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The evaluation of the nutritional status of children by means of the various indexes of nutrition, particularly by weight-height tables, has been found to be unsatisfactory (Dublin and Gebhart1). These standard tables are based on measurement of large numbers of children at given age levels and in America include children of different racial inheritances as well as those from various economic levels. From time to time new tables are published, the standards in which are slightly higher than those of previous periods suggesting that the dissemination of the newer knowledge of nutrition is resulting in more nearly physically fit children.2 The inadequacy of these weight-height tables led von Pirquet3 to develop his "pelidisi" chart, a table of nutritional evaluations based on the relation of weight to sitting height: 3 √ 10 × the weight in grams = 100%. Children whose quotients sitting height in centimeters were below 95

Urinary creatine, which in the adult is found only in exceptional cases, for example in inanition, occasionally in women and in certain types of disease in which the catabolic processes are accelerated, is a constant and seemingly normal associate of creatinine in the urine of children up to the age of puberty. Of the various theories advanced in explanation of this, the most generally accepted is that the immature muscle, although producing no more creatine per unit of muscle mass than the adult, has a lower capacity for retaining it. Other theories, with the experimental evidence supporting them, have been thoroughly reviewed by Hunter.1The variation in the amount of creatine excreted in normal children appears to be influenced by a number of factors, for example, the amounts of creatine and of protein ingested, and the periodicity of the food intake which may result in shorter or longer periods

In infants, endogenous uric acid has been shown to be excreted in much larger amounts proportionately than in adults. This appears to be due, in part, at least, to the relatively larger amount of glandular tissue, which comprises nearly one half of the total body substance of the infant. Other factors, for example, the amount of protein ingested and possibly the amount of carbohydrate, which in the adult has been shown to stimulate cellular metabolism, may have some influence. Roughichitch suggested that in the artificially fed infant the excretion of high amounts of uric acid may be the result of the proportionately high intake of protein, although in his recent study he did not find a close relationship between the urinary nitrogen and uric acid.2 Orgler3 believed that the lower output of uric acid of the breast-fed infant is due to the better utilization of the ingested food.

The inference that rickets in the child can be cured by exposure to the elements, particularly of the seashore and high altitudes, is far from being of recent date; but it is to the observations of Huldschinsky,1 in 1919, that we owe the definite incontestible laboratory demonstration that it is light which is the specific curative agent. As a result, heliotherapy or, more specifically, actinotherapy, is gaining for itself a position in the physician's armamentarium that should have been its own long ago.Hand in hand with the recognition of light as an important therapeutic agent there has developed a growing conviction that cod liver oil represents a remedial agent of such efficacy in the treatment of rickets that it, too, was credited with being a specific in the treatment of this disease. As a matter of fact, cod liver oil has been used almost from time immemorial by

Recent work of Folin and Lyman1 points to the conclusion that gout is caused by an accumulation of uric acid in the blood with a subsequent deposition of this in an insoluble form in the various tissues of the body, particularly in the joints and synovial membranes. The retention and consequent accumulation is due to a deficient and restricted power of the kidneys. By means of the new colorimetric method of Folin and Denis2 these investigators have analyzed the blood from a large number of patients suffering from gout and have found the uric acid content higher than in normal individuals; in these patients the blood was frequently found to have reached the saturation point for this compound, namely, 4 mg. in 100 c.c. of blood. Atophan (2-phenylquinolin-4-carbonic acid) caused a decrease in the amount of uric acid in the blood and a corresponding increase in

The dictum "a quart of milk a day for every child" is largely the result of an investigation by Sherman and Hawley1 in which it was shown that the optimum amount of calcium is retained only when approximately 1 quart of milk is included in the diet. Calcium from other sources was found to be less available, lower amounts being retained when the calcium was supplied more largely from vegetables and fruits. The variations in the retentions of calcium of children who were living under comparable conditions as well as the results reported in more recent studies with both children and adults2 suggest that the difference in the amounts of calcium retained may be due in part to the lack of uniformity in the physiologic condition of the persons studied. For example, the potentialities of growth in children or the physiologic balance in adults may have been less

The experimental work involved in this report is the result of an attempt to determine the comparative nutritive efficiency of milk heated to different temperatures. There is considerable evidence in the literature to the effect that scurvy among infants may be caused by feeding cooked milk exclusively; in fact, this notion is so prevalent that many pediatrists still insist on giving raw cow's milk, notwithstanding that the hygienic conditions of this may be far from desirable. It is only in our larger cities that certified milk may be obtained, and even here the price makes it prohibitive for the great majority of homes.In order to meet present conditions and to make milk more nearly safe for infant feeding, the practice of pasteurizing or boiling has been resorted to. Pediatrists differ as to the relative value of these two processes. The European pediatrists1 report excellent results with boiled milk—the

Since the early methods for the determination of creatinine have been replaced by the more accurate quantitative methods of Folin, studies of the excretion of creatinine by infants and young children have become more significant. In contradiction to the previous investigations, which suggested that creatinine is present in the urine of infants only in febrile cases or when meat extract is added to their diet, Funaro,1 by means of these more recent technics, has shown that creatinine is present always in the urine of infants, and that the amount under normal and pathologic conditions does not vary greatly. Further evidence of the excretion of creatinine by infants was presented by Amberg and Rowntree,2 Sedgwick,3 Rose4 and others. The amount of creatinine nitrogen, according to Steudel,5 is approximately 3.25 mg. per kilogram of body weight, whether the feeding consists of human or of cow's milk. The

It is well known by students of animal nutrition that among the lower animals the physical measurements of individuals of a given species can be considerably altered by changes in the amount and kind of the various components of the diet. Whether the norms of growth of the human body can be modified by such means is not known definitely. It seems probable, however, that as more is learned concerning the quantitative biologic needs of the human organism, and this knowledge is incorporated into daily living, the present standards of height and weight may become considerably changed, particularly in regard to children. Undoubtedly, there is a "fairly definite upper limit of body size that is fixed by heredity,"1 but that the present accepted averages are at all indicative of this upper limit is questionable. The physical measurements of the group of intellectually gifted children in California, reported by Baldwin,

Until recently, interest in rickets has been concerned more especially with the rôle of calcium, other elements being considered of secondary importance in the metabolic disturbance. Schabad,1 however, early called attention to the phosphoric acid imbalance, believing that it was a more significant factor than the calcium deficiency. In a comparative study of the relation of the phosphorus of the urine and feces of normal and rachitic infants, he observed that there was a marked increase in the phosphorus of the feces in both breast-fed and artificially fed infants affected by rickets, and a corresponding decrease in the elimination through the kidneys. The normal breast-fed infants under his observation excreted 80 per cent of the ingested phosphorus through the kidney and 19 per cent through the tract; while in his normal infants who were artificially fed, 65 per cent of the ingested phosphorus was eliminated in the urine and

Important as is the subject of urinary acidity expressed in terms of ph, the negative logarithm of the hydrogen-ion concentration, a survey of the literature shows that little work has been done on the urine of infants. In the few cases reported (György1), the determinations were made on mixed twenty-four hour specimens, and in these apparently no special precautions were taken to prevent the loss of carbon dioxid, the importance of which has been pointed out by Marshall.2 Torres3 worked on the titratable acidity of the urine of infants fed different levels of protein; but no ph determinations were made.In some work in our laboratory which included the determination of the total acidity and the ammonia content of infants' urines, it was observed frequently that the freshly voided urine was alkaline in reaction. Further investigations indicated that from time to time there was considerable

The reports of Eddy and Roper1 and Daniels and Byfield2 on the effect of adding substances containing the antineuritic vitamin3 to the diets of artificially fed infants suggests that at least part of the difficulty in feeding these babies is due to a too low concentration of the antineuritic vitamin in many of the feeding mixtures. Cow's milk has been shown to contain less of this vitamin than many other natural foods,4 the amount present being dependent on the vitamin content of the food of the cow, for it appears that "vitamins pass into the milk only as they are present in the diet of the mother."5 When cow's milk is diluted, a necessary procedure in feeding young babies, unless some antineuritic vitamin is added from other sources, too little may be present in the feeding mixtures. The baby who is well and able to

Goat's milk is occasionally urged as a food for infants (1) because a milch goat can be cared for on a small plot of land by the individual family, thereby making available a supply of fresh milk in not too large amounts, and (2) because goat's milk has seemed to be better adapted to infant nutrition than cow's milk.1 However, apart from the generally accepted fact that goat's milk is largely free from Bacillus tuberculosis, there are, so far as we have been able to find, few data showing wherein goat's milk is superior to cow's milk for infant feeding. The composition of milk from a mixed herd compares with that of cow's milk, although among individual goats there may be considerable variation. The casein of goat's milk appears to be the same as that of cow's milk. The relation of casein to lactalbumin in the two milks does

Orange juice has been so universally regarded as an antiscorbutic, that its other possible properties as affecting the well-being of artificially fed infants have not received much consideration. This, perhaps, is to be expected in view of the fact that the daily giving of orange juice is comparatively recent.1 Orange juice has been widely used as a mild cathartic for infants and young children, its potency having been assumed. Recently, Gerstenberger2 has pointed out that there is no experimental basis for this, and states that, on the contrary, orange juice tends to constipate. The diuretic property of orange juice has been noted by Gerstenberger,3 and again by Hess.4 Orange juice was the chief constituent of a fruit mixture used by Gladstone5 in treating certain cases of marasmus. This mixture, of which he used a surprisingly large amount—24 ounces a day—consisted of 2 parts of orange

From time immemorial substitutes for human milk have been sought in the mammary secretions of other animals. The inadequacy of such substitutes has been made apparent by the distinctly higher incidence of disease and death among artificially fed babies. Early attempts were directed toward the correction of the grosser difficulties. By variously modifying and diluting the substituted milks—more particularly cow's milk—these have been rendered more acceptable to the digestion and quantitative needs of the infant. As a result, artificial feeding in the hands of the skilful worker has been fairly successful if measured in terms of disease and death. But so concerned have we been with the more obvious disturbances that little attention has been paid to the possible deficiencies of these diluted milks which may render them greatly inferior to human milk as far as their growth promoting factors are concerned, although experience has taught that the addition

The more frequent use of low fat milk formulas, especially in certain cases of infant feeding, makes necessary some simple method of modifying the milk in homes where the fat content of the milk is unknown or a variable factor. Even when formulas furnishing larger methods of fat are desired, an easy and reliable method of modification, applicable to home conditions, will be helpful.There are already in general use several methods suited to meet the conditions for which they were devised. For example, if a high fat milk formula is desired, Holt's1 method of siphoning off the upper part of the milk is in every way adequate; or, if one desires a 3 per cent. milk and has a 4, 4.5 or 5 per cent. milk, Schereschewsky's2 method may be employed, although according to Darling3 this has certain limitations, for the results are apt to be

The paucity of data concerning the magnesium needs of man at different periods of his development has stimulated further study of magnesium retentions in children. The first report1 from this laboratory, which included a review of the literature, was concerned primarily with a series of single ten day balance studies with individual children. Calcium and phosphorus retentions also were studied in order to determine if there are any interdependent relations among these three metabolites.The present report represents part of a nine month study of the growth, osseous development and mineral metabolism of 3 preschool boys aged 4 years 10½ months, 4 years 9 months and 3 years 3 months, respectively, at the beginning of the study and considers the magnesium retentions at three levels of ingestion, any one of which might occur in a seemingly well selected diet. Data pertaining to the calcium, phosphorus and nitrogen retentions and

The reports on the amount of the three metabolites—calcium, phosphorus and nitrogen—needed by children of a given age have varied, because, it is believed, there were differences in the growth pattern of the children studied, in the degree of saturation of the tissues at the time of the study and in the availability of the metabolites in the materials fed. Furthermore, the retention of calcium and nitrogen is influenced not only by the amount needed but by whether an adequate amount of phosphorus is supplied by the diet. In many of the studies only calcium balances were reported; comparisons, therefore, may not be valid. The problem is further confused by the fact that many of the studies have been of short duration. Continuous balance studies both with children and with adults have indicated that there is considerable variation from period to period; and although this is due in part to

In an attempt to determine the vitamin C needs of young children, three boys of preschool age were given during twelve successive periods constant weighed diets differing from period to period only in the amount of ascorbic acid contained therein. A 5-day preliminary period for physiological adjustment preceded each two consecutive 5-day metabolism periods. During four periods, a part of the vitamin was supplied by a synthetic commercial preparation.

In an attempt to determine the amount of magnesium needed by growing children, thirty-three balance studies have been made with children between 4 and 7 years of age receiving various levels of magnesium. Calcium and phosphorus balance studies were made simultaneously in order to determine to what extent these may have influenced the magnesium retentions. In the study, the influence of insufficient vitamin D and vitamin C was seemingly ruled out since the children received a constant and what was believed to be an adequate amount of vitamin D obtained from cod liver oil and viosterol, and vitamin C from canned tomato and orange juice given twice daily.

To meet the requirements for the other essential substances of the Vitamin B complex in Vitamin B1(thiamine) assays, early workers used autoclaved yeast. Because of the uncertainties involved in obtaining a yeast quite free from the vitamin in question, the use of autoclaved whey and autoclaved liver has been advocated since the thiamine in these apparently is more readily destroyed. For these assays it is customary to place the test animals on the basal ration at weaning, hold them until the body stores of B1are depleted, manifested by stationary weight, and subsequently for a given specified period add the material to be tested in amounts sufficient for considerably less than the optimum gain. Although theoretically it should be possible to use a test animal for successive assays, in practice it is customary to make only one assay with a given animal. Under these conditions, possible discrepancies in the basal ration may be masked, or the results may be modified by enrichments in the test material. Furthermore, when the basal ration is made up on the percentage basis, the amounts taken will vary with the appetite of the animal. Thus, in certain instances, less than the optimum amount of the other constituents of the Vitamin B complex may be taken. Therefore, to make sure that the basal ration is adequate, several successive assays should be made with the same animal, allowing sufficient time between tests for the animal to become depleted of its B1store. This would seem to be important, even though a negative control accompany the assays.To determine the value of certain basal rations for Vitamin B1assays, successive tests have been made with animals fed ad libituma basal ration consisting of B1-free casein 20 g, sucrose 62 g, Crisco 10 g, cod liver oil 2 g, and 4 g Hawk and Oser's salt mixture1with iron citrate and copper sulphate.