January 1, 1885
RACHITIS. BY A. JACOBI, M.D. - A System of Practical Medicine By American Authors, Vol. II - General Diseases (Continued) and Diseases of the Digestive System
A full description of the disease known as rickets is discussed, as well as the best nutritive treatments. "Meat-soups, mainly of beef, and of mutton in complications with diarrhoea, ought to be given at once when the diagnosis of rachitis becomes clear or probable."
When it seems so, it is complicated with the main cause of rachitis; that is, bad, insufficient, improper food, with its immediate result—viz. intestinal catarrh. Cow's milk, particularly when acid, starchy food administered too early or in too large quantity or too exclusively, early weaning followed by improper artificial food, insufficient mother's milk or such as is either too thin or too caseinous, lactation protracted beyond the normal limit,—may all alike be causes of intestinal disturbances and rachitis.
The alimentary tract is the seat of many changes recognizable during life. The tonsils are often large. The tongue is seldom coated to an unusual degree. On it are found little islands, red, marginated, deprived of epithelium. They will increase in size and number and extend backward. They will heal and reappear. They are by no means syphilitic, as Parrot would have it, and correspond exactly with the erosions near the solitary glands and those of Lieberkühn in the intestinal part, which mean nothing else but a nutritive disorder of the epithelia, and give rise to nothing worse than incompetency of absorption in that locality and abnormal secretion. The stomach is in a condition of chronic catarrh, sometimes dilated. Acid dyspepsia is frequent. Anorexia and bulimia will alternate. Feces contain an abnormally large amount of lime. Diarrhoea and constipation will follow each other in short intervals. The former owes its origin to faulty ingesta or chronic catarrh; the latter, sometimes to improper food, but more generally to muscular insufficiency. [p. 154]This condition has not been estimated at its proper value. Besides myself,17 nobody but Bohn has paid the attention to it which it deserves. Here, again, I have to insist that rachitis is a disease of the whole system, and not exclusively of the bones. Indeed, the muscular system is amongst the first to suffer. In the same way in which the voluntary muscles are not competent to raise and support the head or to allow a baby to sit up without a functional kyphosis, the involuntary muscles of the intestine are too feeble for normal peristalsis. The infant of a month or two months of age may have had normal and sufficiently numerous evacuations; gradually, however, constipation sets in; the feces become dry, but are perhaps not much changed otherwise. If no other cause be apparent, the suspicion of rachitical constipation is justified. Seldom, however, after it has lasted some time—and only after some time has elapsed relief will be sought—it will remain alone. Other symptoms of rachitis will turn up and the case be easily recognized. This constipation is an early symptom, as early as thoracic grooving or craniotabes. Very often it precedes both—is, in fact, the very first symptom—and ought therefore be known and recognized in time.
The skin participates in the general nutritive disorder. It is soft and flabby. In those infants who become rachitical gradually while proving their malnutrition by the accumulation of large quantities of fat, it exhibits a certain degree of consistency. When rachitis develops in the second half of the first year or later, with the general emaciation the skin appears very thin, flabby, unelastic. The veins are generally large. Complications with eczema and impetigo are very frequent; where they are found the glandular swellings of the neck and below are still more marked than in uncomplicated cases. Circumscribed alopecia is sometimes found (not to speak of the extensive baldness of the occiput). It is not attended with or depending on the microsporon Audouini, but the result of a tropho-neurosis. In the hair Rindfleisch found fat-globules between its inferior and central third. Then it would break, the axial evolution would cease, and the end become bulbous by the new formation of cells.
TREATMENT.—To meet the cause of a disease by preventive measures is the main object and duty of the physician. He thus either obviates a malady or relieves and shortens it. Now, if the original disposition to rachitis, as has been suggested, is to be looked for in early intra-uterine life, when the blood-vessels begin to form and to develop, we know of no treatment directed to the pregnant woman or uterus which promises any favorable result. But the more we recognize an anatomical cause of the chronic disorder, the more we can appreciate the influence upon the child of previous rachitis in the mother, and are justified in emphasizing the necessity on the part of the woman to be healthy when she gets married, and to remain so while she is pregnant. After the child is born the most frequent cause of rachitis is found within the diet or the digestion of the patient. To attend to the former is in almost every instance equal to preventing disorders of the latter; for most of the digestive disturbances during infancy and childhood are the direct consequences of errors in diet. It is, however, impossible to write an essay on infant diet in connection with our subject. I have elaborated the subject in my [p. 159]Infant Diet (2d ed. 1876), in the first volume of Buck's Hygiene, and of C. Gerhardt's Handbuch d. Kinderk. (2d ed. 1882). Still, the importance of the subject requires that some points should be given, be they ever so aphoristic.
The best food for an infant, under ordinary circumstances, is the milk of its mother. The best substitute for the mother is a wet-nurse. Woman's milk ought not to be dispensed with when there is the slightest opportunity to obtain it, particularly when the family history is not good and nutritive disorders are known to exist, or to have existed, in any of its members. When it cannot be had, artificial food must take its place, and it is in the selection of it where most mistakes are constantly made. This much is certain, that without animal's milk no infant can or ought to be brought up; as ass's milk can be had only exceptionally, and dog's milk, which has been said to cure rachitis, is still less available, the milk of either goat or cow must be utilized. The former ought not to be selected if the latter is within reach, mainly for the reason that it contains, besides other objectionable features which it possesses in common with cow's milk, an enormous percentage of fat. Cow's milk differs in this from woman's milk, that it contains more fat, more casein, more potassium, and less sugar than the latter, and that its very casein is not only different in quantity, but also in chemical properties. Even the reaction of the two milks is not the same, woman's milk being always alkaline, cow's milk often either neutral or amphoteric, and liable to acidulate within a short time. Thus, the dilution of cow's milk with water alone yields no equivalent at all of woman's milk, though the dilution be large enough to reduce the amount of casein in the mixture to the requisite percentage of one, and one only, in a hundred. The addition of sugar (loaf-sugar) and of table-salt, and sometimes alkali (bicarbonate of sodium or lime-water, according to special circumstances), is the least that can be insisted upon. Besides, the cow's milk must be boiled to prevent its turning sour too rapidly, and this process may be repeated to advantage several times in the course of the day. Instead of water, some glutinous substance must be used for the purpose of diluting cow's milk. As its casein coagulates in hard, bulky curds, while woman's milk coagulates in small and soft flakes, some substance ought to be selected which keeps its casein in suspension and prevents it from curdling in firm and large masses. Such substances are gum-arabic, gelatin, and the farinacea. Of the latter, all such must be avoided which contain a large percentage of amylum. The younger the baby, the less is it in a fit condition to digest starch; thus arrowroot, rice, and potatoes ought to be shunned. The very best of all farinacea to be used in diluting cow's milk are barley and oatmeal. A thin decoction of either contains a great deal of both nutritious and glutinous elements, the former to be employed under ordinary circumstances, the latter to take its place where there is, on the part of the baby, an unusual tendency to constipation. The decoction may be made of from one to three teaspoonfuls of either in a pint of water; boil with a little salt, and stir, from twelve to twenty minutes, and strain through a coarse cloth. It ought to be thin and transparent. Then mix with cow's milk in different proportions according to the age of the baby. Four parts of the decoction, quite thin, and one of milk (always with loaf-sugar), for a newly-born, equal parts for an infant of six months, [p. 160]and gradual changes between these two periods, will be found satisfactory. Whenever there is a prevalence of curd in the passage the percentage in the food of cow's milk must be reduced, and now and then such medicinal correctives resorted to as will improve a disturbed digestion. Care ought to be taken lest for the newly-born or quite young the preparations of barley offered for sale contain too much starch. The whiter they are, the more unfit for the use of the very young, for the centre of the grain contains the white and soft amylum in preference to the nitrogenous substances which are found near the husk. Thus, it is safest to grind, on one's own coffee-grinder, the whole barley, but little deprived of its husk, and thus secure the most nutritious part of the grain, which is thrown out by the manufacturer of the ornamental and tidy packages offered for sale. But very few cases will ever occur in which the mixtures I recommend will not be tolerated. In a few of them, in very young infants, the composition recommended by Meigs19 has proved successful. It consists of three parts of a solution of milk-sugar (drachm xvij¾ in pint j of water), two parts of cream, two of lime-water, and one part of milk. For each feeding he recommends three tablespoonfuls of the sugar solution, two of lime-water, two of cream, and one of milk: mix and warm. The baby may take all of it, or one-half, or three-fourths.
Under the head of roborants we subsume such substances, either dietetic or remedial, which are known or believed to add to the ingredients of the organism in a form not requiring a great deal of change. Rachitical infants require them at an early period. Meat-soups, mainly of beef, and of mutton in complications with diarrhoea, ought to be given at once when the diagnosis of rachitis becomes clear or probable. Any mode of preparation will prove beneficial; the best way, however, is to utilize the method used by Liebig in making what he called beef-tea. A quarter of a pound of beef or more, tender and lean, cut up finely, is mixed with a cup or a tumbler of water and from five to seven drops of dilute muriatic acid. Allow it to stand two hours and macerate, while stirring up now and then. This beef-tea can be much improved upon by boiling it a few minutes. It may be given by itself or mixed with sweetened and salted barley-water or the usual mess of barley-water and milk which the infant has been taking before. Older infants, particularly those suffering from diarrhoea, take a teaspoonful of raw beef, cut very fine, several times a day. It ought not to be forgotten, however, [p. 162]that the danger of developing tænia medio-canellata from eating raw beef is rather great. Peptonized beef preparations are valuable in urgent cases.
Cod-liver oil, one-half to one teaspoonful or more, three times a day, is a trusted roborant in rachitis, and will remain so. Animal oils are so much more homogeneous to the animal mucous membrane than vegetable oil that they have but little of the purgative effect observed when the latter are given. The former are readily absorbed, and thus permit the nitrogenous ingesta to remain in store for the formation of new tissue, but still affect the intestinal canal sufficiently to counteract constipation. As the latter is an early symptom in a peculiarly dangerous form of rachitis, cod-liver oil ought to be given in time (in craniotabes). Diarrhoea is but seldom produced by it; if so, the addition of a grain or two of bismuth or a few doses of phosphate of lime (one to four grains each) daily, may suffice to render the movements more normal. There are but few cases which will not tolerate cod-liver oil at all. The pure cod-liver oil—no mixtures, no emulsions—ought to be given...
October 5, 1949
Nunamuit: Among Alaska's Inland Eskimos
The Nunamiuts thrive on this almost exclusively meat diet; scurvy or other diseases due to shortages of vitamins do not exist. They are, in fact, thoroughly healthy and full of vitality. They live to be quite old. I lived only on meat for nearly five years.
I am writing at the beginning of October. Now the women are going for trips up the hillsides in small parties and enjoying themselves picking berries and gossiping. They find a fair number of cranberries and whortleberries, but no great quantities. Cloudberries are scarce in the Anaktuvak Pass; there are said to be more farther north, on the tundra.
The berries are stored raw, sometimes in a washed-out caribou's stomach, and mixed with melted fat or lard. This dish is called asiun and is considered a special delicacy.
They also dig up some roots. The most sought after are maso, qunguliq (mountain sorrel), and airaq. What is collected is consumed before winter sets in. No new green food is to be had till May; then roots and the fresh shoots and inner bark of the willow are eaten. Thus, for about seven months the Nunamiuts live on an exclusively meat diet, and for the rest of the year their vegetable nourishment is very scanty.
The caribou is dealt with traditionally. Every single part of the animal is eaten except the bones and hooves. The coarse meat, which in civilization is used for joints and steaks, is the least popular. In autumn and spring it is used to a certain extent for dried meat; otherwise it is given to the dogs. The heart, liver, kidneys, stomach and its contents, small intestines with contents (if they are fat), the fat round the bowels, marrow fat from the back, the meat which is near the legs, etc., are eatn. Both adults and children are very fond of the large white tendons on the caribou's legbones; they maintain that food of this kind gives one good digestion. The head is regarded as a special delicacy; the meat, the fat behind the eyes, nerves, muzzle, palate, etc., are eaten. Finally, there are the spring delicacies--the soft, newly grown horns and the large yellowish-white grubs on the inside of the hide(those of the gadfly) and in the nostrils. The grubs are eaten alive.
The meat is often cooked, but to a large extent it is also eaten raw. The children often sit on a freshly killed caribou, cut off pieces of meat, and make a good meal. It is also common practice to serve a dish of large bones to which the innermost raw meat adheres. Dried meat and fat are always eaten raw.
The Nunamiuts' cuisine also offers several choice delicacies. First and foremost is akutaq. To prepare this dish, fat and marrow are melted in a cooking-pot, which must not get t oo warm, meat cut fine is dropped in on the top, and then the woman uses her fist and arm as a ladle to stir it about. The result is strong and tastes very good. Akutuq has since ancient times been used on journeys as an easily made and nourishing food and is fairly often mentioned in the old legends.
Then there is qaqisalik, caribou's brains stirred up with melted fat. A favourite dish is nirupkaq, a caribou's stomach with its contents which is left in the animal for a night and then has melted fat added to it. It has a sweetish taste which reminds one of apples. Finally, there is knuckle fat. The knuckles are crushed with a stone hammer to which a willow handle has been lashed. Then the mass is boiled til the fat flies up. The Eskimos attach great importance to the boiling's not being too hard; delicate taste. Sometimes it is mixed with blood, and then becomes a special dish called urjutilik.
The Nunamiuts like chewing boiled resin and a kind of white clay which is found in certain rivers. Salt is hardly used at all. If an Eskimo family has acquired a little, it is used very occasionally, with roast meat. The small amount of sugar, flour, etc., which is flown in in autumn is of little significance and has, generally speaking, disappeared before the winter comes. Some Eskimos do not like sugar.
For a while coffee or tea is drunk, but these are quickly finished. Then the Eskimos fall back on their old drink, the gravy of the cooked meat.
The Nunamiuts thrive on this almost exclusively meat diet; scurvy or other diseases due to shortages of vitamins do not exist. They are, in fact, thoroughly healthy and full of vitality, so long as sicknesses are not imported by aircraft. They live to be quite old, and it is remarkable how young and active men and women remain at a considerable age. Hunters of fifty have hardly a trace of grey hair, and no one is bald. All have shining white teeth with not a single cavity. The mothers nurse their children for two or three years.
It is an interesting question whether cancer occurs among the Nunamiuts or among primitive peoples at all. On this point I dare not as a layman express an opinion, but I heard little of stomach troubles. During my stay among the Apache Indians in Arizona (1936) a doctor in the reservation told me that cancer had not been observed among the people. According to a Danish doctor, Dr. Aage Gilberg (Eskimo Doctor, George Allen and Unwin, London, 1948), cancer is never sene among the Thule Eskimos in northwestern Greenland. The matter deserves more detailed investigation; it may possibbly give certain results of assistance to cancer research.
The Indian caribou hunters I once lived with in Arctic Canada had a similar meat diet and good health. As for myself, my fare was the same as the Indians' and the Eskimos'--practically speaking, I lived only on meat for nearly five years. I felt well and in good spirits, provided I got enough fat. My digestion was good and my teeth in an excellent state. After my stay with the Nunamiuts I had not a single hole in my teeth and no tartar.
No doubt the hunters of the Ice Age, in Norway and elsewhere, lived in a similar way many thousand years ago. We are probably in the presence of what is most ancient among the traditions of primitive peoples. Taught by experience, they have arrived at a manner of living which, despite its onesideness, fully satisifies the body's requirements. The principle is to transfer almost everything that is found in the caribou to the human organism.
It is interesting to note that the stomach and liver of animals are regular features in the diet of primitive peoples, whereas modern science has only quite recently established that these contain elements of special value to human beings. The remedy for the previously deadly pernicious anemia is obtained from them. The contents of the caribou's stomach and the newly grown horns merit a closer examination by modern methods. It is a question, for example, whether the cellulose of the moss decomposed in the caribou's stomach and thereby becomes available to the human organism. With regard to the horns, it is of interest that certain deer's horns from northeastern Manchuria have from time immemorial been a regular article of commerce in China, where they have been used as a cure for impaired virility.
Typed up by Travis Statham from physical book. This is the best quote in the entire book.
Note: Helge Ingstad lived to be 101 (1899-2001).