VITAMIN C AND INFECTIONS
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443 response was elicited and the lesion was likely to be high. Further study is clearly necessary to confirm this first impression of a poorer prognosis with a lesion which is, at any rate partly, preganglionic and close to the cord. Bonney’s work clarifies two previously misleading find- ings in exploration of the plexus-a normal-looking plexus, and myelinated fibres in a funicular biopsy of cords or roots. Both are consistent with a severe, and probably irreparable, lesion above the posterior-root ganglion and close to the cord. Testing the axon responses in cases such as this may avert an unwarrantably hopeful prognosis and rightly lead to prompt reconstructive surgery. 1. New York Times, Feb. 12, 1955. 2. Comsa, J. Ann. Endocr., Paris, 1951, 12, 91. 3. Sieve, B. J. Science, 1952, 116, 373. 4. Robertson, W. van B., Ropes, M. W., Bauer, W. J. biol. Chem. 1940, 133, 261. 5. Pirie, A. Brit. J. exp. Path. 1942, 23, 277. 6. Hale, C. W. Biochem. J. 1944, 38, 362. 7. Strangeways, W. I. Ann. trop. Med. Hyg. 1937, 31, 405. 8. Jungeblut, C. W. J. exp. Med. 1939, 70, 315. 9. Olitzki, L. Bact. Rev. 1948, 12, 149. 10. Florey, H. W. Proc. roy. Soc. B, 143, 147. 11. Ericsson, Y. Acta. path. microbiol. scand. 1954, 35, 573. FLAVONOIDS AND THE THYMUS SOME plants contain large amounts of flavone deriva- tives, which often account for the yellow colours. A flavonoid may be an essential food factor at least for the guineapig; and " vitamin P," which Szent-Gyorgyi extracted from the skin of citrus fruits and paprika, seems to be a mixture of flavone derivatives. Hitherto these substances have not been isolated from animal tissues. Szent-Gyorgyi, who in 1928 first isolated vitamin C from the adrenal gland, has now found a flavonoid pig- ment in the thymus gland. At a conference, held in New York, on the biochemistry of flavonoids he showed 15 g. of a yellow powder which he had extracted from more than 15 kg. of calf thymus glands.! In man the thymus grows until the age of 2 and persists until puberty; then it usually atrophies. Its function has not been discovered. Reports that an extract delays the onset of first heat 2 and that phosphorylated hesperidin (a flavone derivative) diminishes fertility 3 may gain new signifi- cance in the light of Szent-Gvorgvi’s discovery. VITAMIN C AND INFECTIONS VITAMIN C, in addition to influencing wound healing, is believed by many to combat infection. The cause of this possible effect is obscure ; but ascorbic acid (vitamin C) in the presence of oxidising agents degrades many polysaccharides.4—6 Polysaccharides in bacterial-cell walls might therefore be attacked ; and the bactericidal effect of a mixture of ascorbic acid and oxidising agent 7 8 might be due to this action. A further possible effect is on mucin. Despite its useful lubricating functions in the body, mucin may aid infective processes by protect- ing pathogenic micro-organisms from the attack of the body defences and by enhancing their virulence.9 1 o Therefore ascorbic acid together with oxidising agents, by attacking local accumulations of mucin, may promote resistance to infection and recovery from attacks by fungi, trypanosomes, bacteria, and viruses. Treatment with ascorbic acid and percarbonate has been reported to result in rapid improvement in stoma- titis, gingivitis, and oral mycosis ; and Ericsson 11 suggests that topical application to epithelium-covered surfaces may be helpful in many infections. But, since mucoids in the tissues might be attacked, it would seem advisable to exercise caution in applying this treatment to mucous membranes. ’ ARTIFICIAL FEEDING OF INFANTS PÆDIATRICIANS have been telling us for a long time that in the artificial feeding of infants the quantity of the feed is just as important as its quality ; and many of them believe that the artificially fed infant is too often artificially um,derfed.l2 2 Their opinion has lately been convincingly confirmed by Hytten and MacQueen,3 who, using an ingeniously simple method, determined accur- ately how much fluid, protein, fat, and carbohydrate were received by a series of 100 infants under three months of age, all reared at home. They found that 69% of the infants were receiving less than the generally accepted requirement of 50 calories per-lb. (120 calories per kg.) per day, and 49% were getting less than 100 calories. Underfeeding to this degree is a serious matter ; but its correction should not be difficult, since about 75% of artificially fed infants receive the same type of food - namely, National dried milk. Of the causes of underfeeding, the most important is the instructions given on or in the tin of dried milk. It is debatable whether such instructions should be given at all; and in the U.S.A. manufacturers advise parents to consult their doctor about details of feeding. The instructions provided with a tin, even if they were correct (which is seldom the case), could not possibly deal with the individual variations of particular infants. Hytten and MacQueen point out that-the instructions issued with National dried milk fulfil the infant’s calorie requirements only if the measure is tightly packed with full-cream powder, but mothers are not told this. With part-skimmed milk, even tight packing cannot meet the calorie requirements. The measure of sugar-usually expressed in teaspoonfuls-may also be very inaccurate. The late Eric Pritchard had a collection of spoons, all sold as teaspoons, whose liquid capacities varied from 30 to 90 minims ; when measuring sugar the variation would be even greater. If instructions are to be issued with National dried milk, they should be amended to recommend one level measure to 1 oz. of water, with the addition of 1 drachm of sugar to each 4 oz. of the mixture. This would largely abolish underfeeding, and it would simplify matters for mothers who are not adept at working out the figures. The rule is : half the infant’s weight in pounds is the volume in ounces of a four-hourly feed and the number of level measures. Occasionally this rule may lead to what is technically overfeeding ; but we have been too much afraid of this in the past, and babies can take it more readily than is generally supposed. However clear and accurate the instructions, success in following them depends on the intelligence and resourcefulness of the mother. The doctor’s obligation is not ended when he has given verbal or written instructions. When artificial feeding first became practicable the importance of vitamins was not recognised; so scurvy and rickets became very common. Nowadays we do our best to see that every child has plenty of vitamins, and it seems a slur on the medical supervision if there is even a mention of scurvy or rickets. But it may be too readily assumed that the gap between the required amount and a toxic dose is very large, and there has been little emphasis on control of dosage. The question of vitamin D is the most disquieting. Dried milks and evaporated milks contain additional vitamin D ; cod- liver oil is issued free to every mother-with persuasive propaganda to make sure it is given-and other foods, such as cereals and glucose, may contain added vitamin D. Creery and Neill 4 have suggested that, in our anxiety to avoid rickets, we may be in danger of poisoning our children with vitamin D ; and Ball 5 believes that over- 1. Vining, C. W. Lancet, 1952, ii, 99. 2. Wood, B. S. B. Ibid, 1952, i, 28. 3. Hytten, F. E., MacQueen, I. A. G. Ibid, 1954, ii, 836. 4. Creery, R. D. G., Neill, D. W. Ibid, p. 1124. 5. Ball, W. A. Ibid, p. 243.
Transcript of VITAMIN C AND INFECTIONS
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response was elicited and the lesion was likely to be
high.Further study is clearly necessary to confirm this first
impression of a poorer prognosis with a lesion which is,at any rate partly, preganglionic and close to the cord.Bonney’s work clarifies two previously misleading find-ings in exploration of the plexus-a normal-lookingplexus, and myelinated fibres in a funicular biopsy ofcords or roots. Both are consistent with a severe, and
probably irreparable, lesion above the posterior-rootganglion and close to the cord. Testing the axon responsesin cases such as this may avert an unwarrantably hopefulprognosis and rightly lead to prompt reconstructive
surgery.
1. New York Times, Feb. 12, 1955.2. Comsa, J. Ann. Endocr., Paris, 1951, 12, 91.3. Sieve, B. J. Science, 1952, 116, 373.4. Robertson, W. van B., Ropes, M. W., Bauer, W. J. biol. Chem.
1940, 133, 261.5. Pirie, A. Brit. J. exp. Path. 1942, 23, 277.6. Hale, C. W. Biochem. J. 1944, 38, 362. 7. Strangeways, W. I. Ann. trop. Med. Hyg. 1937, 31, 405.8. Jungeblut, C. W. J. exp. Med. 1939, 70, 315.9. Olitzki, L. Bact. Rev. 1948, 12, 149.
10. Florey, H. W. Proc. roy. Soc. B, 143, 147.11. Ericsson, Y. Acta. path. microbiol. scand. 1954, 35, 573.
FLAVONOIDS AND THE THYMUS
SOME plants contain large amounts of flavone deriva-tives, which often account for the yellow colours. Aflavonoid may be an essential food factor at least for theguineapig; and " vitamin P," which Szent-Gyorgyiextracted from the skin of citrus fruits and paprika,seems to be a mixture of flavone derivatives. Hithertothese substances have not been isolated from animaltissues.
Szent-Gyorgyi, who in 1928 first isolated vitamin Cfrom the adrenal gland, has now found a flavonoid pig-ment in the thymus gland. At a conference, held inNew York, on the biochemistry of flavonoids he showed15 g. of a yellow powder which he had extracted frommore than 15 kg. of calf thymus glands.! In man the
thymus grows until the age of 2 and persists until puberty;then it usually atrophies. Its function has not beendiscovered. Reports that an extract delays the onset offirst heat 2 and that phosphorylated hesperidin (a flavonederivative) diminishes fertility 3 may gain new signifi-cance in the light of Szent-Gvorgvi’s discovery.
VITAMIN C AND INFECTIONS
VITAMIN C, in addition to influencing wound healing,is believed by many to combat infection. The cause ofthis possible effect is obscure ; but ascorbic acid (vitaminC) in the presence of oxidising agents degrades manypolysaccharides.4—6 Polysaccharides in bacterial-cell wallsmight therefore be attacked ; and the bactericidal effectof a mixture of ascorbic acid and oxidising agent 7 8might be due to this action. A further possible effectis on mucin. Despite its useful lubricating functions inthe body, mucin may aid infective processes by protect-ing pathogenic micro-organisms from the attack of thebody defences and by enhancing their virulence.9 1o
Therefore ascorbic acid together with oxidising agents,by attacking local accumulations of mucin, may promoteresistance to infection and recovery from attacks byfungi, trypanosomes, bacteria, and viruses.Treatment with ascorbic acid and percarbonate has
been reported to result in rapid improvement in stoma-titis, gingivitis, and oral mycosis ; and Ericsson 11 suggeststhat topical application to epithelium-covered surfacesmay be helpful in many infections. But, since mucoidsin the tissues might be attacked, it would seem advisableto exercise caution in applying this treatment to mucousmembranes. ’
ARTIFICIAL FEEDING OF INFANTS
PÆDIATRICIANS have been telling us for a long timethat in the artificial feeding of infants the quantity of thefeed is just as important as its quality ; and many ofthem believe that the artificially fed infant is too oftenartificially um,derfed.l2 2 Their opinion has lately beenconvincingly confirmed by Hytten and MacQueen,3 who,using an ingeniously simple method, determined accur-ately how much fluid, protein, fat, and carbohydratewere received by a series of 100 infants under threemonths of age, all reared at home. They found that 69%of the infants were receiving less than the generallyaccepted requirement of 50 calories per-lb. (120 caloriesper kg.) per day, and 49% were getting less than 100calories. Underfeeding to this degree is a serious matter ;but its correction should not be difficult, since about 75%of artificially fed infants receive the same type of food- namely, National dried milk.
Of the causes of underfeeding, the most important isthe instructions given on or in the tin of dried milk. Itis debatable whether such instructions should be givenat all; and in the U.S.A. manufacturers advise parentsto consult their doctor about details of feeding. Theinstructions provided with a tin, even if they werecorrect (which is seldom the case), could not possiblydeal with the individual variations of particular infants.Hytten and MacQueen point out that-the instructionsissued with National dried milk fulfil the infant’s calorierequirements only if the measure is tightly packed withfull-cream powder, but mothers are not told this. Withpart-skimmed milk, even tight packing cannot meet thecalorie requirements. The measure of sugar-usuallyexpressed in teaspoonfuls-may also be very inaccurate.The late Eric Pritchard had a collection of spoons, allsold as teaspoons, whose liquid capacities varied from30 to 90 minims ; when measuring sugar the variationwould be even greater. If instructions are to be issuedwith National dried milk, they should be amended torecommend one level measure to 1 oz. of water, with theaddition of 1 drachm of sugar to each 4 oz. of the mixture.This would largely abolish underfeeding, and it wouldsimplify matters for mothers who are not adept at workingout the figures. The rule is : half the infant’s weight inpounds is the volume in ounces of a four-hourly feed andthe number of level measures. Occasionally this rule maylead to what is technically overfeeding ; but we havebeen too much afraid of this in the past, and babies cantake it more readily than is generally supposed. Howeverclear and accurate the instructions, success in followingthem depends on the intelligence and resourcefulness ofthe mother. The doctor’s obligation is not ended whenhe has given verbal or written instructions.When artificial feeding first became practicable the
importance of vitamins was not recognised; so scurvyand rickets became very common. Nowadays we do ourbest to see that every child has plenty of vitamins, andit seems a slur on the medical supervision if there iseven a mention of scurvy or rickets. But it may be too
readily assumed that the gap between the requiredamount and a toxic dose is very large, and there has beenlittle emphasis on control of dosage. The question ofvitamin D is the most disquieting. Dried milks and
evaporated milks contain additional vitamin D ; cod-liver oil is issued free to every mother-with persuasivepropaganda to make sure it is given-and other foods,such as cereals and glucose, may contain added vitamin D.Creery and Neill 4 have suggested that, in our anxietyto avoid rickets, we may be in danger of poisoning ourchildren with vitamin D ; and Ball 5 believes that over-
1. Vining, C. W. Lancet, 1952, ii, 99.2. Wood, B. S. B. Ibid, 1952, i, 28.3. Hytten, F. E., MacQueen, I. A. G. Ibid, 1954, ii, 836.4. Creery, R. D. G., Neill, D. W. Ibid, p. 1124.5. Ball, W. A. Ibid, p. 243.
