EVOLUTION OF OUR KNOWLEDGE OF THE DISEASES OF NUTRITION IN EARLY CHILDHOOD Both the clinical aspect and statistics of the mortality of the first years of life disclosed to physicians the important significance and the fatal character of the diseases, which, in manv localities almost deci mate the rising generation, and have from the earliest times excited interest in their etiology and aroused the therapeutic endeavors of all earnest observers.
ft would lead us too far afield. would not conform to the purpose of this book, and would but slightly further our knowledge of the pro cesses to be described here, to unroll the entire tedious evolution of our knowledge of the symptomatology, essential nature, and treatment of the acute and chronic disturbances of nutrition in early childhood. This shall only be done in so far as the observations have been of value in pointing the way, and in providing new standpoints for the under standing and treatment of the affections under discussion.
60 The natnes of Bretonneau (1.818), Parlitill (1826), Dewees, Billard (1830), Trousseau, Bouchut (1815), Rilliet-Barthez, Virchow and von Widerhofer (1880), are associated with the clinical aspect of the matter, and with the treatment corresponding to the etiological views held at the time. These authors, with the master-eye of gifted observers, uninfluenced by secondary considerations, so thoroughly compre hended, described, and created a clear conception of the symptoms of the various forms of gastro-enteric affections, that the characteristics established by them have for the most part survived the changes caused by our later point of view as to their etiology, and our newer methods of clinical observation. The types described by- them, such as "cholera infantum," "enteritis follicularis," "atrophy," and in a certain sense the "athrepsia" described by Parrot (1877) have so thoroughly pene trated our medical consciousne.ss, that all the progress of knowledge in this field has not been sufficient to eradicate them.
The recognition of the seasonal relation of gastro-enteric cases, to the oc.currence of high summer temperature, as well as to a certain
level of surface water, was brought out chiefly by American authors, from whom we derive the term "summer complaint," which term has been adopted by numerous German, French, am] English writers. The etiologic basis of these summer diarrhoffis has been attributed to con taminated milk. Such ca.ses have also been considered analogous to the beat-strokes of adults. All these observations have been significant of further progress in the 'working out of the etiology of the subject.
The decade of bacteriologic discovery from 1880-1890 which we have to thank for much new light on the question of causation of dis ease, did not neglect this particular division of human pathology. The important researches on the normal intestinal flora of newborn and nursing infants, undertaken and carried on by Escherich, ushered in the work, and brought us near enough to attack the pathological con ditions from seemingly solid ground. The following years produced such researches as those of Escherich himself, Lesage, Booker, Bag insky, and many others. The literature on this subject, of which A. B. Marfan has compiled an excellent resum6 in his monograph "Les Hastroentffiites des Nourissons," (The Gastro-enteritis of Infancy) 1900, extends immeasurably, till it reaches a provisional conclusion which is essentially widely different from the original starting point. Especially noteworthy are the interesting researches of H. Tissier (1900) on the normal and pathologic intestinal flora; those of Nobecourt (1899-1904) on the significance of the association of different organisms in the pathogenesis of intestinal diseases; the works of Escherich and his pupils, Spiegelberg, Hirsh, Libman, 'Moro, and others, on specific intestinal infections in infants (colicolitis and streptococcus enteritis); and filially the. published investigations of American physicians col lected by Timmer and Holt, on the significance of the various types of dysentery bacilli in the pathogenesis of infantile intestinal infections.