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The effect of ketosis on carbohydrate metabolism has been studied by the use of the glucose tolerance tests. Many have studied the immediate results of ketosis, but few have considered the period following it. To ascertain this after-effect, it was necessary to study the two preceding periods; first, before the onset of ketosis; second, during the ketosis.Two groups of children were investigated; first, children who developed ketosis on a ketogenic diet; second, children who were admitted to the hospital in a state of ketosis following cyclic vomiting. It is difficult to say whether the two forms of ketosis are comparable; certainly, the etiologic factors are so different that we considered it best to study them separately.The first group consisted of nine children, six boys and three girls, ranging in age from 6 to 12 years. Eight of these patients were admitted to the pediatric service of Mount Sinai

In previous papers,1 one of us (M. E. F.) has shown that there is not any appreciable increase in basal metabolism due to ultraviolet radiations over a long period of time.To determine whether there might be an immediate effect on basal metabolism following ultraviolet radiation, five children were studied in the wards of the pediatric service of the Mount Sinai Hospital from December, 1925, to June, 1926. The fact that the ultraviolet rays from the sun were fairly potent during the later months of this study did not in any way interfere with the experiment, as the immediate effect of the rays was of interest.Two of the children were admitted to the hospital because of poor appetite; the other three were convalescing from diseases which did not affect their metabolism.These children were first trained to use the Krogh basal metabolism apparatus until the readings on two

The interrelations of the physical and the psychologic aspects of the life of the growing infant and child are of paramount importance. Nevertheless the opportunity to study them is rare, owing in part to the intensive specialization in medicine. The pediatrician, since he is in more or less continuous attendance on the child, has the opportunity of observing the development and course of physical ailments. Through this study he has learned not only to cure but to prevent many of them. Unfortunately the mental hygienist has not the same opportunity to study the development of psychologic disorders for he is called only after they have arisen.When the attending physician is both a pediatrician and a mental hygienist, he can study the growth of the child completely. This, of course, necessitates not only observing and treating the child, but studying the environment as well. Many observations of this kind should

Workers in modern well baby clinics have seen the necessity of studying and directing the psychic as well as the physical life of the infant. Habit training, modes of punishment and methods of education are as intrinsic a concern of the well baby clinic as are the regulation of diet and hours of sleep. There is, however, a marked difference in the ability to judge the results and, consequently, to deal with the management in the two fields.It is comparatively simple to ascertain whether the prescribed regimen is beneficial to the physical development of the infant. One need only observe the weight, height and muscle tone and compare these observations with an average standard. In accordance with the observations the regimen for the particular infant is changed. But what standards are there by which to check the results of treatment in the psychic development of the infant? In fact,

Attempts have been made to inhibit the growth of microorganisms by using secondary rays. These secondary rays are emitted from metals when they are exposed to x-ray. It has been shown that the higher the atomic weight of a metal, the greater is the bactericidal power of the secondary ray.1, 2, 3Many substances have been used with varying clinical success by different investigators.4-10Holthusen11has pointed out that there are many difficulties in the clinical application of secondary rays. The amount of the substance acting as radiators must be relatively large and still nontoxic. The action of secondary rays is limited, since they are so easily absorbed.Experiments were conducted with Lipiodol and Beck's paste as the radiators. These substances are non-toxic, contain a metal of high atomic weight (33% Bismuth subnitrate in Beck's paste and 40% metallic iodine in Lipiodol) and have been previously used for their therapeutic value in certain clinical conditions.4, 13-17Staphylococcus aureusand Bacillus coli communiswere used as the test bacteria.The bacteria were grown on agar slants for 18 to 24 hours and emulsions were made containing approximately 3,000,000 and 1,200,000,000 organisms per cc. Of the first emulsion 0.2 cc. was pipetted on to a dry sterile agar plate which had been incubated for 48 hours, of the second emulsion 0.1 cc. was used. With a glass spatula the emulsion was spread evenly over the surface of the plate. These plates were dried in the incubator for 10 minutes before exposure to the x-ray. The inoculated agar plate was turned up side down and the substance acting as radiator was placed 1 mm. below the surface of the agar growth. The x-rays, therefore, first entered the bottom of the glass dish, next penetrated the agar, then the surface culture and finally struck the substance which was being investigated.11, 12, 18The secondary rays from the latter were reflected on to the surface of the growth and either caused inhibition of the growth or none at all. Ten erythema doses of x-ray were given in 30 minutes with the following factors: Transformer machine, 200 K. V., 4 M. A., 30 cm. focal distance. No filter. The plates were then incubated at 37° and the results read 20 hours later.

When malnourished children are exposed to ultra-violet radiations, there is often an improvement in their appetite and a gain in weight. The cause for this phenomena has not been satisfactorily explained. Until recently the impression has been that there is a concomitant rise in the basal metabolism. Otto Kestner1and his co-workers have demonstrated that there is an immediate rise in the basal metabolism, which, as far as they investigated, remains elevated for only a short time. Therefore the present work was undertaken to ascertain whether this rise in the basal metabolism extended over a long period of time, and whether it bore any relation to the clinical results.The investigation was carried on from the beginning of December to the end of March, a period when the intensity of the ultra-violet rays from the sun is not sufficiently strong to influence results. Three children on the Pediatric Service of the Mount Sinai Hospital were studied. Two were free from all organic defects, while the third had a simple goitre. To obtain comparative figures these children were observed in the hospital for a control period of one month. They were on a fixed calculated diet, and their basal metabolism was determined three times each week. The children were then subjected to ultra-violet radiations from a Hanovian Quartz Mercury lamp. The routine and diet were continued as before. Basal metabolism determinations were again made three times a week, each determination following the light treatment by twenty to seventy hours.Case 1 received twenty treatments within twenty-four days. Case 2, due to the isolation of the ward, at first received treatment at irregular intervals. The first four treatments were given within one month, and the (last eight within nineteen days.

Experiments with subcutaneous oil injections have been frequently tried. The first clinical observations were published in 1869. Extensive animal experiments were carried out by Leube in 1895 and by Mills in Lusk's laboratory in 1911. Both considered oil injections were of practical value. Others have repeated this work using fat and oil for injections with varying degree of success. Winternitz was, for instance, unable to obtain good results.We resorted to this method of treatment in a very serious case of Hirschsprung's disease (child 11 years of age). Following the total extirpation of the colon and sigmoid the child either refused or vomited most of his food. He also had loose stools. His condition was desperate, his weight having fallen from 63 to 47 pounds, a loss of 16 pounds.The first two days we injected 50 cc. of sterile cotton seed oil. The child gained in weight, but after stopping the injections the weight remained stationary. For the following seven days we increased the amount of oil to 100 cc. per day. The general condition and appetite improved to such an extent that he took food by mouth better than before. His weight likewise increased.Again the injections were discontinued, with the same effect upon his gaining, namely, almost no rise. We therefore decided to continue the oil injections for fifteen days more. Simultaneously the weight rose. As the child was eating well and his state of nutrition was much improved, we have discontinued the oil injections.Apparently the greater part of the oil was absorbed, but there are a few areas of swelling undoubtedly due to the oil. Over a period of forty-one days thirty injections of oil were given. The total amount was 2250 gm., equal to 20,475 calories or 500 calories per day (750 nem).