(1) Prevention Of Beriberi

It is unlikely that any danger of beriberi will arise among the famine-threatened districts of Eastern Europe as long as wholemeal flour from rye, wheat, barley, maize, or peas, beans, and lentils are provided. Mere shortage of food does not cause beriberi, and poverty ensures that the whole grain is consumed for purposes of economy.

(2) Prevention And Cure Of Rickets Or Growth Failure In Children Or War Edema In Adults

Evidence is accumulating that rickets is caused by a shortage not of fat as such, but of the "fat-soluble growth factor" which is contained in certain fats. Xerophthalmia, a severe disease of the external eye, leading, if untreated, to blindness, has also been attributed to lack of this factor. Infants and young children must therefore be supplied with the right kind of fat. To prevent rickets (1) full cream milk should be secured for artificially fed infants when possible; failing that, (2) full cream dried milk or (3.) full cream unsweetened condensed milk. (2) is preferred to (3), and, in case of ignorant or careless mothers, even to (1), in order to prevent spread of infection and intestinal disorders. In all cases where (2) or (3) are used, an extra antiscorbutic should be given (see below).

Sweetened condensed milk is undesirable for the reason that the degree of dilution required by the high sugar content renders the food, as prepared, deficient in the fat-soluble (antirachitic) factor as well as in fat and protein.

Milk and butter are the best sources of the antirachitic (or fat-soluble) factor for young and growing children; margarines made from animal fats are also valuable; those made from vegetable oils are to be condemned. If there is a shortage of butter it should be reserved for children, but if totally lacking the deficiency can be replaced by codliver oil and other fish oils, or by eggs. If all animal fats are unavailable, peanut oil should be selected in preference to other vegetable oils for preparation of margarines, etc., and some effort should be made to utilize the fat-soluble vitamine contained in green leaves.

Green leaves are a cheap and readily available source of the fat-soluble vitamine, and adults can probably maintain good health when animal fats are substituted by vegetable fats if green-leaf vegetables are consumed in fair quantity. In case of this vitamine, the loss involved in ordinary cooking is not serious. Unfortunately infants or very young children cannot take green vegetables in the ordinary way, but the juices expressed from cabbages and other green-leaf vegetables, raw or even after steaming (not immersing in boiling water) for a few minutes, might be given even to infants if all other sources of this most necessary vitamine have failed.

Purees, carefully prepared from cooked spinach or lettuce, can be tolerated in small quantities (one teaspoonful daily) by many young infants, and the amount taken can be increased regularly with age.

In cases where rickets or growth failure or xerophthalmia are already well established, a daily dose of codliver oil is essential in addition to all other procedure.

Pregnant and nursing mothers should have as liberal a supply of the fat-soluble factor as is possible. Rickets is not confined to artificially fed children. Breast-fed children depend for an adequate supply of this factor on the milk, which in turn depends upon the diet of the mother.

(3) Prevention Of Scurvy

Use of germinated seeds. If fresh vegetables or fruit are scarce or absent an antiscorbutic food can be prepared by moistening any available seeds (wheat, barley, rye, peas, beans, lentils) and allowing them to germinate. It is necessary, of course, that these should be in the natural whole condition, not milled or split. The seeds should be soaked in water for 24 hours, and kept moist with access of air for 1-3 days, by which time they will have sprouted. This sprouted material possesses an antiscorbutic value equal to that of many fresh vegetables, and should be cooked in the ordinary Way for as short a time as possible.

In case of shortage it should be remembered that salads are of more value than cooked vegetables. The extent to which the antiscorbutic factor is destroyed during cooking depends chiefly upon the time employed. When supplies are limited vegetables should be cooked separately and for as short a time as possible; they should not be cooked for long periods with meat in soups or stews.

Preserved foods, with a few exceptions, may be regarded as devoid of the antiscorbutic principle. Lemon juice retains some value in this respect; canned tomatoes (and presumably other tinned acid fruits) have also antiscorbutic value. Canned vegetables are useless for prevention of scurvy, as also are dried vegetables.

Infantile scurvy must be considered separately as many of the above foodstuffs are unsuited to infants or young children. To avert danger all artificially nourished infants should receive an extra antiscorbutic. Cow's milk, even when raw, is not rich in the antiscorbutic vitamine; when heated, dried, or preserved, the amount contained is still further reduced. The most suitable antiscorbutic material to use is fresh orange juice, 1-3 or 4 teaspoonfuls (5-15 c.c.) daily, according to age. Raw swede (or, if unavailable, turnip) juice is a potent antiscorbutic, and an excellent substitute for orange juice; to obtain the juice the clean-cut surface is grated on an ordinary kitchen grater and the pulp obtained is squeezed in muslin. Tomato juice, even from canned tomatoes, and grape juice can also be used; the latter is, however, less potent than orange juice, and a larger dose should be given.

Pregnant And Nursing Mothers

If babies are breast fed it is important that the pregnant and nursing mother should receive an adequate supply of antiscorbutic food in her diet. The popular belief that green vegetables are harmful in such cases is often without foundation. Infantile scurvy is not unknown in breast-fed children.

It is evident that many of the above deficiency diseases are rife among the populations of Central and Eastern Europe. It is essential, therefore, that the principles set forth in the preceding paragraphs should be fully understood by all persons engaged in administering relief to these districts. Signed on behalf of the Committee,

F. G. Hopkins, Chairman. Harriette Chick, Secretary. June, 1919.