Similar evidence of such an influence is seen in the fact that although rickets is not seen among breast-fed babies whose mothers are on satisfactory diets, it may and does occur in breast-fed babies who are nourished by mothers who are, themselves, on dietaries which are poor in milk and fresh fruit and vegetables.
Drs. Hess and Unger made a study of the occurrence of rickets among colored babies in a section of New York City and the value of cod-liver oil as a preventive of this disease. In commenting upon their findings, they state, “This tendency is so marked that it may be safely stated that over ninety per cent. of the colored babies have rickets, and that even a majority of those that are breast-fed show some signs of this disorder.” They ascertained that the average diet of the mothers of these rickety babies was largely made up of carbohydrates and proteins, being poor in fats, although the diets yielded a daily quota of calories which represented almost the requisite amount for their individual weights. But they took little fresh milk or fresh fruit or vegetables, using canned and dried products freely.
It is important to note here that it is a diet of heated milk, rich in carbohydrates but poor in fats, that produces rickets in a bottle-fed baby—almost the same type of diet which in a nursing mother results in rickets in a breast-fed baby.
In an endeavor to prevent rickets among these incompletely nourished babies, Drs. Hess and Unger carried on a definitely organized experiment. “Our plan,” they report, “was to give infants under six-months one-half teaspoonful of oil three times daily and older infants twice this amount. It was found that almost all babies can take cod-liver oil, although it may disagree temporarily and may have to be discontinued for short intervals when there is digestive disturbance. Infants of from two to three months tolerate the oil in half-teaspoonful doses, and younger ones may be given still smaller amounts.” In commenting upon the tabulated results of this interesting study they say: “It is seen that we were able to prevent the development of rickets in more than four-fifths of the infants who received the oil for six months, and in more than half of those who were given it for four months. This result must be considered satisfactory when we note that, of the sixteen infants who did not receive the oil, fifteen showed signs of rickets, though all of them lived under the same conditions and many in the very same families. No other treatment was given, nor was a change of diet or mode of life attempted which could account for the difference in the results between the two groups of cases.” The poor quality of the breast milk of these inadequately nourished mothers is suggested by the further statement: “Table two shows that the cod-liver oil proved to be a more potent factor than breast feeding in warding off rickets, and that almost all the colored babies developed rickets even though nursed.”
It may seem like a far cry from scurvy among sailors, on shipboard, xerophthalmia among lumbermen in Labrador, and beri-beri among the Orientals to the nursing mother and her baby in our care.
But when we gather all of these apparently unrelated threads together and consider them in their possible relation to this same nursing mother and her baby, right here at hand, the following facts stand out as being of insistent importance to their well-being:
1. There are five recognized diseases resulting from faulty nutrition, which may be both prevented and cured by a diet which contains the protective substances which are now regarded as essential to normal growth, development and well-being. 2. These essential substances are not necessarily provided in adequate amounts by a diet that is satisfactory in bulk or in its balance of fats, carbohydrates, proteins, salts and water or that yields the requisite number of calories. The familiar diet of meat, potatoes, peas, beans, bread, pie and coffee is so far from providing complete nourishment that those who are limited to it are in a state of partial starvation. 3. The diseases resulting from a lack or deficiency of the protective substances, fat-soluble A, water-soluble B and water-soluble C, respectively, are xerophthalmia, beri-beri and scurvy. With these are often included pellagra and rickets, the causes of which are not definitely known but result from diets that are poor in certain respects. The serious aspect of the deficiency diseases, however, does not lie entirely in those conditions which are well enough developed to be recognizable, thus prompting treatment; but also in the wide prevalence of malnutrition, of some form, which is not severe enough to be diagnosed as disease, and which is caused by a sustained diet that is poor in one or more essential food factors. This condition is serious because it produces a legion of individuals who are spoken of as being “not strong.” They are tired, nervous, susceptible to infections, have poor recuperative powers and in general fall short of a normal state of health and efficiency. 4. Although the breast tissues are capable of converting into milk certain substances which they extract from the blood, and may, for example, convert poor proteins into proteins of higher value, they cannot create the protective substances which we have been considering. They can merely excrete these substances if they are contained in the mother’s diet. The absence, or shortage of these food essentials in the mother’s diet, and therefore in her milk, may result in rickets or other malnourished conditions in the baby, or in a degree of faulty nutrition which is not marked enough to be diagnosed, but enough to keep him frail. Enough to give him the poor start that is so likely to put him, ultimately, in the class of those adults who are more or less unfit, though not actually ill.
We must see to it, therefore, that our selection of food for the expectant and nursing mother provides those substances which are necessary to promote growth and development and preserve health, if we are to live up to our claim that the aim of obstetrical nursing is to aid in building a strong, vigorous and buoyant race.
The nurse may find herself feeling a bit dismayed at the prospect of trying to remember at all times which foods contain fat-soluble A, for example, and which are poor in water-soluble C, but she can remember in general, that milk and leafy vegetables are the great protective foods and that any diet which is poor in these is incapable of nourishing satisfactorily; and by calling to mind the deficiency diseases, previously described, she will be impressed anew by the seriousness of faulty nutrition.
By milk we mean, in addition to fresh milk, cream, butter, butter-milk, cream-soups and sauces, custards, ice-cream and all dishes and beverages made of milk.