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THE BLOOD PICTURE IN INFANCY
1293
suffered from complications.
The authors state, giving any explanation of what seems a remarkably high incidence, that 26 per cent. had pellagra and 70 per cent. polyneuritis (including 22 also having pellagra). Of those addicts not suffering from one or both of these complications only 15 per cent. were found to have achlorhydria, .an incidence which is only very slightly higher than might normally be expected-i.e., 12 per cent. Amongst the polyneuritic patients 29 per cent. showed absence of free acid and amongst the pellagrins 52 per cent. The amount of alcohol consumed and the length of time it had been taken did not appear to be concerned in these differences, and nine of those with normal gastric acidity had drunk from 8 to’24 ounces of whisky daily for periods up to 40 years. The association of alcohol excess, achlorhydria, and proved lack of vitamin B was somewhat striking, but other workers have shown that in beriberi achlorhydria is not a frequent finding. No relationship was found between the degree of anaemia or of liver dysfunction (as far as this could be judged and tested) and the frequency of achlorhydria, and the authors suggest that some factor closely associated with vitamin B may be concerned in the prevention of achlorhydria ; this they refer to as the " achlorhydria preventive factor " and regard as distinct from either vitamin B or the pellagra preventive fraction. It is not necessary to postulate such a factor when recognising the importance of dietetic factors in the maintenance of normal gastric secretion, thus lessening the significance of the direct effects of prolonged irritation from abuse of alcohol in reducing this secretion. If a man must drink to excess, it would seem that he will better preserve his gastric acidity if he takes his wine with bran.
without
THE BLOOD PICTURE IN INFANCY
Mackay’s classical study of the haemoglobin level in infancy, published in 1931,1 has been followed by similar large-scale investigations in all parts of the world. Two recent surveys, one from Gothenburg and the other from Aberdeen, bring out further important facts about the cause of the so-called nutritional anaemia of infancy. Dr. Nils Faxén,2 using well-controlled technique and statistical methods of analysis, studied all the red cell elements in 374 infants which he considered were in everyway healthy. They all weighed at least 3000 grammes at birth ; they were breast-fed with the addition of vitamins until six or seven months, when mixed feeding was gradually begun ; and they all lived at home under the care of visiting nurses from the children’s care centre. All children who had had any illness were excluded. His curve for haemoglobin levels during the first year of life is considerably higher than that of other observers, though he notes the same tendency to a’ lower level of red cells and haemoglobin and smaller cell size that has been found by all workers in the second six months. Faxen himself attributes his satisfactory figures to the careful selection of his material, and his children must be regarded as healthy infants living under the best conditions. He found no lowering of haemoglobin during the winter months, as others have done, and believes this is explained by his exclusion of children showing any infection. The truth of this conclusion is only too obvious from different results obtained by Dr. Fullerton3 working with less carefully selected 1 Mackay,
H. M. M., Goodfellow, L., and Hill, A. B. (1931) Ser. med. Res. Coun., Lond. No. 157. N. (1937) Acta Pœdiatr., Stockh. 19, Suppl. 1. Faxén, 3 Fullerton, H. W. (1937) Arch. Dis. Childh. 12, 91.
Spec.2 Rep.
children in Aberdeen. He found subnormal haemoglobin levels in 87 per cent. of 298 infants from poor homes between the age of nine and twenty-three months, and he concludes that this anaemia is due mainly to iron deficiency dependent on low birthweight, artificial feeding, and infective illness. The part played by even mild infections, originally suggested by Josephs4 is well brought out. A group of 26 infants aged six to twenty-two months was observed for a year in an institution under excellent dietetic and hygienic conditions. The haemoglobin level was lowered with unfailing regularity after each infection, however mild ; even pyrexia associated with teething was effective. This fall occurred even when iron was already being given and no response to therapy was made until several weeks after pyrexia had subsided. Why fever causes a fall in haemoglobin is unknown. Possibly the sum of unobserved and mild infections are responsible for the slight fall seen even in Faxén’s admirable children. Unlike other workers, Fullerton does not regard maternal iron deficiency as likely to be a significant aetiological factor. From theoretical calculations he decides that this anaemia of infancy cannot justifiably be called " nutritional," since during the first nine months deficiency of iron intake has little effect on the haemoglobin level. On theoretical grounds alone his conclusion that the importance of a deficient iron intake in infancy can be at present only a matter of conjecture is possibly correct, but the practical fact demonstrated by Mackay remains-namely, that infants given iron gain weight better and resist infections better than children not given iron. Fullerton himself holds that all children should be given medicinal iron after even mild infections. Since mild infections seem inevitable under the present conditions of town life and overcrowding, and the healthy babies fulfilling Faxen’s ideal criteria are probably rare in this country, it seems wise to attempt the widespread prophylaxis of the anaemia of infancy, whatever its cause, by the use of medicinal iron.
FRIENDLY GIVING " Not only do we help to support the needy by grants of money, food, coal and clothing, by advising them when in difficulties or ill-health, by providing medical or dental attention, invalid comforts and medical appliances, we arrange for holidays, and even for Christmas gifts through our special Fund. We recommend suitable schools for the young, help with fees and outfits and advise as to future We also try to re-construct those lives which careers. have been shattered by bereavement, lack of means and ill-health ..."
These words are quoted from the annual report of the Ladies’ Guild of the Royal Medical Benevolent Fund and the detailed reports of the various committees show how well and truly this work is being carried out. It is a record of personal service of which the guild may well be proud. The hon. visitors have paid more than 225 visits to beneficiaries during the year and the case committee has dealt with 462 persons, while assistance and supervision have been given in the education of 86 boys and girls. The clothes committee reports a successful year with 681 parcels sent to 370 beneficiaries in spite of the extra work entailed by a flood in their premises. Three new branches of the guild have been opened at Weston-super-Mare, East Devon, and Grays Thurrock, and others are in view. But the need is very great and the work of the guild and society is always increasing, since their help is not limited to any
4 Josephs,
H. (1934) Bull. Johns Hopk. Hosp.
55, 259.
suffered from complications.
The authors state, giving any explanation of what seems a remarkably high incidence, that 26 per cent. had pellagra and 70 per cent. polyneuritis (including 22 also having pellagra). Of those addicts not suffering from one or both of these complications only 15 per cent. were found to have achlorhydria, .an incidence which is only very slightly higher than might normally be expected-i.e., 12 per cent. Amongst the polyneuritic patients 29 per cent. showed absence of free acid and amongst the pellagrins 52 per cent. The amount of alcohol consumed and the length of time it had been taken did not appear to be concerned in these differences, and nine of those with normal gastric acidity had drunk from 8 to’24 ounces of whisky daily for periods up to 40 years. The association of alcohol excess, achlorhydria, and proved lack of vitamin B was somewhat striking, but other workers have shown that in beriberi achlorhydria is not a frequent finding. No relationship was found between the degree of anaemia or of liver dysfunction (as far as this could be judged and tested) and the frequency of achlorhydria, and the authors suggest that some factor closely associated with vitamin B may be concerned in the prevention of achlorhydria ; this they refer to as the " achlorhydria preventive factor " and regard as distinct from either vitamin B or the pellagra preventive fraction. It is not necessary to postulate such a factor when recognising the importance of dietetic factors in the maintenance of normal gastric secretion, thus lessening the significance of the direct effects of prolonged irritation from abuse of alcohol in reducing this secretion. If a man must drink to excess, it would seem that he will better preserve his gastric acidity if he takes his wine with bran.
without
THE BLOOD PICTURE IN INFANCY
Mackay’s classical study of the haemoglobin level in infancy, published in 1931,1 has been followed by similar large-scale investigations in all parts of the world. Two recent surveys, one from Gothenburg and the other from Aberdeen, bring out further important facts about the cause of the so-called nutritional anaemia of infancy. Dr. Nils Faxén,2 using well-controlled technique and statistical methods of analysis, studied all the red cell elements in 374 infants which he considered were in everyway healthy. They all weighed at least 3000 grammes at birth ; they were breast-fed with the addition of vitamins until six or seven months, when mixed feeding was gradually begun ; and they all lived at home under the care of visiting nurses from the children’s care centre. All children who had had any illness were excluded. His curve for haemoglobin levels during the first year of life is considerably higher than that of other observers, though he notes the same tendency to a’ lower level of red cells and haemoglobin and smaller cell size that has been found by all workers in the second six months. Faxen himself attributes his satisfactory figures to the careful selection of his material, and his children must be regarded as healthy infants living under the best conditions. He found no lowering of haemoglobin during the winter months, as others have done, and believes this is explained by his exclusion of children showing any infection. The truth of this conclusion is only too obvious from different results obtained by Dr. Fullerton3 working with less carefully selected 1 Mackay,
H. M. M., Goodfellow, L., and Hill, A. B. (1931) Ser. med. Res. Coun., Lond. No. 157. N. (1937) Acta Pœdiatr., Stockh. 19, Suppl. 1. Faxén, 3 Fullerton, H. W. (1937) Arch. Dis. Childh. 12, 91.
Spec.2 Rep.
children in Aberdeen. He found subnormal haemoglobin levels in 87 per cent. of 298 infants from poor homes between the age of nine and twenty-three months, and he concludes that this anaemia is due mainly to iron deficiency dependent on low birthweight, artificial feeding, and infective illness. The part played by even mild infections, originally suggested by Josephs4 is well brought out. A group of 26 infants aged six to twenty-two months was observed for a year in an institution under excellent dietetic and hygienic conditions. The haemoglobin level was lowered with unfailing regularity after each infection, however mild ; even pyrexia associated with teething was effective. This fall occurred even when iron was already being given and no response to therapy was made until several weeks after pyrexia had subsided. Why fever causes a fall in haemoglobin is unknown. Possibly the sum of unobserved and mild infections are responsible for the slight fall seen even in Faxén’s admirable children. Unlike other workers, Fullerton does not regard maternal iron deficiency as likely to be a significant aetiological factor. From theoretical calculations he decides that this anaemia of infancy cannot justifiably be called " nutritional," since during the first nine months deficiency of iron intake has little effect on the haemoglobin level. On theoretical grounds alone his conclusion that the importance of a deficient iron intake in infancy can be at present only a matter of conjecture is possibly correct, but the practical fact demonstrated by Mackay remains-namely, that infants given iron gain weight better and resist infections better than children not given iron. Fullerton himself holds that all children should be given medicinal iron after even mild infections. Since mild infections seem inevitable under the present conditions of town life and overcrowding, and the healthy babies fulfilling Faxen’s ideal criteria are probably rare in this country, it seems wise to attempt the widespread prophylaxis of the anaemia of infancy, whatever its cause, by the use of medicinal iron.
FRIENDLY GIVING " Not only do we help to support the needy by grants of money, food, coal and clothing, by advising them when in difficulties or ill-health, by providing medical or dental attention, invalid comforts and medical appliances, we arrange for holidays, and even for Christmas gifts through our special Fund. We recommend suitable schools for the young, help with fees and outfits and advise as to future We also try to re-construct those lives which careers. have been shattered by bereavement, lack of means and ill-health ..."
These words are quoted from the annual report of the Ladies’ Guild of the Royal Medical Benevolent Fund and the detailed reports of the various committees show how well and truly this work is being carried out. It is a record of personal service of which the guild may well be proud. The hon. visitors have paid more than 225 visits to beneficiaries during the year and the case committee has dealt with 462 persons, while assistance and supervision have been given in the education of 86 boys and girls. The clothes committee reports a successful year with 681 parcels sent to 370 beneficiaries in spite of the extra work entailed by a flood in their premises. Three new branches of the guild have been opened at Weston-super-Mare, East Devon, and Grays Thurrock, and others are in view. But the need is very great and the work of the guild and society is always increasing, since their help is not limited to any
4 Josephs,
H. (1934) Bull. Johns Hopk. Hosp.
55, 259.