Epidemiology and public health in 1906 England: Arthur Newsholme's methodological innovation to study breastfeeding and fatal diarrhea.

In 1906 Arthur Newsholme linked artificial feeding and fatal diarrhea in infants aged one year and younger on the basis of two independent sources of information: mortality registration and a three-year (1903-1905) census of infants from Brighton, United Kingdom. Artificial feeding was more common in the infants who had died (89.3%) than in those in the survey (22.3%). However, boldly assuming the two data sources were nested, Newsholme computed the risks of fatal diarrhea: these were 48 times greater for infants fed fresh cow's milk and 94 times greater for those fed condensed milk than for infants who were exclusively breastfed. This mode of computing risks and risk ratios before the invention of the cohort study design was more innovative than was the usual investigation techniques of his contemporary epidemiologists. Newsholme's conclusions were consistent with the current knowledge that breastfeeding protects against fatal diarrhea.

The impact of water supply and sanitation on area differentials in the decline of diarrhoeal disease mortality among infants in Stockholm 1878-1925.

This study analyses the impact of improved water supply and sanitation on the level and rate of decline of child diarrhoea mortality in Stockholm 1878-1925. Previous studies have failed to demonstrate an effect of improved water supply on the risk of diarrhoea mortality at the individual level. Using data on access to water and sanitation from a household survey in 1895 and mortality rates and sociodemographic information from individual data 1878-1925 to analyse area differentials in diarrhoea mortality, it was found that the proportion having their own latrine in the household was associated with lower mortality risk in 1895-1900, while the proportion having water in the household was associated with lower diarrhoea mortality risk during the mortality decline until 1925. Population effects of improved water and sanitation on diarrhoea mortality may be better measured at area level than at individual level.

Correspondence of George Newman (1870-1948) during his years as school boy, medical student and recent graduate (1880-1907).

The correspondence is reported of Sir George Newman, the first Chief Medical Officer of the United Kingdom, during his school and university education. Extracts are included of this hitherto unpublished correspondence with his family members. His conception of idealistic service to the community, first enunciated in his school days, was expanded by practical action as a medical student among the urban poor of the Cowgate, Edinburgh. The correspondence reveals his unmarried maternal aunt as the person who influenced him most.

The evolution of therapy for dehydration: should deficit therapy still be taught?

OBJECTIVE: To describe the evolution of rehydration therapy for cholera and diarrheal dehydration from its beginning in 1832 to the present. To reaffirm the central role for extracellular fluid (ECF) expansion and question the continued teaching of deficit therapy in many current pediatric texts. METHODOLOGY: I reviewed the rationale underlying three treatment strategies: rapid parenteral infusions of saline solutions to restore ECF; deficit therapy to replace specific electrolyte and water losses; and oral rehydration therapy (ORT) to effect both. I used crude mortality rates as the measure of outcomes. RESULTS: (1) Beginning in 1832 for cholera and 1918 for infant diarrheal dehydration, parenteral saline infusions were infused to replace losses of salt and water; they were very effective in salvaging moribund dehydrated patients by quickly restoring ECF volume and renal perfusion. Mortality rates dropped from more than 60% to less than 30%. (2) Deficit therapy as it evolved in the 1950s defined potassium and other fluid and electrolyte deficits and replaced them using specific but complicated fluid and electrolyte replacement regimens. Mortality rates dropped to single digits. (3) ORT, with intravenous expansion of ECF volume when indicated, rapidly corrected specific fluid and electrolyte disorders with a very simple therapeutic regimen. Mortality rates dropped to less than 1%. CONCLUSIONS: The simpler, more effective ORT regimen should be taught as standard therapy for diarrheal dehydration. Principles of body fluid physiology should be taught in their own right.

[The history of the first "voluntary" oral hydration center in Mexico (1959)]. / Historia del primer centro de hidratación oral "voluntaria" en México. (1959).

There are some historic facts about the "First Center for Voluntary Oral Rehydration" begun 1959 at Hospital Infantil de México (Children's Hospital) was clearly demonstrated useful, 508 infants with diarrhea were treated. 90.94% were cured and dehydration corrected. Antibiotics were not much useful. Oral rehydration is considered the method of choice to begin treatment of the patient with gastroenteritis.