Frederic W. Schlutz

The lung volume and its subdivisions in normal boys 10-17 years of age.

disease. Because the absolute values obtained have no meaning for children varying so greatly in size, except as they can be referred to some standard of reference, such as height, weight, and other measurements of body size, the results were analyzed by statistical methods in order to determine the relation of the lung volume and its subdivisions to various physical characteristics of the child. These relationships were then expressed in the form of regression equations which can be used to predict the lung volume and its subdivisions for a given individual and, by means of the standard error of estimate, can give a measure of the amount of variation that may be expected in the normal child. Of the various subdivisions of the lung volume

Is breast milk adequate in meeting the thiamine requirement of infants

Summary 1. Thiamine and pyrimidine have been determined by microfermentation technique in eighteen double collection periods, of four hours each, for fourteen infants. 2. Nine infants receiving unsupplemented breast milk excreted 3.0 μg of thiamine and 9.0 μg of pyrimidine during the first four hours and 6.5 μg of thiamine and 8.4 μg of pyrimidine during the second four hours. The administration of a test thiamine dose between the two periods did not affect the results materially. These infants had received breast milk containing about 20 μg of thiamine per 100 ml., which gave them daily intakes, depending on their size, of between 150 and 210 μg of thiamine. 3. One 22-week-old infant on unsupplemented breast milk excreted 37.1 μg of thiamine after his test dose, as compared to 3.2 μg during the first four hours. He had received milk containing about 23.5 μg of thiamine per 100 ml. to give him an intake of approximately 325 μg of thiamine. 4. Eight infants whose mothers had received vitamin B 1 supplements,or who had been given evaporated milk formulas, excreted larger amounts of both thiamine and pyrimidine than did the unsupplemented breast-fed infants. Averages of 11.6 and 41.6 μg of thiamine and 12.8 and 20.1 μg of pyrimidine were found for the first and second four-hour periods, showing that these infants had not needed to retain their test doses as had the other group of infants. 5. It was concluded that young infants appear to have a minimumthiamine requirement of approximately 200 μg daily. This can just be met by the normal healthy infant if his mothers milk contains 20 or more μg of thiamine per 100 ml. The suggestion is made that 40 μg of thiamine per kilogram may be a practical standard to cover the ordinary needs of the young infant.

The influence of fruit and vegetable feeding upon the iron metabolism of the infant

Summary 1. A study of the iron metabolism of three normal infants, ranging in age from five weeks to seven months, has shown that vegetable (spinach) or fruit (apricots) feeding in addition to the milk formula exerts no significant effect upon the amount of iron retained by the infant. Such feeding increased the iron intake 60 to 171 per cent. The hemoglobin concentration and the number of erythrocytes in the blood were within or above the normal range for infants of this vicinity and age, and were not raised by the vegetable or fruit feeding. 2. A study of the effect of such feeding upon an anemic infant, twenty-three months old, who had been living on an almost exclusive milk diet, has shown a lack of effect in the case of dried spinach, but a marked increase in retention of iron when apricots were added to the diet, an effect which disappeared again after wheat germ extract was also included. The effect in each case is related to the amount of fecal matter eliminated in the metabolism period. We prefer to with-hold interpretation until more data are available. The hemoglobin concentration and erythrocyte count of the blood were not improved during the course of such feeding. 3. A very large increase in the concentration of soluble iron in the diet of the anemic infant, brought about by adding ferric ammonium citrate, resulted in a large increased retention of iron, but up to the end of three weeks on the diet, only a very slight increase in the number of erythrocytes had occurred and practically no change in hemoglobin concentration. 4. When the diet of the anemic infant was further supplemented by liver, the retention of iron was increased still more. The retention in this instance was accompanied by a rise in hemoglobin from 6.0 to 9.1

The comparative values of various carbohydratesused in infant feeding

Summary The monosaccharides—glucose and levulose; the disaccharides—sucroseand lactose; and the sugar combinations—dextrimaltose, karo corn syrup, and honey have been compared as to their value in infant feeding. One hundred twenty-three blood sugar tolerance curves were determined following administration of 2 gm. of sugar per kilogram of body weight to four children aged 7 to 13 years and to nine infants aged 2 to 6 months. Fasting blood sugar ranged from 87 to 110 for the older children and from 76 to 92 for the infants, with average values of 97 for the children and 86 for the infants. Although considerable difference in rates of absorption was encounteredbetween results from different individuals, an individual in general maintained a certain type of blood sugar curve. The relative differences in results between kinds of sugars also remained comparable for the various individuals. Repeated tests with the same individual were considered to have an important effect upon the validity of the data. The infants had a greater tolerance for glucose than did the children, while levulose gave somewhat similar results for the two age groups. Glucose, dextrimaltose, and karo gave the highest blood sugarcurves, with honey, sucrose, levulose, and lactose next in order. Honey appeared to have special advantages for infants because, withthe exception of dextrose, it was absorbed most quickly of all the sugars tested during the first fifteen minutes following ingestion, yet it did not flood the blood stream with exogenous sugar. It also maintained both a steady and a slow decrease in blood sugar until the fasting level was again reached. With its easy and widespread availability, palatability, and digestibility it would seem to be a form of carbohydrate which should have wider use in infant feeding.

The use of honey as a carbohydrate in infant feeding

Summary Ten healthy male infants have been studied during the first 6 months of their lives for a total of 151 weeks. Formulas for all infants were restricted to either evaporated or dried milk and carbohydrate, with additional supplements of pure vitamin or mineral solutions. The response of the infants to honey as a source of carbohydrate has been contrasted with their response when receiving karo corn syrup. The general well-being of the infant, the number of stools per day, and weight gains have been used to determine the value of honey in regular feedings. Besides these criteria, blood sugar tolerance studies have been employed to contrast the response to honey with that resulting from administration of other common sources of carbohydrate. From these studies it is concluded that honey is easily digested, being absorbed more rapidly than most sugars during the first fifteen minutes after ingestion. It is well tolerated by the infant and does not cause diarrhea. It may facilitate weight gains, since there was a slight tendency for greater average gains per day to occur on lower calorie intakes when honey was included in the formulas. It would seem, therefore, that honey is a type of carbohydrate which is well suited to the infants needs and probably should be recommended for wider use in infant dietaries.

Some responses of the child to exercise.

Summary The effects of exercise have been studied intensively in twelve children from 11 to 13 years of age. The study has included determinations of the changes in heart rate and systolic and diastolic pressures, resulting from both moderate and maximal work on the bicycle ergometer, and determinations of the changes in many of the blood components under the two conditions of work. An attempt has also been made to relate these changes to the nutritive status and to the physical capacity of the child. The nutritive status of each child has been established by clinical examination, by the weight and fat indices of McCloy, and by creatinine indices. Physical capacity has been measured by performance on the bicycle ergometer. With the exception of serum pH and sodium during moderate work and diastolic pressure, blood sugar, serum chloride, and CO2 tension during maximal work, all of the factors measured showed significant changes as the result of exercise. Pulse rate and systolic pressure increased with exercise, but as work was changed from a moderate to a maximal character little further increase occurred, as a rule. Diastolic pressure showed great variability of response under either condition of work, decreasing in the majority of children during moderate exercise, but showing an increased tendency to rise during maximal exercise. Hemoglobin, red cell volume, and serum protein increased with both moderate and maximal exercise. With one exception (R. W.), the magnitude of the rise was greater during maximal exercise, the maximum increase for an individual child reaching 8.2 per cent for protein, 8.6 per cent for cell volume, and 10.4 per cent for hemoglobin. The sodium and chloride concentration of the serum showed little change, although an increase of approximately 0.7 meq. in chloride during moderate exercise appears to be significant. Serum phosphate increased during both moderate and maximal exercise by a small amount not exceeding 0.3 meq. The rise in phosphate tended to be higher during maximal work. Blood sugar showed small variable responses to exercise but increased slightly in the majority of persons. Serum lactate increased, on the average, by 3.5 meq. during moderate exercise, and by 7.8 meq. during maximal exercise. Serum bicarbonate, corrected to initial pH, showed a corresponding, but slightly greater, fall. The pH did not change appreciably during moderate exercise but decreased on the average, by 0.09 during maximal work. Greater variations in response occurred during moderate work in pulse rate and serum lactate, bicarbonate, CO2 tension, sugar, and phosphate, and during maximal work in systolic, diastolic and pulse pressures. These factors would, therefore, appear to offer more fruitful fields for investigation of individual differences and their relation to physical capacity. The present investigation was limited to too small a number of children and too heterogenous a group to enable us to draw conclusions, but a few relationships appear suggestive. Superior physical capacity is indicated in the child, as well as in the adult, by the lack of a significant rise in serum lactic acid and a corresponding fall in bicarbonate when a fixed moderate task is performed. Those children showing the smaller, often insignificant, rises in phosphate during moderate exercise possess good or superior physical capacity. These children also show little change or a slight fall in blood sugar under such conditions while the others exhibit a rise which may become marked. The children showing the higher cardiovascular responses to moderate work are only fair or poor in physical capacity. While nutritive status undoubtedly has some effect upon the physical response of the child, many other factors complicate the problem. Many more children will have to be studied and the various factors interrelated in some statistical manner before much progress can be made in the solution of the problem. We feel, however, that the methods used in the present investigation offer valuable tools for its solution.

The effect of various supplements to the diet on the iron balance of the anemic infant

Summary The effect of various supplements to the diet on the iron retention and hemoglobin of three cases of secondary anemia has been shown. Additional iron, when supplied by pureed spinach, was not utilized by these infants. The iron of apricots, although utilized somewhat better than that of spinach, affected no change in hemoglobin and only a slight increase in retention. Iron salts, when given in large amounts either in the form of ferrous sulphate or ferric ammonium citrate caused a marked increase in the retention and a rise in hemoglobin. There was no evidence shown that the ferrous salt was more efficacious than the ferric salt. Copper salts, given in conjunction with either a low or a high iron intake, did not seem to have any effect on the iron retention or the hemoglobin level. The copper contents of the previous diets were apparently adequate. The introduction of liver into a diet of low iron content caused a slight increase in retention, but no gain in hemoglobin. With a high iron intake, a decreased retention of iron occurred coincident with the addition of liver to the diet. It is suggested that this lowered retention was due not to the liver per se, but to a lessened need of the infant for iron at that time.

Malnutrition and Fatigue.

taining a good prognosis on account of individual reactions and a possible anergia which may disturb a true judgement of the fever. From the preceding we can see that! besides observing the height of a temperature, its quality must also be paid attention to. The observation of the quality of the fever makes it necessary to introduce into pathology besides the notion of high and low temperatures, the ideas of resistant and wnresistant fevers (strong and weak fevers).