AlexanderR.P. Walker

An investigation of the rarity of infantile scurvy among the South African Bantu.

Various nutritional problems of Bantu infants and young children have been investigated recently at this centre. We have studied, for example, the composition of breast milk (Walker, Arvidsson & Draper, 1954) and of the foods used at weaning (Walker, Fletcher, Strydom & Anderson, 1955), the utilization of nutrients by infants during and after gross malnutrition (Walker, Kahn & Reynolds, 1955) and so forth. One point which has particularly impressed us is that, though in all other respects the various stigmata of malnutrition and undernutrition are such as would be expected from the inadequate diet, infantile scurvy does not apparently occur. Thus, in Johannesburg, at Baragwanath Non-European Hospital (1350 beds), out of about 6000 admissions under 2 years of age during the last 5 years, there have been only two cases of frank infantile scurvy. At Coronation Hospital (500 beds) within the last 5-year period, there have been only two cases of the disease among over 3000 admissions under 2 years of age. With breast feeding, particularly when practised for protracted periods as in rural areas in Africa, there is no doubt that the amount of vitamin C from the milk and from the irregular amounts of fruit and vegetables provided, is sufficient to protect against the development of infantile scurvy. In urban areas, however, breast feeding is practised for shorter periods, indeed, some mothers, in their desire to get back to work quickly, wean their babies as soon as possible after parturition. In such areas, the giving of fruit and vegetables is obviously limited, and it is generally accepted as being by no means uncommon for infants to be weaned on an almost exclusive diet of cereal ‘paps’ or similar foods, likely to contain either very little or no vitamin C. Under conditions where infantile scurvy would be expected to occur frequently, and occasionally severely, available evidence indicates the disease to be virtually absent. Freedom from the disease cannot be ascribed to racial differences: firstly, the disease occurs among American Negro (Hess, 1920) and also Indian (Singh, 1954) infants; secondly, scurvy occurs among Bantu adults (Bronte-Stewart, 1953 ; Grusin & Kincaid-Smith, 1954). In an endeavour to throw light on the subject, we have carried out an investigation on (I) Bantu infants under the age of 2 admitted to Coronation Hospital suffering 7 Nutr. 10, z

Methionine concentration in South African Bantu breast milk.

Although going under different names, the disease commonly referred to as kwashiorkor is of world-wide distribution affecting infants and young children fed on diets habitually deficient in amino-acids. According to Brock & Autret (1952), the syndrome usually includes fatty infiltration, cellular necrosis, or fibrosis of the liver. These authors have reported that in West Africa, fibrosis of the liver may develop in infants at the age of 6 months and possibly even earlier while they are still getting the whole of their food from the breast. It has, therefore, been postulated that a factor or factors may be missing from, or deficient in, the breast milk during the first 6 months of lactation. The fact that experimental methionine deficiency in the rat results in a fatty liver (McHenry & Patterson, 1944) raises the question whether a deficiency of this amino-acid may be involved in the causation of kwashiorkor. It is thus of interest that Auffret & Tanguy (1949) have reported that the breast milk of West African mothers of Dakar is low in methionine. They found a mean value of 16 mg/roo ml., which is unusually low in comparison to the mean value of 29 mg/Ioo ml. quoted by them for American mothers examined by Block (1945). However, more recently, Srinivasan & Ramanathan (1954) have examined the milks of twenty-five Indian mothers, both mothers and babies being apparently healthy, and also of six Indian mothers whose children were suffering from kwashiorkor. No abnormality was apparent; for the milks from the two groups of mothers, they found average values of 29.1 and 30.4 mg methionine/Ioo ml. respectively. In South Africa we have found no abnormality in the mean protein concentration of Bantu breast milk (Walker, Arvidsson & Draper, 1954); moreover, the stigmata of kwashiorkor are not observed in exclusively breast-fed infants. But in view of the report from West Africa, it was thought worth while to carry out determinations of methionine in the breast milk of both Bantu and South African European mothers.

CALCIUM BALANCE IN PREGNANCY

Pacû2 and plasma-bicarbonate concentration requires the measurement of both those variables, throughout the range of mild to severe single-factor disturbances. Given the uncertainty of the universal correctness of the constants ’ used to calculate plasma-bicarbonate concentration the accurate measurement of that quantity in blood awaits the development of bicarbonate-activity electrodes. Meanwhile,