NUTRITIONAL DISTURBANCES IN CHILDREN 335 



CARBOHYDRATE DYSTROPHY (MEHLNAHRSCHADEN) 



It is evident that under this name conditions are classified, the 

 etiology of which is fundamentally different. In 1905-1910, par- 

 ticularly in Germany, but also in other countries, widespread diseases 

 of children appeared. These arose as the result of proprietary foods 

 fed over a long period of time. Czerny (1181) was first to recognize 

 the dangers of this regime, and called the resultant condition, 

 "Mehlnahrschaden." It need hardly be said that the disease occurred 

 only in artificially fed babies. Children who could tolerate cow's 

 milk'poorly or not at all, were fed for weeks, more often for months, 

 on various proprietary foods. Recently, Bloch (1181a) also warned 

 against the danger of a carbohydrate-rich diet in infants. At first, 

 this food seems to be well tolerated; the splendid appearance of the 

 child permits of no suspicion that the food in inadequate. Later, 

 however, after a lapse of time which varies within wide limits in 

 different children, a disease develops which, according to Rietschel 

 (1182), occurs in three different forms: pure atrophic (hunger), 

 atrophic-hydremic and hypertonic. 



The pure atrophic form occurs in children fed on flour, with the 

 following symptoms. The stools react acid, with considerable slimy 

 substance and fermentation. At the same time, there develops a 

 severe atrophic hypertonicity of the musculature; the muscles are 

 tightly stretched, which simulates a healthy condition. Electrical 

 supersensitivity of the peripheral nerves is frequently noted. Here, 

 there is often a great susceptibility to secondary infections (thrush, 

 aphthae, abscesses of the skin, otitis, phlegmons, and pneumonia). 

 In spite of the severe symptoms, the gastro-intestinal tract, on 

 autopsy, is found almost intact. 



The atrophic-hydremic form manifests itself, at the beginning, in 

 edema of the lower extremeties, which, according to Noeggerath 

 (1183) is due to heart weakness; later, the children show a blown-up 

 face, sometimes also scorbutic changes of the gums (Bogen, 1184). 



The hypertonic form resembles peripheral nerve affections very 

 much. In this category, we find cases where the legs are drawn up 

 to the abdomen, with rigid spinal column, tetany with increased 

 electrical irritability and carpopedal spasms lasting for weeks. The 

 prognosis is bad and the children die with neuritis (Griineberg, 1185). 



