Derrick B. Jelliffe

Acute Toxic Hypoglycaemia in the Vomiting Sickness of Jamaica

Trial with Gallamine In order to determine whether the abolition of visible muscle fasciculations prevented the muscle pains following suxamethonium a further series was attempted identical with group I (out-patients) except that the injection of suxamethonium was preceded by 40 mg. of gallamine triethiodide. This abolished visible twitching in every case. Of 15 cases examined, 6 (40%) complained of muscle pains. The significance of results based on such a small series is difficult to analyse, but the general impression was that following gallamine the incidence and severity of the muscle pains were diminished, though with this dosage they were not abolished. Further support is given to this suggestion by the finding in 12 in-patient cases (that is, confined to bed for 48 hours after operation), that if a dose of gallamine triethiodide (80 mg.) was given before the administration of suxamethonium there was no case of post-operative muscle stiffness.

Veno-occlusive Disease of the Liver and Indian Childhood Cirrhosis

Cirrhosis of the liver is rare in childhood in the temperate zone and it is then usually due to some specific and traceable cause, such as Rhesus incompatibility, galactosaemia, congenital syphilis, in association with congenital abnormalities of the biliary apparatus, or following infective hepatitis. In most of the subtropics and tropics-at least according to present probably incomplete evidencecirrhosis in childhood is somewhat more common, but it is still infrequently seen, despite the fact that the condition may have a high incidence amongst adults. There appear to be only two widely separated regions of the world from which cirrhosis in childhood has been commonly reported in the medical literature-the West Indian island of Jamaica and the subcontinent of India, especially the eastern States of Madras and Bengal. As it has recently been possible for the writers collaboratively to have had experience in both regions, the present paper has been written in order to compare clinical and histological features of cirrhosis in childhood as seen in both Jamaica and Calcutta, West Bengal.

Lactation, conception, and the nutrition of the nursing mother and child

Summary Successful unsupplemented lactation has a definite contraceptive effect lasting for months, which is less effective if early supplementary feeds are given. This contraceptive effect declines with time, and ultimately menstruation, ovulation, and conception are resumed during prolonged breast-feeding. 71 The decline in breast-feeding in newly urbanized families in the shanty towns and slum areas 64 does not only have direct nutritional ill consequences for young children, with an increase in the “diarrhea-marasmus syndrome,” but also has an anticontraceptive potential of public health proportions. The importance of breast-feeding needs consideration as one mode of child spacing, especially by religious groups concerned with natural methods. With regard to hormonal contraceptives, the low-dose progestagen drugs, both those given by mouth and by intramuscular injection, do not appear to have major ill effects as far as lactation is concerned, and may even increase the yield. However, further investigation is needed into the effect of various types and doses of contraceptives on the composition and yield of milk in various nutritional circumstances, into possible effects on the nursing baby, and into nutritional consequences in the women concerned, especially folic acid deficiency. What seems to be needed in less developed regions is initial unsupplemented breast-feeding of the infant for six to eight weeks after birth, followed by a mutual reinforcement of the proved contraceptive effects of lactation and mechanical (intrauterine contraceptive devices * ) or hormonal contraceptives—preferably long-lasting, “one-attendance” methods, such as intramuscular Depo-Provera, given initially at the postnatal clinic. Optimally, a hormonal compound is needed which is not only a contraceptive but also has no nutritional ill consequences for the mother and enhances lactation. Research into these important interactions and interdependences between mother and infant should be a priority in world nutrition; there are indications that the efforts needed are being given increased emphasis. 10,11

Tropical Problems in Nutrition

Abstract The terms kwashiorkor, marasmus, defective cellular immunity, and famine are exotic terms to most Americans, but they have foreboding implications for both present and future American medi...

Adrenal function in normal infants and in marasmus and kwashiorkor: Plasma aldosterone concentration and aldosterone secretion rate

In normal infants 2.1 to 3.2 months of age and in those 4.8 to 10.6 months of age, plasma aldosterone concentrations were, respectively, 88±42 and 61±43 ng. per 100 ml. (S.D.) and the aldosterone secretion rates were 75±21 and 70±36 μg per 24 hours. Older infants, 12.5 to 18.5 months of age, had plasma aldosterone levels of 17±7 ng. per 100 ml. and aldosterone secretion of 73±43 μg per 24 hours. The plasma aldosterone concentrations of the two younger groups were significantly higher than that of the 12.5-to 18.5-month-old children (p

Doulas confidence and the science of lactation.

The psychophysiology and practice of breast-feeding is discussed. Successful lactation involves stimulation of the nipple and areola by the nursing baby which causes the secretion of prolactin. This is followed by the milk-ejection reflex. This reflex is psychosomatic in nature and leads to contraction of the myoepithelial cells which results in expulsion of the milk. These reflexes can be inhibited by anxiety doubt and other forms of emotional tension. Prolactin secretion is proportional to the stimulation of the nipple and areola. Western practices such as oversedation of the newborn the use of prelacteal bottle feeds and the separation of mother and the newborn seriously limit the amount of suckling time. In rural India it is customary for another woman to remain with the mother during childbirth and the neonatal period while the mother is secluded for several weeks. The routines practiced in Western societies do not enhance the prolactin and milk-ejection reflexes. No-cost modifications of procedures during pregnancy childbirth and the newborn period would substantially improve upon the success of breast-feeding.

Energy metabolism and hormonal profile in children with edematous protein-calorie malnutrition

Modifications in energy metabolism and endocrine homeostasis (plasma insulin and growth hormone values, glucose and free fatty acid levels, serum thyroxine and TSH, free thyroxine index, and urinary catecholamines) were investigated in eight children with edematous protein-calorie malnutrition. Caloric expenditure was low at admission and correlated linearly with increased caloric intake throughout the study. The hormonal changes at admission were characterized by a negligible insulin response to intravenous arginine or glucose and by markedly elevated growth hormone levels which were neither increased by arginine nor suppressed by intravenous glucose. Serum thyroxine values were low, but free thyroxine index and serum TSH levels were within normal limits. At admission to the study, 24-hour urinary excretion of dopamine and norepinephrine was relatively reduced in relation to the excretion of epinephrine. All these modifications were corrected at time of the recovery study. It is suggested that in edematous protein-calorie malnutrition, insulin acts as the primary regulator of peripheral fuel release and that the high, nonsuppressible growth hormone levels may form part of an important homeostatic mechanism to provide substrates for brain metabolism via lipolysis.

Education of the public for successful lactation† : Psycho‐social considerations

Success or failure in human lactation mainly depends on two psycho‐physiological reflexes, the prolactin reflex and the let‐down reflex. In actual communities, frequent suckling and confidence are major factors, and the latter is related in large measure to knowledge and social support. Success in social mammals, including traditional human societies, is made more likely by the presence of what Raphael has termed a doula or culturally defined assistant, usually female. Consideration is given to the anti‐doula function of most modern midwifery units, and to the need to consider the need for the doula role in programmes designed to promote lactation in the community.

Nutrition and human milk

The nutritional composition of human milk is specifically suited to the needs of the human infant. In addition to eliminating the chance for contamination, human milk provides active protection against infection, and breast-fed babies have fewer metabolic anomalies and are less subject to allergy than formula-fed babies.

Early Infant Nutrition: Breast Feeding

Functional and practical understanding of infant feeding can best be achieved by appreciating its dyadic nature—that is, as a nutritional, psychological, and biological interaction between mother and offspring, both in pregnancy and lactation, with each affecting the other, and, at the same time, by considering the early stages of the young human organism according to the biological classification of Bostock (1962)—that is, the fetus, the exterogestate fetus (up to 6–9 months postnatally), and the transitional (9 months to 2–3 years) (Jelliffe, 1967) rather than by the statistical calendar catagories of “infant” and “preschool child.”