis. Even the infant is usually taken out for an airing and is given some sort of play time each day. The hours in the school room have been shortened that the children may have more time for play and relaxation. The normal child scarcely needs to be urged to exercise; rather the reverse is true. A mother usually must curb her child in this respect, or he will exercise to exhaustion. Proper cleanliness of person and clothing has received much attention of recent years. With modern facilities for bathing, there are few children in the average home who are neglected in this respect. Both dress reforms and improved housing conditions have had an influence in bettering the physical health of our children.

Not denying the urgency of the foregoing,

INTRODUCTION factors, nutrition surpasses in importance all other health considerations, and is the one in which failure is most common. One-fifth of all deaths occur during the first year of life, and more than half of these are directly due to nutritional disturbances. Not only is this true, but death in later life is so often traceable to improper feeding in childhood that we cannot afford to ignore the value of proper nutrition.

Many mothers who realize the necessity of a well-balanced and properly regulated diet, do not comprehend what constitutes such a diet. This is not surprising when we consider the rapid progress recently made in nutritional knowledge. A study of food factors and the metabolic requirements of the human body is here presented, beginning with the old, long established facts of nutrition, and coordinating with these the newer discoveries of recent years.

Introduction

Contents

I. Former Knowledge of Nutrition. 19

II. Newer Nutritional Knowledge . 26

III. The Three Known Vitamins. 31

Chapter I Former Knowledge Of Nutrition

In a brief review of the history of nutrition it is hardly necessary to discuss the physiology of digestion or assimilation of food. The pro¬ cess of converting food into body materials is called metabolism. All foods contain one or more of the five main elements, protein, fats, car¬ bohydrates, salts, and water, each of which has its distinctive part in the work of metabolism.

The Food Elements. Fuel Factors. —Carbo¬ hydrates, in the form of sugars and starches, form a large part of our diet and have two uses in the body: they produce heat and are stored up as a reserve food. The preponderance of carbohydrates in the diet is justified by the ease with which they are digested and assimilated by most individuals. The function of fats and oils in nutrition is very similar to that of carbohy¬ drates—both serve as fuel for heat and energy and both are a source of body fat. Though the consumption of carbohydrates is larger, the heat value of a unit weight of fat is much greater. One of the chief differences is that fat may be depos¬ ited in the animal without material change, whereas carbohydrates must undergo complex transformations before appearing as fat. How¬ ever, fats and carbohydrates are essentially the same in their chemical processes and uses in the body.

Phot kin.— Protein is the food element that furnishes the material with which to build new body tissue and repair old tissue. The muscles, connective tissues, skin, and the tissues of the various organs, are largely formed from the protein of our foods. Hence, we see how impor¬ tant a part of our normal diet is this element and how erroneous is the idea presented by some vegetarian enthusiasts that animal food is unnecessary. Many plants, such as peas and beans, contain small quantities of protein in some of its forms, but our best sources of this necessary food are in milk, meat, and eggs. Gelatin and zein are proteins which are not capa¬ ble of yielding structural material because they are incomplete, that is, they lack some of the constituents that are necessary to form complete proteins suitable for the formation of body structures. Like fats and carbohydrates, pro¬ tein also has a heat-producing function. Per¬ sons living in an Arctic climate subsist largely upon meats and fats, and succeed in being very comfortable even in the coldest weather, whereas, on a vegetable diet, they could never withstand the rigors of their native land. On the other hand, those living in a torrid climate, where an excess of body heat is undesirable, and where great energy of body muscles is not required to procure a livelihood, subsist almost exclusively on a plant diet. We of the temper¬ ate zones find that a combination of animal and vegetable foods is best suited to our needs with more meat in winter and less in summer.

Minerals. —A fourth and very necessary food element is that of minerals or salts. The tissues, blood, digestive fluids, and especially the bony framework of the body, contain large amounts of various minerals. For instance, phosphorus and lime are requisites for the for¬ mation of bone; iron is necessary to form the haemoglobin of the blood. Children fail to develop if given no mineral food and adults become weak, nervous, and inactive. Minerals are espe¬ cially important to the pregnant and nursing mother, that her child may develop healthy tis¬ sues, strong bones, and a stable nervous system. Those on a mixed diet rarely suffer from mineral deficiency, as there are various mineral salts in milk, meats, and cereals, while the ever neces¬ sary iron is abundant in the yolks of eggs and green vegetables.

Water. —One of the most important elements in nutrition is water. A person will die of thirst long before hunger becomes fatal. A large part of the tissues, as well as the fluids of the body, are composed of water; in fact, it comprises from one-half to two-thirds of the body weight. Water acts as a solvent for the building mate¬ rials, as a carrier of food from one organ to another, and as a remover of waste products. The last is accomplished through the skin, lungs, bowels and kidneys.

Water in Disease .—However great the need of water in health, the demand is vastly increased during disease. There are then more waste materials to be removed; the temperature is higher, causing an increased evaporation from the skin; and the loss of water through the bowels is frequently increased. These addi¬ tional demands make it imperative to increase, rather than to decrease, the amount of water taken. At least fifty per cent, of the usual amount should be added to the normal daily intake in case of severe diarrhoea; in high fevers the amount should be twice that given in times of health. In former times it was believed to be almost fatal to give water in measles, typhoid, and other fevers. Now we know that these oldtime beliefs and fears were without scientific foundation, and that many diseases are best combated with an abundant supply of water. Among these are included pneumonia, acute digestive disturbances, various fevers, and even common 4 ‘ colds. ’ ’ Frequently headaches, espe¬ cially those due to indigestion, biliousness, or insufficient exercise, may be speedily relieved by drinking one or two pints of lukewarm water. This results in no injury to the body, such as is often occasioned by the use of drugs, but is a positive benefit to the system in general. Water may and should be given, even when other foods must be withheld.

Calories.—Every food contains one or more of the elements enumerated above. All of them are necessary, and no diet should consist of excessive amounts of any one element to the exclusion of others. Chemists have experi¬ mented elaborately and painstakingly with various foods until they have evolved lists repre¬ senting the value of each article of diet to the human body in the language of calories. A calory is the unit of measurement used to indi¬ cate the amount of heat or energy derived from a certain quantity of food. Calories thus serve to represent the value of foods from the energy standpoint. An article of diet high in caloric value, such as butter, is capable of maintaining life much longer than an equal amount of a food which is of low caloric value, such as tomatoes. About 1840, the famous chemist, Liebig, advanced the theory that the essential constit¬ uents of an adequate diet were proteins, fats, carbohydrates, certain mineral salts, and water. Others have taught that calory values, protein content, and digestibility are the three nutri¬ tional factors which should determine our choice of food stuffs.

Value of Calobies. —Calories have been con¬ sidered of such importance that, until recently, a large part of the attention given to diets in household science courses was centered upon the caloric value of food. To the ordinary mother, busy with her manifold duties, these caloric calculations seem so cumbersome and ultra-scientific that they have never been popu¬ larly used. The human appetite, as a rule, is a sufficient index to the needed amount of food for the energy requirements of the body. It is only in the case of some unusual condition, such as an undernourished child or an over¬ weight adult that particular attention need be given to caloric valuations. Carefully com¬ puted problems in diets have evolved estimates of the caloric requirements for adults and for children at various ages. In estimating the food allowances of children, both the size and age must be considered; for instance, an eight year old boy who is very large for his age may require as much food as a twelve year old of normal size. A detailed list of the caloric val¬ ues of common foods is given on page 203.

Daily Food Allowance for Healthy Children.

Age

Boys

Weight

Calories

Weight

Girls

Calories

26.4

30.5

47.5

•77

Mother

35 135 2600

Father

40 154

Chapter II Newer Nutritional Knowledge

The preceding chapter gives, in brief, the substance of our knowledge of nutrition prior to a decade ago. Useful as this knowledge is, we have discovered that there are other factors in nutrition just as important as calories. One may partake of protein, fats, carbohydrates, minerals, and water in adequate amounts and proper proportions and yet die of starvation. We wonder why the scientific world was so slow in discovering that protein values, calories, and digestibility are not the complete story of nutri¬ tion. The reason probably lies in the fact that that part of the world in which scientific research flourishes has usually consumed such a widely varied diet. The existence and the importance of certain factors normally present in such a diet, long failed to be appreciated.

Vitamins. —For years, ardent students of the subject had felt that the chemists were at fault in believing that they could fully determine the value of foods by chemical analysis. In 1911, Funk crystallized these ideas and shattered our former beliefs of nutrition by announcing his theory of vitamins. He held that in our food there are certain minute substances of unknown composition which have not, as yet, been chemi¬ cally separated or analyzed, but which exercise a very marked influence upon nutrition. To these he gave the name “vitamin.” About the time Funk announced his belief in the exis¬ tence of vitamins, McCollum and his coworkers, at the University of Wisconsin, brought forth further scientific proof of the accuracy of this theory.

The Tale of The Calves. —Have you heard the story of McCollum’s calves! It reads like a fairy tale. In the year 1906, three groups of heifer calves were selected and placed on diets chemically equal; the fat, protein, and carbohy¬ drate contents of the three were identical as were, consequently, the caloric values. One group was fed on corn, another on oats, and the third on wheat—the complete plant, stalk, leaves, and kernel being used in each case. The calves grew and thrived and only minor differ¬ ences were noted until they were grown and pro¬ duced young. The cows that had been fed on a wheat diet from babyhood produced calves that were born dead and weighed only 40 to 50 pounds, while a normal calf at birth weighs from 75 to 80 pounds. The oat-fed cows brought forth calves practically normal in weight, but these were also born dead. The corn-fed cows produced calves that were normal in weight and that were on their feet within a few hours. Considered from a casual point of view, these results would seem to indicate the superiority of corn above other cereals. The real point of advantage lay in the larger amount of green leaves and stalk in the corn diet, rather than in the grain itself. This point will be en¬ larged upon later.

A New Era. —When the results of these experiments were published, the eyes of the world were opened to amazingly wonderful facts in the science of nutrition and a new epoch in dietetics was entered upon. We came to realize that a diet may be chemically complete and yet be wofully inadequate for proper growth, devel¬ opment, and reproduction. Since this elaborate undertaking was completed, many scientists have conducted other dietetic experiments, using smaller animals such as mice, rats, dogs, guineapigs, and pigeons. The smaller animals are preferred, both because of the lesser expense involved and because the cycle of growth, maturity, and reproduction is completed in a much shorter time. Practically every medical, chemical, and nutritional institution in the country is now conducting experimental studies in vitamins.

Each year new facts are being established, and we cannot but feel that our knowledge of these accessory food factors is still in its infancy. During the past few years the sad experiences resulting from inadequate war diets have also been a means of changing many beliefs and theories. This has led to an intensive study of infant morbidity and mortality from the stand¬ point of nutrition. So surprising have been the results of all these recent experiments that our former mathematical calculations of food values have been proven altogether inadequate.

Vitamin Knowledge .—There are so many points about which we are, as yet, uncertain that we sometimes feel our knowledge of vitamins is very meagre; however, we do know some of the essentials. One of the peculiar facts about vitamins is the disproportion between their great importance and the very insignificant amounts in which they are consumed. They are present in amounts far too small to add to the energy supply of the body. Scurvy, that dread disease known for centuries among sea¬ faring men, can be wholly prevented by the daily addition to a sailor’s diet of three or four tablespoonfuls of orange or lemon juice. These fruits owe their efficacy to the vitamin they contain. Whether these minute amounts of vitamins are necessary foods themselves, or whether their presence merely helps other food to become effective we do not as yet know, nor is it positively necessary that we should know this. We know that the body is extremely sensitive to certain substances existing in natural food¬ stuffs in minute quantities; and that if these substances are destroyed or removed, such foods fail to support nutrition, and actual grave disease may result. Our modern desire to have all food perfectly sterilized, and our present day methods of preservation of various foods, are, in many instances, responsible for the destruc¬ tion of these necessary substances. Vitamins in some form are always present in natural foods, and any individual will have a sufficient supply of these essential factors as long as his diet is sufficiently varied and has had no destructive influences applied to it.

The reader may say, “ Since my family has a varied diet, do they not receive these vitamins in different foods V 9 They may and they may not. Many persons have idiosyncrasies of taste that lead to a very unbalanced ration; sometimes limited means is an influencing factor ; and very often children consume a scanty variety of foods, even where an abundance is provided upon the family table. Also, while an individual may receive enough of a given vitamin to pre¬ vent actual disease, it may be in amounts far too small to promote proper nutrition and to insure good health and longevity. This is par¬ ticularly true in the case of young children, as their vitamin requirements are far greater than those of adults. Even a partial deficiency of one or more of these necessary food substances, occurring in early childhood, may lead to extremely serious results; and these ill effects cannot be repaired, even by excessive amounts taken in adult life.

Chapter III The Three Known Vitamins

At present there are three vitamins recog¬ nized as necessary for health, proper growth and normal development. For want of knowledge as to their chemical nature, they have been desig¬ nated by the first three letters of the alphabet. One of these accessory food factors, found in animal fats and in green leaves, is called the A vitamin or fat-soluble A. Another, called the B vitamin or water-soluble B, is found in the seeds of plants, in egg yolks, and in many fruits and vegetables; a third one, termed water-soluble C, is also found in most juicy fruits and vegetables.

Fat-soluble A. —This vitamin has its original and natural source in the vegetable kingdom— the green leaves of plants. Its presence in ani¬ mal foods is due to the fact that the animals which produce this vitamin have first obtained it from plants that furnish their diet. The fat-soluble factor was first detected in butter, cod-liver oil and egg-yolk, and these are still considered the richest sources of this vitamin. It may vary in amount in animal foods at differ¬ ent seasons according to the amount of green food the animal has been consuming. A cow that has been fed for some time entirely on hay and grain produces butter-fat of a lesser vitamin content than when green grass or other fresh food has formed a part of her diet. In children, many of the symptoms arising from deficiency diets appear in late winter or early spring, when both animal and vegetable foods are lowest in this necessary factor. The well-known crav¬ ing for green foods in the early spring is the call of the body for its necessary quota, of vitamins.

Animal and Vegetable Sources. —The fat-soluble vitamin is present in a variety of foods of daily use, and no individual in ordinary cir¬ cumstances need be without it. Since butter is one of its richest sources, every child should have an adequate amount each day. This should be fresh and unheated. If there is a limited amount of butter available in the family, it should be given to the children, even though the adults have to refrain from its use. Chil¬ dren are much more sensitive to a deficiency diet than their elders, who have completed their growth. Fish oils, from cod, cod liver, salmon, and whale, are also satisfactory sources of this substance. Oleomargarine made from animal fats contains the A-vitamin in lesser amounts than butter, but nut margarines made from vege¬ table oils are lacking in this substance. The glandular organs of animals such as liver, kid¬ neys, heart and sweetbreads, represent a much richer source of fat-soluble A than do the muscular portions of the animal which we more generally consume. Pork fat seems to be almost wholly deficient in this factor. In the vege¬ table kingdom, spinach, carrots, peas, and green leaves contain varying amounts. Yellow corn contains some, but white corn is considered val¬ ueless as a source of the A vitamin. Corn, olive, and cotton-seed oils have been shown to be deficient in this respect.

Water-soluble B.— Experiments have demon¬ strated that egg-yolk, cereals, spinach, cabbage, carrots, onions, beets, tomatoes, and certain other vegetables contain the B vitamin. The germ of the grain, rather than the bran, as was formerly supposed, is one of the most potent sources of this factor. The germ is usually removed with the bran as ‘ ‘ shorts ’ ’ and is used as stock food. Thus, we feed the growth-promo¬ ting portions of our grains to our animals and give the lifeless starch to our children. Com¬ mercial bran, sold by grocers to be added to refined cereals, is not of much vitamin value as, usually, the germ has been removed. Whole grain products should constitute a large part of our cereal consumption, and would do much to correct the faulty diets of our children. The water-soluble B is more often lacking in our dietaries than the fat-soluble A. This is especially true among children, who fre¬ quently dislike vegetables and prefer white bread and refined or prepared cereals to the whole grain products, One of the richest known sources of the B vitamin is ordinary yeast. This is often prescribed in the diet of weak or nervous children, frequently with mar¬ velous results. However, promiscuous con¬ sumption of yeast has become a fad, and is to be discouraged, except under a physician’s di¬ rection. Next to yeast rank whole grain cereals and egg-yolk. These latter should be included in all well-balanced diets.

Milk is not an abundant source of water-soluble B and, hence, milk and white bread, upon which many children largely subsist, is far from a complete or satisfactory diet.

Water-soluble C. —The C vitamin is an essen¬ tial of every individual’s diet, but is frequently lacking in the food of young children under two years of age. Its presence has been determined in most fruits and green vegetables, less in root vegetables. It is found in small amounts in meat and milk, but has not been detected in yeast, fats, or cereals. Orange, lemon, tomato, and raw cabbage juices are the richest sources of this vitamin.

Cabbage Juice .—Dr. Harriette Chick of Lon¬ don has recently demonstrated the very interest¬ ing and practical fact that raw cabbage juice is fully as effective as orange juice. Since the relative cost of cabbage is very small compared with that of oranges, hers is a most important discovery. A half cup of cabbage, put through the food grinder and then compressed in a cheese cloth, will yield from one to two ounces of juice. Naturally, only for infants is it necessary to express the juice; older children may eat the raw cabbage, whole or finely chopped, according to age. The juices of raw turnips, beets, and carrots are likewise good sources of the C vita¬ min. Mothers should see that their families receive this substance every day in some form.