vitality, to the inefficiency of the group, and to parental inefficiency as shown by a lack of proper food, of good air, of hygienic habits, and of attention to defects.

NUTRITION

Barring infections, and perhaps the heating, ventilation and lighting of school rooms nutrition is the most important point to be considered in connection with school hygiene.

As a basis for nutritional standards it is necessary to have correct data regarding growth. L. E. Holt* has made a study of the differences in height of the Japanese, Italians, Germans, English, Poles and

*Standards for Growth and Nutrition, American Journal of Diseases of Children (Dec., 1918), p. 359.

Russians. The variation is so great that it is important to consider it in dealing with the problems of nutrition confronting physicians and educators in a country composed of many heterogeneous groups, such as are found in the United States; therefore tables of height and weight based on age are giving place to the weight-height coefficient (the weight in kilograms or pounds divided by the height in centimeters or inches).

The approximate monthly gain in weight:

Measurements and weights should be computed after the removal of shoes and

coats.

B. T. Baldwin, of Swarthmore, Pennsylvania, has published an excellent "Individual Record Card in Physical Growth" (p. 930) which presents norms for height, for weight, and for lung capacity in the form of curves, as well as tables of the height-weight coefficients. These cards are taken with the child through the various grades, his own record being plotted in corresponding curves, thus keeping him constantly informed of his physical growth progress.

Tables based on age, with a monthly increment of both height and weight, have been compiled by Boas and Burk, and may be procured from the Elizabeth McCormick Memorial Fund, 6 North Michigan Avenue, Chicago, "Methods and Standards in the Weighing and Measuring of Children."

See also Julia C. Lathrop, Physical Standards for Working Children, Children's Bureau, U. S. Dept. of Labor.

The child's food requirements are fundamentally like those of the adult's, with some differences to be noted later. They are:

1. A sufficient number of calories.

2. A sufficient amount of protein for sustaining and building purposes.

3. Carbohydrates and fats in sufficient amount to provide for body fuel and energy, and to avoid an excessive draft upon the protein of body tissue.

4. Mineral salts, especially calcium, phosphorus, and iron, for building purposes and the regulation of body functions.

5. Foods that prevent acidosis.

6. Foods containing fat soluble A Foods containing water soluble B

VOL. I-59

Vitamins.

8. Water for the regulating of body functions.

7. Protective foods: milk, eggs, leaves.

MEASURING SCALE FOR PHYSICAL DEVELOPMENT (BOYS) English System

Schools. Examiners.

CHART 7.

Form I

In order that vital processes may go on in the body, the tissues, in warm-blooded animals, must be kept at a certain degree of temperature, and must have brought to them by the blood a certain quantity of food in solution which can be assimilated and which will compensate for the katabolism resulting continuously as the product of combus

tion. This is designated by Benedict as "the energy requirements for maintenance, or overhead charges."* The growing child also requires additional food for body development, and for both the ordinary and excessive physical activity which characterizes this period.

Basal metabolism, which is accurately estimated by an instrument called the calorimeter,† is the amount of heat production necessary to meet maintenance requirements only. Experiments in basal metabolism are performed with the body in complete muscular repose and after 12 hours' starvation. If only the amount of food necessary to meet the requirements of basal metabolism were ingested, pronounced malnutrition would soon result, as the natural growth in height must be accompanied by a parallel growth in weight, and provision must be made for these and for physiological and muscular energy.

Formerly basal metabolism for both adults and children was computed upon the square meter of body surface. Benedict has shown more recently that this computation cannot be used for children, and presents a chart from which the following tables for boys and girls have been derived:

TABLE 17.-TOTAL CALORIES REFERRED TO WEIGHT (BASAL METABOLISM)

A study of this table shows that there is a greater increment of metabolism at the lower weight limits than at the higher, and also that there is far less difference in metabolism between boys and girls than might be expected if one takes into consideration the difference of their life habits (p. 964).

1. Caloric Estimation (Food Requirements as to Quantity).—The prevalent method of measuring food values, and basal metabolism, is by calories or heat units, determined by the calorimeter. The calorie

* Energy Requirements of Children from Birth to Puberty, Boston Medical and Surgical Jour., clxxxi, No. 5 (July 31, 1919).

† Ibid., or Lusk, "Science of Nutrition."