certain features of the nutritional value of milk: a ... · assessing the potency of specific food...

CERTAIN FEATURES OF THE NUTRITIONAL VALUE OF MILK:A TRIBUTE TO GAIL BORDEN

Borden Award Address

By A. A. Weech, M.D.Children’s Hospital Research Foundation and the Department of Pediatrics,

College of Medicine, University of Cincinnati

Presented at the Annual Meeti’:g, October 10, 1956.

ADDRESS: Elland Avenue and Bethesda, Cincinnati 29, Ohio.

330

[In presenting the Borden Award to Dr.

Weech, Dr. Harry Bakwin, President of the

Academy read the following citation : “for his

fundamental contributions in major fields of

pediatric investigation. His studies in rickets,

nutritional edema and physiologic hyperbili-

rubinemia stimulated newer lines of thought of

the pathogenesis of these conditions. He char-

acterized nutritional edema as a disturbanceresulting from inadequate dietary protein. Asthe concentration of albumin in serum repre-

sents a practical means of recognizing protein

deprivation in the pre-edema stages, he under-

took studies of the effect of many basic dietarysubstances on the synthesis of this blood corn-

ponent. His comprehensive investigation of

the causation of jaundice of the newborn estab-

lished its relationship to liver immaturity. Dr.Weech is also being honored for his inspira-

tional qualities as a teacher and a leader of re-search in numerous aspects of child health andwelfare.”]

O N THE ANNUAL occasion of the presenta-

tion of the Borden Award of the

American Academy of Pediatrics it is

precedent that the recipient review those

aspects of his personal investigations as

have been cited by the Awards Committee

in justification of its decision. In the face of

such tradition I was at first perplexed. The

citation begins by averring that selection

has rested on “fundamental contributions in

major fields of pediatric investigation.” The

statement is broad, too broad to serve the

purpose of concise review. The citation goes

on to mention studies in rickets, bili-

rubinemia, nutritional edema and basic

dietary substances essential for the syn-

thesis of serum albumin. The broad range

of investigations still defies terse retrospec-

tive survey. Some other bond is needed to

tie together the component parts of a speech

of acceptance.

The occasion itself will furnish the bond

for which I seek. The gold medals that ac-

company a Borden Award carry upon them

in bas-relief the image of Gail Borden (Fig.

1). They remind us that these affairs of

presentation have in reality a dual purpose.

On the one hand they permit us of the

American Academy, and others in compar-

able national organizations, to express in

tangible form affection and respect for the

accomplishments of one of our group. In

quite another way they serve to keep alive

the memory of a great scientist of a cen-

tury ago. Gail Borden1 whose life span ran

from 1801 to 1874 was indeed a man of

many abilities. Farming, stockraising, news-

paper publishing, and surveying in Missis-

sippi and Texas were all among his activi-

ties. As a surveyor he laid out much of the

city of Galveston and for some years was

collector of customs there. Gail Borden was

also a self-made scientist and inventor. In

1856-just a hundred years ago-he was

granted a federal patent on a process for

producing condensed or evaporated milk.

Here in the field of nutrition lies the bond

of linkage to which I have referred. It will

become clear as the essay unfolds how the

logical links may be forged. For the moment

we shall note that Borden was not satisfied

with mere science of discovery. With fi-

nancial help from Jeremiah Milbank the

first evaporating milk plant was opened in

1858.

F shall not attempt to assert that Borden

was primarily concerned with the preven-

by guest on August 22, 2020www.aappublications.org/newsDownloaded from

AMERICAN ACADEMY OF PEDIATRICS - PROCEEDINGS 331

FIG. 1.

tion of nutritional edema or even with

eradicating the milder signs of dietary

deficits of protein. Nevertheless, history re-

veals that the term “nutritional edema” is

synonymous with many nosobogic expres-

sions born of human adversity. Among the

expressions we find such words as “war

edema,” “camp edema,” “prison edema,” etc.

Within a few years of the start of com-

mercial production of evaporated milk our

country was to l)ecome engulfed in a tragic

civil war. It is a matter of record that during

the strife the product was described as

being of “greatest value” to the troops of

the Union Army. In my own mind there is

no doubt that the wide use of evaporated

milk by the Army mitigated to some extent

the otherwise devastating consequences of

dietary protein privation. This is a dogmatic

statement. We shall try to support it with

evidence.

To present evidence adequately there is

first required a method. Over a number of

years my colleagues and I had studied, in

dogs, the consequences of inadequate die-

tary protein, that is, of maintenance on a

diet yielding a negative nitrogen balance.

Two of the consequences immediately con-

cern us here: (a) maintenance on the diet

is accompanied by a steady decline in the

serum concentration of albumin; (b) an as-

sociation exists between the serum albumin

concentration and the presence or absence

of edema. I might add that although mul-


NUMBER OF DAYS ON PROTEIN DEFICIENT DIET

332 WEECH - NUTRITIONAL VALUE OF �lILK

‘S

zU

MI

0

0

NUMUR OF ANIMALS

FIG. 2. The average trends of albumin, globulin, and total protein during maintenance on the low pro-

tein diet. The dotted lines above and below the unbroken lines for albumin and total protein are placed

at a distance of one standard deviation from the average values. (From the Journal of Experimental

Medicine.’)

tiple factors are concerned in the accumu-

bation of tissue fluid that leads to edema,

there is little doubt that depleted serum

albumin is a major cause of edema.

Figure 22 depicts the average course of

the serum proteins in a group of dogs sub-

sisting on a diet which permitted a daily

loss of nitrogen of 1.15 gm. It is apparent

that the steady decline in total serum pro-

tein concentration is due almost exclusively

to depletion of the albumin moiety. It is

further apparent that the charted pathway

of depletion is not linear, that losses in con-

centration are greater during the early days

and weeks than later in the experiment. The

slowing in the rate of decline with the pas-

sage of time has been shown in metabolism

studies to be associated with a progressive

diminution in the nitrogen lost by the body.

There is thus portrayed an adaptive ability

of the body in adjusting its metabolic pro-

cesses so as to spare protein.

Figure 33 shows the association in these

animals between plasma protein concentra-

tions and edema. The black dots represent

analyses of plasma made when edema was

present and the open circles refer to estima-

tions before edema had developed or in a

few instances after it had disappeared.

Edema rarely appeared before the albumin

was below 2�; it was more often present

than absent when the albumin was between


8

ALBUMIN GLOBULIN

7

TOTAL

6

5

4

3

UU

00

Lu

a.ui

2

1


1 and 2%; below 1% edema was always pres-

ent. Between globulin and edema no corre-

lation can be discerned.

The foregoing association between de-

ficits in serum albumin and the existence of

edema led naturally to attempts to discover

which dietary proteins would be most effec-

tive in promoting albumin synthesis and

thereby relieving edema. The dog rendered

hypoalbummnemic by dietary deprivation

could obviously be used as a test animal for

assessing the potency of specific food pro-

teins in bringing about increases in serum

albumin concentrations. An additional ob-

servation brought greater confidence in the

validity of an assessment of this type. This

observation was that the path of replenish-

ment of serum albumin concentration from

a depleted level and on a standardized in-

take of test-food protein is linear until the

deficit has been obliterated, that is, re-

plenishment does not simply reverse the

path of depletion. Figure 44 illustrates the

linear nature of the regeneration gradient

and will help in understanding why the

slope of the gradient can be used as a meas-

ure of the synthesizing value of a food pro-

tein undergoing test. Apparently the value

obtained from an assay will be independent

of the initial degree of depletion.

In assaying the various food proteins we

used a standardized regeneration diet fur-

nishing 5 gm of protein per kilogram of

body weight. An assay value was defined as

the gain in grams per cent of serum albumin

concentration over a period of 7 days plus

Fir.. 3. The relation between plasma protein concentration and edema in dogs. Open circles indicateeStilflationS when no edema was present; black circles refer to determinations when edema was present;

vertical lines in the middle of each column indicate the range of normal variation. (From the Journal ofClinical Investigation.3)


3.’

ALBUMIN L(VIL BEFORE DEPLITION

,.. 3S �zwU

3.7 �wI.

‘1a 3.1 .

I,

3.5 �

z0 3.� � .

p.

p. 33 � .zwU20 33 .

U

22 3.1 �

�

‘(

RIG�NERAYION GRADUINTON

2 3.0 � DIET OP Bur CHUCK

* 2., �

(AVERAGE PINDINGS - 4 DOGS)

I 2 3 4 5 1 7 S

DAYS ON IVIP SIlT

Fic. 4. (From the Bulletin of the John.s Hopkins Hospital.4)

S 10

334 WEECH - NUTRITIONAL VALUE OF MILK

0.15, a figure corresponding to the average

expected loss during the 7-day period if no

test protein were being fed. Recorded po-

tency values for each food protein represent

the average of a number of assay values.

Table J5 summarizes the food proteins

that have been so characterized. They are

arranged in descending order of effective-

ness in promoting the synthesis of serum

albumin. It is perhaps not surprising that

serum itself should be in the highest cate-

gory of potency but it was a surprise to us

that the whey protein of milk, soluble lact-

albumin, did not differ significantly in po-

tency from serum. It is worthy of note that

the soluble lactalbumin used in these ex-

periments was prepared without cost by

Dr. George C. Supplee in the laboratories

of the Borden Milk Company in Bainbridge,

New York. The other milk protein, casein,

acts effectively in stimulating the synthesis

and belongs in the same grouping as liver

and muscle.

There is no doubt then that the proteins

of milk constituting part of a diet can be

highly efficient deterrents to the develop-

ment of depleted serum albumin and nu-

tritional edema. The evidence has been pre-

sented and constitutes a reason for believing

that evaporated milk, the discovery of Gail

Borden, was of genuine value in maintain-

ing a positive nitrogen balance in the

soldiers of the Army of the Republic.

In quite another way, by necessity tin-

foreseen at the time of invention, evapor-

ated milk was destined to play a leading

role in the ultimate conquest of a then

rampant nutritional disease. I bring the sub-

ject up because the citation accompanying

this Borden Award mentions contributions

once made by the recipient to the knowl-

edge of rickets. Back in the middle Twenties


1’ABLI� I

‘I’i IK l�FFI(IEN(Y OF I )IF’F:uENT Fool) PW)TEINS iou

TIlE SYNThESIS OF SERUM ALBIMIN*

\unzberPotency � of

I alue

0.801

0. 7730 . 770

0.73!)

0.61(1

0.611

0.608

0.60�2

1)453

0.475

0.445

().4�5

0.��07

-0.01)3

.ls.sa!js

11

11

11

9

H

1112

It

at Johns Hopkins and the attempt to per-

suade a reasonable number of young Negro

mothers to imbibe cod-liver oil during the

��::::::::- :-��-: period when they would he nursing their

ProbaUe babies. At this time the incidence of activeLrror rickets among breast-fed Negro infants in

� Baltimore was extremely high. The lot of

� 0.033 having to persuade adults of the human race0.04t� to drink fish oil “is not a happy one.” I was0(130 favored in the ill-conceived exneriment0 0’��)

-. (a) by the constant support of visiting nurses0.0�3 from the city’s well-baby clinics, (b) by the0.04� fact that we were dealing largely with0.0�() young mothers keenly interested in the wel-0.033 .

fare of first babies, and (c) by the cir-().thfl cumstance that I was too young to knowo.0�n better. As it turned out the amounts of cod-

().()�5 liver oil consumed by the 47 mothers in-

0.0�H eluded in the study varied widely. Never-

- the less when the infants were studied at0 . 06a

j the age of 6 months, it was possible to

demonstrate that the quantity of cod-liver

oil taken by the mother did have an effect

on the degree of rickets exhibited by the

infant.

The demonstration was made both by

roentgenography and by analysis of serum

for calcium and inorganic phosphorus. In

Figure 56 the roentgenographic findings are

* Froni t11(.� !J11114’tin of the .Io/i,is IIo/)kins JIosj)iIal.5

investigators in many places became in-

terested ill the potentialities of milk as a

vehicle for vitamin D. I was among the

many. My share of the over-all problem in-

volved daily visits to the maternity ward

2-3 : Severe

I-2 = Moderate

I � Slight

o� None

0I I I I

OIL, No l0�202O�3O(ounces) amount ofcod-liver

30..4040..50 5060oil taken in 6 months

Cases9 7 10 II 6 4Fic. 5. Analysis of roentgenograms of 47 patients whose

in a 6 months’ test period. (From the Bulletin

mothers took varying amounts of cod-liver oil

of the Johns Hopkins Hospital.’)

AMERICAN ACADE�IY OF PEDIATRICS - PROCEEDINGS

“o,iree of I(fl)d

l’ro/( ill

Ihtf sertilit ( fres}I�

S�OIUhIe IactLII11IniII

Ik�ef 50111111 (all assays)

J�(�(�f SCI’IIIII (dried)

I:gg ��Iiite

( aws colostrurii

Igg (all assays)

Igg (whole)

(‘ow’s 11111k

J�(�(�f (Illick

11(01 liv(r

(‘aseill

\\lieat gluten((l1Iti1I

0

U

*�0

00S..

as0

0

335


336 WEECH - NUTRITIONAL VALUE OF MILK

summarized. In interpreting the films cri-

teria were used that made it possible to

classify each infant numerically with re-

spect to the degree of rickets present. The

chart shows only the average findings which

are represented on the ordinate both by

the numerals that were averaged to give

each point and also by the degree of rickets

corresponding to each numeral. Successive

points along the abscissa correspond to

groups of infants whose mothers received

increasing amounts of cod-liver oil over the

6-month period. The declining curve with

respect to severity of rickets suggests

strongly that some of the vitamin D present

in cod-liver oil was finding its way into the

breast milk.

The chemical findings presented in Fig-

tire 66 are even more impressive. Here the

degree of rickets is represented on the or-

dinate by the Ca X P product. Again from

55

50

left to right along the abscissa we have th#{128}

findings in groups of babies whose mothers

received increasing quantities of cod-liver

oil. We can see clearly that a high maternal

intake of vitamin D was associate(l with a

high level of lime salts in the sera of the

infants. Again there is evidence of vitamin

D being excreted in the milk.

These studies to which I have referred

were of course only a tiny part of mass in-

vestigations of milk as a vehicle for vita-

mm D. And in turn the studies with milk

are only a small part of the total of work

on vitamin D. Out of it all a miracle has

been wrought. Today we find it difficult

to locate an occasional case of privational

rickets for teaching purposes and most of

our graduating residents have never seen a

case of rachitic tetany. Gone are the days

when Ethelbert Nevin’s immortal song,

“The Rosary,” had a persoii�il implication

No Rickets

a.4

)c ..................0 �

035Rickets May or May Not

� �

30

2Oil, No 10-20 20-30 30-40 40-50 50-60

(ounces) amount of cod-liveroil taken in6months

Cases 9 7 9 9 5 4

Fic. 6. Analysis of blood findings in 43 patients whose mothers took varying amounts of cod-liver oilin a 6 months’ test period. (From the Bulletin of the Johns Hopkins Hospital.6)



for more than 50% of the childhood popula-

tion. Gone are the days when the minds of

medical students need be clogged with

such phrases as hot-cross-bun head, caput

quadratum, Harrison’s groove, string-of-

pearl deformity or even the saber shin. I

am aware that vitamin D is now available

on the market in hundreds of different

forms. Under the circumstances it is per-

haps brash to attribute the miracle of the

disappearance of rickets to any single com-

modity. I am not alone, however, in holding

the belief that the widespread practice of

fortifying milk with vitamin D has been

the most important factor. This viewpoint

has been ably supported by the Council on

Foods and Nutrition of the American Medi-

cal Association.7 Dr. Eugene H. Stevenson,

acting secretary of the Council, informed

me recently that at the time of last tabula-

tion in February, 1955, there were listed 340

different brands of evaporated milk in this

country, all of them fortified with vitamin

D. The opinion seems justified that this al-

most universal fortification of evaporated

milk has done more than has anything else

to eradicate rickets in the very segments

of the population least liable to avail itself

of what we may call the newer knowledge

of nutrition.

I wish now to conclude this speech of

acceptance by dedicating it to the memory

of Gail Borden on the centennial of the

issuing of the patent on his process for pro-

ducing evaporated milk.

REFERENCES

1. Frantz, Joe B. : “Gail Borden; Dairyman toa Nation.” Oklahoma City, Univ. Okla-homa Press, 1951.

2. Weech, A. A., Goettsch, E., and Reeves,E. B. : Nutritional edema in the dog; de-velopment of hypoproteinemia on a diet

deficient in protein. J. Exper. Med., 61:299, 1935.

3. Weech, A. A., Snelling, C. E., and Goettsch,

E. : Relation between plasma protein con-

tent, plasma specific gravity and edemain dogs maintained on a protein made-

quate diet and in dogs rendered edema-tous by plasmapheresis. J. Clin. Investi-gation, 12:193, 1933.

4. Weech, A. A., and Goettsch, E. : Dietary

protein and the regeneration of serum

albumin; method of assay and discussionof principles. Bull. Johns Hopkins Hosp.,63:154, 1938.

5. Weech, A. A. : Dietary protein and the re-

generation of serum albumin; potencyvalues of dried beef serum, whole egg,

cow’s milk, cow’s colostrum, lactalbumin,and wheat gluten. Bull. Johns HopkinsHosp., 70:157, 1942.

6. Weech, A. A. : Influence of the administra-tion of cod-liver oil to the mother on the

development of rickets in the infant. Bull.Johns Hopkins Hosp., 40:244, 1927.

7. Importance of Vitamin D Milk. Report ofthe Council on Foods and Nutrition

of the American Medical Association.

J.A.M.A., 159:1018, 1955.


1957;19;330Pediatrics A. A. Weech

TO GAIL BORDEN: Borden Award AddressCERTAIN FEATURES OF THE NUTRITIONAL VALUE OF MILK: A TRIBUTE

ServicesUpdated Information &

http://pediatrics.aappublications.org/content/19/2/330including high resolution figures, can be found at:

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtmlentirety can be found online at: Information about reproducing this article in parts (figures, tables) or in its

Reprintshttp://www.aappublications.org/site/misc/reprints.xhtmlInformation about ordering reprints can be found online:


http://http://pediatrics.aappublications.org/content/19/2/330

http://www.aappublications.org/site/misc/Permissions.xhtml

http://www.aappublications.org/site/misc/reprints.xhtml

1957;19;330Pediatrics A. A. Weech

TO GAIL BORDEN: Borden Award AddressCERTAIN FEATURES OF THE NUTRITIONAL VALUE OF MILK: A TRIBUTE

http://pediatrics.aappublications.org/content/19/2/330the World Wide Web at:

The online version of this article, along with updated information and services, is located on

American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397. American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 1957 by thebeen published continuously since 1948. Pediatrics is owned, published, and trademarked by the Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has


http://pediatrics.aappublications.org/content/19/2/330

certain features of the nutritional value of milk: a ... · assessing the potency of specific food...

Documents