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THE USE OF BANANA PULP IN THE
FEEDING OF MARASMIC INFANTS.
BY
H. THURSFIELD, M.D., F.R.C.P.,
Physician to the Hospital for Sick Children, Great Ormond Street, London.
Physician to O.P.; St. Bartholomew's Hospital.
The experience of all childrens' physicians in the feeding of marasnil
infants is, I suppose, identical. It is not difficult to devise a method of feeding
which shall be sufficient in quantity, and scientific in quality, and further
is tolerable to the infant: but it is extremely difficult to secure that such a
food shall be absorbed and built up into the tissues of the body. I am, of
course, using the term marasmus in a strict sense to indicate that condition
in which wasting disease is progressive or stationary without sufficient discoverable cause. In such cases it is, I believe, a common experience for the
physician to find that in spite of his efforts to contrive a food which will benefit
his patient, the condition remains unaltered for many weeks, with no gain in
weight or strength, and yet with no appreciable lack of capacity in the digestion
of the various foodstuffs of which trial is made. Further it is, I think not
uncommon to find that such infants begin to put on weight, if their food
contains an excess of carbohydrate material; and it is probable that this
factor is mainly responsible for the reputation of some of the proprietary
foods which contain starch or starch-products in large quantity. Yet even
with the use of such foods there is a proportion of marasmic infants, who
steadily refuse to improve and are the despair of the physician and the nurse.
It is with cases of this type that I have lately experimented with the use of
ripe banana pulp to supply the excess of carbohydrate which seems to be
required, and the sudden and to me the unexpected improvement appears to
be worth recording.
The cases to which I shall refer are six in number; four of the true
marasmic type, and two " ruminators."
The first patient was admitted to the Hospital at the age of three months
weighing about ten pounds. He had had a convulsion at the age of six weeks
and since then had suffered from intermittent vomiting and failure to progress.
In the ward the vomiting soon ceased but at the end of ten weeks in the Hospital
he had made no gain in weight and actually weighed rather less than on
admission. He was at this time on a diet which consisted of cows' milk, whey
and Benger's Food. This had a calorie value of 580 C. per diem and was readily
taken and retained and apparently well digested. Of the 580 C. roughly
300 were carbohydrate, 200 fat, and the remainder protein. At this point
he was given the pulp of one ripe banana per diem and a few days later the
Benger's food was omitted and on May 1st his diet was merely cows' milk
and the pulp of two bananas with a calorie value of about 590 C. A reference
L) 2
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ARCHIVES OF DISEASE IN CHILDHOOD
50
to the chart will show that the weight had already taken an upward turn.
The pulp of a second banana was added and shortly it was possible to increase
the amount of milk, an increase which had always previously been attended
by indigestion and loss of weight. He was discharged from the Hospital three
weeks after he had begun the banana diet on a diet of about 700 C. of which
100 C. were banana-carbohydrate calories.
CHART I.
G.H. 3/12. Admitted 20.XI.25. From date of admission to 10.Iv.26,
no
gain in weight.
Mlay
April
10
12
14
18
16
20
25
27
26
29
30
1
4
2
6
8
10
9
12
1I
18
14
15
r
*
-
p)
I
.
I
it lb.
14
12
i
i
0
I
1%.I
. .4
I
t
10
-I
pq
i
-1
I
i i
I I
I
I
2
10 lb.
-I
.
I 00*1
I /A. -vrl
.AIII
.
I
I 'VI
I- I
I
I I
I
I
II(A I
I
I
-I
I
.
a
-I
14
II
12
I
I
I
-
4
x
:7 H
I~
6-
8
6
.I
V'
I
10
S
6
9
lb.
4
IV
t
I
L-
.d
i
L- L-
I have gone somewhat into detail in this case so that I shall not need
to repeat the minuter details in other instances. The point which I wish to
emphasise is that the addition of the banana pulp to the diet did not increase,
but in fact slightly diminished, his total carbohydrate intake, though it maintained it at a point considerably above the normal proportion found in cows'
milk: that is, that the good effects must not be attributed to added carbohydrate, but rather to the special form in which this was given, i.e., the
banana pulp.
4-
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USE OF BANANA PULP IN MARASMIC INFANTS
51
The second, third and fourth charts exhibit the same phenomenon,
though in an even more marked degree. The addition of banana pulp to the
diet, replacing some of the carbohydrate previously given in another form,
had the effect of increasing the weight and general well-being almost at once.
I must here add that the change in the general condition must be seen to be
appreciated at its proper value: from puling unsatisfactory infants they
quickly became smiling and contented children. When once improvement
has begun the amount of food which can be taken and utilised is rapidly
increased. In the first case the increase in weight took place without any
marked addition to the actual amount consumed, but in some of the other
cases after the increase had begun with an unchanged amount of milk, this
could be augmented rapidly without any fear of indigestion, whereas the
previous attempts to increase the intake had invariably failed for this reason.
This feature was especially noticeable in the patient whose progress is recorded
CHART II.
CHART III.
From admission to April 14,
Apr!-il
__
Atay 2
14 15 17 20 22 24 26 27 28 29 30 1
_
6
4 _ _
r-
2}_
3
I -I
I
__
10
__
4
_l_ r
12
14
.6 I
I
5 27
4
-
No V.
1-1
1110
I
I
I
Weight stationary till Nov. 22nd.
gain in weight.
no
F.
I
II
I I
I I
II
II
___
_I
I
6 _
4
i _4
9
w U~v
II I
II
I
4
I
I
I
I
14
12
10
f
I
:7
IIV
04
8
l
811).
I-I
11
11
11
11
I
I
_.
I* I
11
I
F.
IEI
II
II
II
12
10
8
i
6
11
11
I
I
I
4
11
lb.
I
I
I
-
+---4i----4
II I
II I
II I
II
II
1..f---+
I
I
I -1
I
I
*1
I
I
I
I
)
10
8
6
II I
I
I)
A^
II
(
d!t .41
PI. I
I ffII )P1
I -I -I / I I I
I I
-*I I -.1
I
I I I I -I
II - I I I I I
1,
30
1Z
t
I
I
I
l
23 26
r---lT--"
I
I
-I I
I I
rI
14
IE
20 21
I
I
t-
17
w
12 11bb.
-
4
I
I
E
11-1 I
-I
II
lb.
14
12)
10
6
7
Dec.
8
10 12 14 15
6
21 30 2 4
r-"r--rr--Tr---rr---rr--Tr---l r--" ---I ---If
I
6
Q.
ft
22
S
10 _
8
Admitted 23.ix.24.
M.B. 4/12.
C.C. Aged 9/12. Admitted 17.ii.25.
V
#- 1
I
II
III
I
I I
I- .
I-I
I
I -I
---%I
:.w F-
+-
-
+---4
I
I
I
I -1
I I
I
I -I
--j
.
. I
. I
Li.,-j--j.1__j--I L L L-1 __j --i -1 L
t
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ARCHIVES OF DISEASE IN CHILDHOOD
52
in Chart IV. Repeated attempts had been made to increase the amount of
intake and each attempt had been followed by a set-back due to indigestion.
Wheni once the improvement had been initiated by the use of the banana pulp
CHART IV.
T.W. 7112. Admitted 9.vii.26.
No gain in weight.
Aug.
Sept.
Nov.
Oct.
July 26 2S 2 6 1216 28 1 7 12 1619 2126 30 1 2 4 7 1317 2124 29 2
13 lb. 14 _ _ _ _ _ _ _ _ - -- - - I 1 1'1-41
13 lb.
12
10
4
12 11).
14
10
6
144
t
{
t
11 11).
14
12
10
8
4
10 lb.
14
10
it was possible to add milk in considerable quantity to her diet, and eventually
rusks, green vegetable and gravy. The same thing was observed in the case
of the older of the two " ruminators." In the younger the increase in weight
took place without any addition to the total calorie value of the diet. These
two " ruminating " cases belong to a slightly different category than that of
the other infants. They are marasmic infants, but there is an appreciable
cause for their steady refusal to put on weight, in the " rumination " and
rejection of some portion of the food which they have actually swallowed.
Yet in both cases the addition of the banana pulp was the first step in solving
the problem of the feeding.
To sum up the facts here recorded: six infants in whom the prolonged
efforts of the physician, his house-physicianis, and the Sister, had entirelyfailed to produce any improvement in power of absorption and utilisation of
food, with the addition of comparatively small quantities of banana pulp at
once began to make headway.
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VISE OF BANANA PULP IN TMARASMIC INFANTS
53
Naturally the question arises as to the property in the pulp which is apt
to produce such welcome resuilts. The actual facts regarding the composition
of the banaiia are as follows : Of 100 grami-ines of ripe banana pulp approx-
CHART VI.
F.G. 8/12. Admitted 2.iv.205.
Ruminator.
CHART V.
D.S. 1/12. Admitted 21.x.24. Riiminator.
Weight stationary from August
to Deceniber.
1
.11
IDee.
13
4
6
9
11
1I
13 14
1618
90 2:3
27,
21)
April
3
8
1a
lb.
50 2t
27
?.0
MIay
2
4
8
10
H--
1? h.
4
11).
_f_ _X
_
--_-- ___1
___
14 0_._
_
----I
__ _
4
12 lb.
14
_
_r
40 __
12
S
el ___t
s4 __ _-__ _ w82
11 11).
S
11 11.
10 0.
___
___
___ __
__ _ _
__ ___
9 lb.
imately 70 are water; about 1.5 grm. are fibre, which is mainly discarded
in the method of preparation which has been employed; and from 21 to 27
grm. represent starch or sugar. There is practically no fat, less than 0.1 grin.
per cent. and protein is about half of one per cent. Ripe banana pulp prepared
as will presently be described, may be considered to have a food-calorie value
of 85-100 C. per 100 grammes. The average weight of one stripped banana
varies from 50-70 grammes. In addition, bananas have a certain, not a high,
anti-scorbutic content, and contain water-soluble B. Their content of fatsoluble A is negligible.
I think it may safely be concluded that the results are not due to any of
these vitamines. In all the cases recorded fresh orange-juice had been given
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54
ARCHIVES OF DISEASE IN CHILDHOOD
in ample quantity during the whole of the ' pre-banana ' period. It certainly
cannot be contended that it is due to the mere addition of carbohydrate because
sometimes, as in the first case, the total carbohydrate intake was actually
diminished when the banana pulp was added.
Nor can the nature of the carbohydrate account for the effects produced.
In a ripe banana the starch has been converted into various sugars, chiefly, it
would appear, maltose and glucose, with a small proportion of saccharose:
that is, broadly speaking, sugars identical with those present in the malted
foods such as Benger's.
The method which we have used in preparing the banana pulps is as
follows: A ripe banana with as few bruises as possible is selected, stripped
and any bruised portion cut away. The obvious fibres are removed and the
remainder is pulped with a fork and then strained through coarse-meshed
muslin so that the fibrous portions remain behind. The resulting pulp is
mixed with the milk in the proportions ordered in one or several feeds;
the pulp of one average banana being considered to have a calorie value of
rouighly 50 C. The teat used for the bottle has an aperture rather larger than
usual.
A further point which should be noted is that the stools of infants on the
pulp present a characteristic appearance; small black particles which represent
the fibre which has passed through the sieving process are so abundant as to
give the stool a stippled appearance.
SUMMARY.
An account is given of a method of feeding ' difficult ' infants with
banana pulp.
It is claimed that by this method in many cases progress is secured
which is superior to that obtained by other methods.
It is suggested that the benefit is due not to any known peculiarity of the
banana as a food, but possibly to some unidentified eIaent in the banana.
I may add that Dr. Harrison investigated this point for niwithout discovering
anv new elemeint.
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The Use of Banana Pulp in the
Feeding of Marasmic Infants
H. Thursfield
Arch Dis Child 1927 2: 49-54
doi: 10.1136/adc.2.7.49
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